Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization

Attila Kovács; Arno Bücker; Marc-Oliver Grimm; Christian R. Habermann; Marcus Katoh; Alexander Massmann; Andreas H. Mahnken; Bernhard C. Meyer; Michael Moche; Peter Reimer; Ulf Teichgräber; Frank K. Wacker; In Zusammenarbeit mit der DeGIR-Lenkungsgruppe Wissenschaft und dem DeGIR-Vorstand

doi:10.1055/a-1183-5438

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2020; 192(09): 835-846
DOI: 10.1055/a-1183-5438

Guideline

Positionspapier der Deutschen Gesellschaft für Interventionsradiologie (DeGIR) zur Prostataarterienembolisation

Article in several languages: English | deutsch

Attila Kovács

¹MediClin Robert Janker Clinic, Clinic of Diagnostic and Interventional Radiology and Neuroradiology, Bonn, Germany

,

Arno Bücker

²Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany

,

Marc-Oliver Grimm

³Jena University Hospital, Department of Urology, Jena, Germany

,

Christian R. Habermann

⁴Kath. Marienhospital Hamburg, Department of Diagnostic and Interventional Radiology, Hamburg, Germany

,

Marcus Katoh

⁵Helios-Hospital Krefeld, Diagnostic and Interventional Radiology, Krefeld, Germany

,

Alexander Massmann

²Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany

,

Andreas H. Mahnken

⁶Marburg University Hospital, Clinic of Diagnostic and Interventional Radiology, Marburg, Germany

,

Bernhard C. Meyer

⁷Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany

,

Michael Moche

⁸Helios-Park-Klinikum Leipzig, Department of Interventional Radiology, Leipzig, Germany

,

Peter Reimer

⁹Städtisches Klinikum Karlsruhe, Academic teaching hospital of the University of Freiburg, Institute of Diagnostic and Interventional Radiology, Karlsruhe, Germany

,

Ulf Teichgräber

¹⁰Jena University Hospital, Department of Radiology, Jena, Germany

,

Frank K. Wacker

⁷Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany

,

In Zusammenarbeit mit der DeGIR-Lenkungsgruppe Wissenschaft und dem DeGIR-Vorstand

› Author Affiliations

Abstract

Zusammenfassung

Hintergrund Mit der Prostataarterienembolisation (PAE) steht seit einigen Jahren ein klinisch etabliertes minimalinvasives endovaskuläres Verfahren zur Behandlung des benignen Prostatasyndroms (BPS) zur Verfügung.

Methoden In diesem von der Lenkungsgruppe Wissenschaft und Forschung der Deutschen Gesellschaft für Interventionelle Radiologie initiierten interdisziplinären Positionspapier wird die Methode der PAE dargestellt und im Kontext der aktuellen Datenlage diskutiert.

Ergebnisse Die PAE ist ein sicheres interventionell-radiologisches Verfahren zur Behandlung des BPS. In Bezug auf die Beschwerdesymptomatik, gemessen mit dem IPSS (International Prostate Symptom Score), hat die PAE im Vergleich zu dem historischen Goldstandard der transurethralen Resektion (TUR) der Prostata einen vergleichbaren Effekt. Im Hinblick auf die subvesikale Desobstruktion ist die PAE der TUR unterlegen, sie behindert allerdings eine spätere chirurgische Therapie nicht. Aufgrund der bereits vorhandenen Evidenz wird die PAE vom britischen National Institute for Health and Care Excellence als Therapiealternative empfohlen. Die Durchführbarkeit in Lokalanästhesie und der Erhalt der Sexualfunktion sind für die Patienten wichtige Argumente für die interventionelle Therapie. Patientenauswahl und Therapiekonzept erfordern eine enge interdisziplinäre Zusammenarbeit zwischen Urologen und Radiologen.

Schlussfolgerung Effektivität und Sicherheit der PAE zur Behandlung des BPS sind nachgewiesen. In weiteren randomisierten Studien sollten Langzeitergebnisse generiert und die am besten geeigneten Indikationen für die PAE bei BPS definiert werden.

Kernaussagen:

Die PAE als endovaskuläres Verfahren ist eine patientenfreundliche minimalinvasive alternative Therapieoption des BPS.
Die PAE kann die Beschwerden des unteren Harntraktes (LUTS), vergleichbar der transurethralen Resektion (TUR), reduzieren. Das desobstruktive bzw. volumenreduzierende Potenzial der PAE ist dem der TUR unterlegen.
Die wichtigsten Vorteile der PAE sind Durchführbarkeit in Lokalanästhesie (ohne Narkose), kurze Ausfallzeiten des Patienten und Erhalt der sexuellen Funktion, inklusive der antegraden Ejakulation.
Die PAE ist aufgrund der bisher vorliegenden Evidenz im therapeutischen Algorithmus zwischen der konservativen, medikamentösen Therapie und der TUR zu positionieren. Der Stellenwert der PAE im Kontext anderer minimalinvasiver Verfahren (MIST) bedarf noch weiterer Evaluation, setzt aber einen grundsätzlich offenen Umgang mit der PAE voraus.
Die PAE wird zumeist auf Zuweisung von Urologen von interventionellen Radiologen durchgeführt und erfordert eine enge interdisziplinäre Zusammenarbeit.

Zitierweise

Kovacs A, Bücker A, Grimm M et al. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. Fortschr Röntgenstr 2020; 192: 835 – 846

Key words

prostate - interventional procedures - benign prostate syndrome - lower urinary tract symptoms - prostate artery embolization

Full Text

References

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