Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia (PAE)

Benign prostatic hyperplasia (BPH) has a high prevalence rate in men aged 50-79 years and is ubiquitous with aging. Prostatectomy by open surgery or by transurethral resection of the prostate is still considered the gold standard of treatment. Alternative options include minimally invasive treatments. Urinary tract infection, strictures, postoperative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are complications associated with surgical treatments. Minimally invasive treatments were originally conceived as an attempt to offer equivalent efficacy without the burden and risk of operative morbidity. The introduction of arterial embolization to treat uterine fibroids has led to its use for BPH. Prostatic arterial embolization (PAE) is a technically demanding procedure that blocks the blood supply of the arteries that supply the prostate gland. With CTA we define the male pelvic vascular anatomical pattern and the PA anatomy (number of independent PAs, their origin, trajectory, termination, and anastomoses with surrounding arteries). Each pelvic side should be considered separately. The inferior vesical artery and finally the prostatic vessels were selectively catheterized with a 3-F coaxial microcatheter. For embolization, nonspherical 200 ?m PVA particles were used. We conclude that PAE is a feasible procedure, with preliminary results and short-term follow-ups suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume.