Prostate Artery Embolization: Challenges, Tips, Tricks, and Perspectives

Abstract

Prostatic artery embolization (PAE) consists of blocking the arteries supplying the prostate to treat benign prostate hypertrophia (BPH). Its effectiveness on both urinary symptoms and flowmetric parameters has now been amply demonstrated by around a hundred studies, including several randomized trials. The main advantage of this procedure is the very low rate of urinary and sexual sequelae, including ejaculatory, with an excellent tolerance profile. The arterial anatomy is a key element for the realization of PAE. Its knowledge makes it possible to anticipate obstacles and prevent potential complications related to nontarget embolization. Nontarget embolization can occur with a small intraprostatic shunt or reflux and has no consequences except some local inflammation symptoms that resolve in a couple of days. Nevertheless, some situations with large arterial shunts arising from the prostatic artery must be recognized (accessory rectal, bladder, or pudendal branches), and must imperatively be protected before embolization, at the risk of exposing oneself to otherwise ischemic complications that are more severe, such as bladder necrosis and skin or mucosal necrosis. This article offers a step-by-step review of the various anatomical and technical key points to ensure technical and clinical success, while avoiding the occurrence of adverse events.

Prostatic Artery Origin Variability: Five Steps to Improve Identification during Percutaneous Embolization

“…The main purpose of this paper is to present the procedural protocol in our department and the results of the study on the arterial origin of the PA. We expect this study to serve as a guide for young interventional radiologists who want to perform PAE by presenting the protocol of the procedure from our department and the main challenges we have encountered [9].…”

Special Issue: Present and Future Perspectives of Vascular Interventional Radiology

“…One prominent focus of this issue revolves around prostatic artery embolization, an increasingly promising technique for treating benign prostatic hyperplasia. The articles within this issue present invaluable insights, offering tips and tricks to enhance the precision of the procedure using real-time navigation [8] devices and showcasing the benefits of radial access in facilitating outpatient management [9]. These techniques not only bolster the safety and efficiency of the procedure but also lead to reduced patient recovery times.…”