BackgroundCurrently, large prostate size (>80 mL) of benign prostatic hyperplasia (BPH) still pose technical challenges for surgical treatment. This prospective study was designed to explore the safety and efficacy of prostatic arterial embolization (PAE) as an alternative treatment for patients with lower urinary tract symptoms (LUTS) due to largeBPH.MethodsA total of 117 patients with prostates >80 mL were included in the study; all were failure of medical treatment and unsuited for surgery. PAE was performed using combination of 50-μm and 100-μm particles in size, under local anaesthesia by a unilateral femoral approach. Clinical follow-up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow (Qmax), post-void residual volume (PVR), international index of erectile function short form (IIEF-5), prostatic specific antigen (PSA) and prostatic volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter.ResultsThe prostatic artery origins in this study population were different from previously published results. PAE was technically successful in 109 of 117 patients (93.2%). Follow-up data were available for the 105 patients with a mean follow-up of 24 months. The clinical improvements in IPSS, QoL, Qmax, PVR, and PV at 1, 3, 6, 12, and 24 months was 94.3%, 94.3%, 93.3%, 92.6%, and 91.7%, respectively. The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P < .0.01), the mean QoL (5.0 vs 3.0; P < 0.01), the mean Qmax (8.5 vs 14.5; P < 0.01), the mean PVR (125.0 vs 40.0; P < 0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P < 0.01 ) at 24-month after PAE were significantly different with respect to baseline. The mean IIEF-5 was not statistically different from baseline. No major complications were noted.ConclusionsPAE is a safe and effective treatment method for patients with LUTS due to large volume BPH. PAE may play an important role in patients in whom medical therapy has failed, who are not candidates for open surgery or TURP or refuse any surgical treatment.

PAE could be used as an effective, safe, and well tolerable method in the treatment of elderly symptomatic BPH patients, similarly to younger patients, and it may play an important role in patients in whom medical therapy has failed, who are at high surgical and anesthetic risk or who refuse the standard surgical therapy.

rostatic arterial embolization (PAE) is a safe and effective therapeutic option for symptomatic benign prostatic hyperplasia (BPH), as has been indicated by multiple studies (1-8). The major technical challenge of PAE is the identification and catheterization of the prostatic arteries (PAs), especially with regard to navigating arteries with atherosclerosis and variant prostatic vascular anatomy, leading to longer procedures and higher doses of radiation (9,10). There are many branches of the internal iliac artery (IIA) that cross over and overlap with each other, which seriously affects the judgment of the origin and trajectory of blood vessels during interventional therapy. Knowledge of the origins, trajectory, and number of PAs can help interventionists avoid the potential risk of unintentional embolization of the surrounding organs (eg, bladder, rectum, or penis), in addition to reducing the procedure time and the radiation dose. At present, identification of the PA is mainly achieved by performing multiple digital subtraction angiography (DSA) examinations or with DSA combined with conebeam CT (10,11). Maclean et al (12) assessed the value of CT angiography in identifying the PAs and anastomoses and found an accuracy of 97.3% for the PA, as well as a sensitivity of 59.0% and a specificity of 94.2% for anastomoses detection. The pitfalls of CT angiography include a higher radiation dose and the risks of contrast material-related renal toxicities; in addition, CT has low tissue resolution and is not suitable for the diagnosis of prostate lesions. Kim et al (9) first assessed the ability of MR angiography to identify the origins of PAs prior to embolization and demonstrated that MR angiography is useful in treatment planning. However, that study was performed in a small sample and did not include a control group. Therefore, larger and controlled clinical trials are required to confirm the value of MR angiography prior to PAE.

Introduction:Primary pulmonary choriocarcinoma (PPC) is extremely rare, especially in males. It is characterized by a poor response to therapy and shortened survival times. Here, we report a successful diagnosis and modified treatment for PPC in a male and a review of the literature.Case presentation:This case report describes a 67-year-old male who was discovered to have a left pulmonary mass. The patient underwent a pulmonary lobectomy. Pathological examination showed a poorly biphasic differential tumor. Immunostaining displayed that beta-human chorionic gonadotropin (β-HCG), CD10, and GATA3 were positive, and the increase of postoperative serum β-HCG secretion was also confirmed. Systemic and genital screening was performed, but other abnormal findings were not observed. The diagnosis of PPC was confirmed. Then, the patient received 4 cycles of modified chemotherapy according the condition of his body. The patient has been alive for >13 months without recurrence, and the level of serum β-HCG has already decreased to normal. In addition to reporting this case, we have also summarized the similar previously published cases.Conclusions:Currently, there is no standard treatment for PPC. A rapid and correct diagnosis is necessary. Surgery and modified chemotherapy, based on the physical condition of the patient, may currently be the best therapy for PPC.