Single-Center Retrospective Study of Preoperative Prostatic Artery Embolization with the Use of Gelatin Sponge: Initial Experience and Influence for Blood Loss in Prostate Surgery

Purpose: To investigate the safety and effectiveness of preoperative prostatic artery embolization (PAE) in relation to decrease in hemoglobin level, requirement for blood transfusion, length of hospitalization, and procedure-related complications. Materials and Methods: Ten consecutive patients who underwent surgery after preoperative PAE were identified from May 2017 to October 2018 (embolization group: holmium-laser enucleation of the prostate [HoLEP] in 6 patients and robotic simple prostatectomy in 4 patients, mean age 72.9 ± 8.7 years, mean prostatic volume 106.5 ± 22.0 mL). For comparison, consecutive patients with a large prostatic volume (≥70 mL) who underwent surgery without preoperative PAE during the same period were enrolled (nonembolization group: HoLEP in 9 patients and robotic simple prostatectomy in 1 patients, mean age 71.2 ± 5.7 years, mean prostatic volume 87.8 ± 26.7 mL). Results: PAE was technically successful in 90% of patients (9/10). The median interval between PAE and surgery was 2 days. The mean hemoglobin reduction was lower (1.40 ± 0.92 g/dL vs 3.07 ± 1.50 g/dL; P =.008) and the median length of hospitalization was shorter (8.5 days vs 11 days; P =.039) in the embolization group than the nonembolization group. The operating time (mean for HoLEP 146 ± 38 min vs 179 ± 59 min [P =.248], mean for robotic simple prostatectomy 223 ± 32 min vs 354 min) and number of blood transfusion (1 patient vs 2 patients; P =.392) were not significantly different between the 2 groups. None of the patients developed any complications except bleeding requiring transfusion. Conclusions: Preoperative PAE is safe and may reduce blood loss during prostate surgery.