What is the probability of spontaneous voiding after prostate embolization for a patient with urinary retention and a 150 cc prostate?

Probability of Spontaneous Voiding After Prostate Embolization for Urinary Retention with 150 cc Prostate

The probability of spontaneous voiding after prostatic artery embolization (PAE) for a patient with urinary retention and a 150 cc prostate is approximately 84-95%. 1, 2

Success Rates for Large Prostates

• PAE has demonstrated high clinical success rates specifically for patients with large prostates (>80 mL) suffering from urinary retention, with studies showing:
  • 95.2% of patients with large prostates (>80 mL) were able to void spontaneously after PAE 2
  • 84% of patients with urinary retention passed voiding trials after PAE in a larger study of 240 patients 1
• Spontaneous voiding typically occurs within 4-25 days after PAE (mean 12.1 days) following Foley catheter removal 3

Factors Affecting Success Rates

• Prostate size of 150 cc is considered very large, but PAE has shown effectiveness specifically for large prostates that would be technically challenging to treat surgically 2
• Technical success (defined as bilateral PAE) is approximately 75%, while clinical success (catheter removal and symptom improvement) reaches 91% 3
• The use of a "two-step embolization" technique combining different sizes of embolization particles (50-μm and 100-μm) may improve outcomes for very large prostates 2

Post-Procedure Outcomes

• After successful PAE, patients experience significant improvements in:
  • International Prostate Symptom Score (IPSS) 3, 2, 1
  • Quality of Life (QoL) scores 3, 2, 1
  • Prostate volume reduction (>30% after 1 year) 3
• Voiding symptoms improve more dramatically than storage symptoms:
  • Voiding domain scores show 68-69% improvement 1
  • Storage domain scores show 46-53% improvement 1
• These improvements are sustained through 36 months of follow-up 1

Potential Complications and Considerations

• Patients may experience "postembolization syndrome" with mild pain in the perineum, retropubic area, and/or urethra 3
• Some patients may experience intermittent periods of LUTS improvement and aggravation before stabilizing 4
• Prostatic tissue elimination through the urethra can occur in some patients 1-5 months after PAE, which may temporarily worsen symptoms before significant improvement 4
• Rare complications include:
  • Urethral obstruction from sloughed prostate tissue 4
  • Non-target embolization affecting bladder, rectum, or other pelvic structures 5
  • Acute urinary retention (though this is more common with other procedures) 6

Comparison to Other Procedures

• Traditional surgical approaches like TURP have higher rates of complications:
  • 5% acute urinary retention requiring secondary catheterization post-TURP vs. higher rates with laser procedures 6
  • 8% transfusion rate with TURP 6
  • 65% ejaculatory problems with TURP 6
• PAE offers advantages for patients with very large prostates who may not be good surgical candidates 2

In conclusion, patients with urinary retention and a 150 cc prostate have a high probability (84-95%) of successful spontaneous voiding after PAE, with catheter removal typically possible within 4-25 days after the procedure.