Analysis Of The Application Value Of Prostatic Artery CTA For Preoperative Examination Of PAE

ObjectiveBenign Prostatic Hyperplasia(BPH)is a common urinary tract disease in middle-aged and elderly men.The pathogenesis is still unclear.It is related to multiple factors and age is one of the recognized causes.With the aging of the global population,the incidence of BPH is gradually increasing,which is often accompanied by Lower Urinary Tract Symptoms(LUTS),which seriously affects the physical and mental health and quality of life of many middle-aged and elderly men.Prostatic Artery Embolization(PAE)is an emerging technology for the treatment of BPH.It can be used as a minimally invasive treatment option for patients with BPH who have moderate to severe lower urinary tract symptoms and are not suitable for traditional surgery.The intrapelvic arteries are complex and have many variations,and identification of prostate arteries(PA)during PAE is particularly critical.CT angiography(CTA)of the prostate artery can visually display the source and course of the pelvic artery,as well as the supply artery and the dominant artery around the prostate.In order to clarify whether preoperative prostate artery CTA can provide reliable guidance for PAE surgery,this study will explore the application value of CTA as a preoperative examination of PAE,observe its display of PA,as well as its impact of the length of PAE operation,clinical efficacy and postoperative complications.MethodsAccording to the inclusion/exclusion criteria,BPH patients who had undergone PAE in the Fifth Affiliated Hospital of Zhengzhou University from 2017-01-01 to 2019-03-01 were selected and divided into group A(preoperative CTA Examination)and group B(no CTA examination before surgery).Collect preoperative CTA images of prostate arteries in group A patients,observe the origin of the prostate arteries and the dominant blood supply arteries,and compare with digital subtraction angiography(DSA)images during PAE to understand whether there is a difference between the CTA test results and the gold standard DSA.Retrospectively compared the operation time of the two groups of patients in A and B,and followed up postoperative prostate volume,international prostate symptom score(IPSS),quality of life score(QOL),maximum urinary flow rate(Qmax),urination after the residual urine volume and other clinical efficacy-related functional indicators at 6 months after surgery,as well as postoperative complications.Compare the differences between the parameters of the two groups of patients.Results1.All 32 patients in group A received preoperative CTA of prostate artery.CTA results showed that PA was mainly derived from internal pudendal artery(IPA)(63.89%),superior vesical artery(SVA)(11.11%),inferior vesical artery(IVA)(11.1%)and obturatorArtery,OA(8.33%)and internal iliac artery(IIA)(5.56%).For 32 cases of patients,1 patient received blood from bilateral double-branch PA,4 patients received blood from double-branch PA on one side and single-branch PA on one side,1 patients received blood from 3-branch PA on one side and single-branch PA on one side,1 patients received blood from single-branch PA on one side and without PA on one side,the rest patients received blood from bilateral single-branch PA,a total of 72 PA.Intraoperative DS A results showed that the total number of PA in 32 patients was 74.There was no statistical difference between preoperative CTA examination results and the results of DSA(P>0.05).2.The time of PAE in group A was significantly shorter than that in group B(t=-10.9,P<0.001).3.Prostate volume,Qmax,residual urine volume,IPSS,and QOL in the two groups at 6 months after surgery were all improved compared with those before surgery,and the intra-group differences were statistically significant(P<0.001).The improvement of prostate volume,Qmax,residual urine volume,IPSS,QOL and other indicators in group A at 6 months after surgery was not statistically significant compared with group B(P>0.05).4.The incidence of total postoperative complications in group A was lower than that in group B,and the difference was statistically significant(χ2=4.267,P<0.05).ConclusionProstate artery CTA examination showed no statistical difference in the source and number of PA compared with the gold standard DSA.PAE is a safe and effective BPH treatment method,and its clinical efficacy is worthy of recognition.Preoperative CTA examination of the prostate artery before PAE can better guide the operation,shorten the operation time and reduce the occurrence of postoperative complications.