No abstract

Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95% of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.

Regarding safety, it is pivotal to understand the pathophysiology of adverse events following PAE and their standardized reporting. The aim of this article is to discuss adverse events, their management and to review the current literature.

Prostate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.

Background: Long-term experience with prostatic artery embolization (PAE) for benign prostatic hyperplasia remains limited.Purpose: To evaluate the efficacy, safety, and long-term results of PAE for benign prostatic hyperplasia. Materials and Methods:This retrospective single-center study was conducted from June 2008 to June 2018 in patients with moderate to severe benign prostatic hyperplasia-related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed. PAE was performed with 100-500-mm embolic microspheres. Mixed-model analysis of variance and Kaplan-Meyer method was accessed, as appropriate.Results: A total of 317 consecutive men (mean age 6 standard deviation, 65 years 6 8) were treated. Follow-up ranged from 3 months to 96 months (mean, 27 months). Bilateral and unilateral PAE was performed in 298 (94%) and 19 (6%) men, respectively. Early clinical failure occurred in six (1.9%) and symptom recurrence in 72 (23%) men at a median follow-up of 72 months. Mean maximum improvement was as follows: IPSS, 16 points 6 7; quality-of-life score, 4 points 6 1; prostatic volume reduction, 39 cm 3 6 39 (39% 6 29); maximum urinary flow rate, 6 mL/sec 6 10 (155% 6 293); and postvoid residual volume, 70 mL 6 121 (48% 6 81) (P , .05 for all). Unilateral PAE was associated with higher recurrence (42% vs 21%; P = .04). Baseline PSA was inversely related with recurrence (hazard ratio, 0.9 per nanograms per milliliter of PSA; 95% confidence interval [CI], 0.8, 0.9; P , .001). Embolization with combined particle sizes (100-500 mm) did not relate to symptom recurrence (hazard ratio, 0.4; 95% CI: 0.2, 1.1 for 100-500-mm group vs 300-500-mm group and hazard ratio, 0.4; 95% CI: 0.1, 1.5 for 100-500-mm group vs 100-300-mm group; P = .19).None of the patients presented with urinary incontinence or erectile dysfunction. Conclusion:Prostatic artery embolization was a safe and effective procedure for benign prostatic hyperplasia with good long-term results for lower urinary tract symptoms.