Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of 50 patients (mean age, 67.6 +/- 7.4 years; range, 54-85 years) treated with NBCA between 2017 and 2020 was conducted. PAE was performed using a mixture of Glubran 2 glue and Lipiodol in a 1:8 ratio, under local anesthesia, on an outpatient basis, after cone-beam computed tomography vascular mapping. Mean total injected NBCA/Lipiodol volume was 0.9 +/- 0.3 mL, total injection time was 21.9 +/- 7.8 s, and total radiation dose was 18,458 +/- 16,397 mGy center dot cm. Statistically significant improvements over time occurred for the International Prostate Symptoms Score (9.9 +/- 6.8 versus 20.5 +/- 6.7, p = 0.0001), quality-of-life score (2.2 +/- 1.5 versus 4.9 +/- 1.0, p = 0.0001), prostate-specific antigen level (4.6 +/- 3.0 versus 6.4 +/- 3.7, p = 0.0001), and prostate volume (77.3 +/- 30.5 versus 98.3 +/- 40.2, p = 0.0001) at a median of 3 months versus baseline. Minor adverse events developed in 11/50 (22%) patients, but no major complications occurred. The International Index of Erectile Function did not change significantly. PAE with NBCA is feasible, safe, fast, and effective for patients with BPH-related LUTSs. Prospective comparative studies with longer follow-ups are warranted.