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Prospective study of percutaneous transarterial embolization in the treatment of benign prostatic hyperplasia

Grant number: 13/13603-5
Support type:Scholarships in Brazil - Scientific Initiation
Effective date (Start): July 01, 2015
Effective date (End): March 31, 2016
Field of knowledge:Health Sciences - Medicine - Surgery
Principal researcher:MARCONE LIMA SOBREIRA
Grantee:Vanessa Mariane Clara
Home Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

The Benign Prostatic Hyperplasia (BPH) is a common disease in elderly men and their care increase as the population ages. About 25% of men over 40years and 90% of those aged over 80 years will present some symptoms related to lowerurinary tract due to BPH Currently, treatment options include drug therapy (conservative) and surgeries, which are indicated in the failure of pharmacological treatment or in the presence of complications. In general, the surgical treatment gives good results, especially in minimally invasive forms, such as transurethral resection ofthe prostate (TURP), still considered reference therapy, with improvement in about 70%of cases. For bigger glands, open prostatectomy, whether by transvesical access (PTV)or the Millin's retropubic via, is an excellent treatment option. However, consideringthe high prevalence of BPH in elderly patients, often suffering from severe comorbidities, surgery in this age group may have restrictions. In this scenario,Percutaneous transarterial embolization of the Prostate (PTEP) emerges as an alternativeto classical surgical therapy, particularly in patients who did not respond to drug therapyand surgery is contraindicated, as for prohibitive risk Objectives : In this project, we intend to evaluate clinically the effects of microspheres PTEP with this group of patients treated at Botucatu School of Medicine. Methods: The project must be aprovved by the CEP. There will be recruited 10 consecutive patients that had beenfollowed at Prostatic Disease ambulatory of Urology Service at FMB-UNESP and withdefinitive diagnostic of BPH. The sample will be of convenience. The patients will beevaluated about the cardiac risk by a cardiologist, using the AHA criteria. The inclusion criteria will be: patients with Benign Prostatic Hyperplasia with surgery indication,without clinical condition to be operated by standard treatment (high cardiac risk by theAHA protocol), that didn't answered to the classic drug terapy e that are agree with thefree and informed consent form. The exclusion criteria will be: patient with less than 40years old; that had been submitted to a surgery (endoscopic or open) previously fortreatment of BPH (recurrence); with prostate neoplasia: exclusion by the prostatespecific antigen (PSA); touch and biopsy, when necessary; that are not agree with thetreatment in question; that have others concomitant urologic diseases, as urethrastenosis, neurogenic bladder, kidney chronic insufficience, etc; that have 8 contraindications to the proposed therapeutic procedure, as contrast allergy, kidneychronic insufficience and access difficulty by the femoral artery.In short, the proposed procedure will be superseletive catheterization of theprostatic artery and provoke prostate ischemia with the use of microespheres.The studied variables will be: evaluation of the life quality by the IPSS (Internation Prostatic Symptoms score); objective evaluation of the urinary flow;prostatic volume characterization, by ultrasound and magnetic resonance; and evaluation of the post-miccional residual volume.

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