Prostate Artery Embolization: Indication, Technique and Clinical Results

Abstract

ABSTR AC T Background Prostate artery embolization (PAE) is a new embolization therapy to treat benign prostate syndrome (BPS). Materials and MethodsThis review article presents the rationale and impact mechanism of PAE, criteria for patient selection, and discusses the anatomy of prostate arteries. The study results are seen in the context of complications and clinical partners.Results Important preconditions for successful prostate artery embolization are a strict indication, precise knowledge of the anatomy of the pelvic arteries and advanced interventional-radiological skills. Several studies showed that urological parameters after prostate artery embolization improve at a similar level as for established post-surgical treatments. At the same time, it could be proven that prostate artery embolization has no impact on erectile function and is associated with a relatively low complication rate.Conclusion PAE is increasingly developing to an alternative for the established surgical treatments in BPS patients. Key Points▪ PAE is a new embolization method for treating BPS and represents an alternative to classic urological surgical procedure such as TURP. ▪ Due to the low caliber of the prostate artery (0.5 -2 mm), the presence of anatomical variations, and the arteriosclerosis seen in most older men, PAE is a technically challenging embolization method. ▪ In patients with a high postoperative bleeding risk in classic urological surgical treatment concepts, PAE is a very gentle alternative method. Citation

An Update on Minimally Invasive Surgery for Benign Prostatic Hyperplasia: Techniques, Risks, and Efficacy

“…Ideally, the prostate should begin to reduce in size over the next several days, relieving symptoms. This effect is a result of the ischemia of intraprostatic vessels and subsequent inflammatory response along with a decrease in dihydrotesterone and intraprostatic testosterone, all of which initiate and aid the shrinking process [31,32].…”

“…Inclusion and exclusion criteria for this procedure are listed in Table 3 [31,32]. Approximately 33% of patients seen in a pre-procedural evaluation satisfy the criteria to be selected for PAE [31].…”

“…Approximately 33% of patients seen in a pre-procedural evaluation satisfy the criteria to be selected for PAE [31]. Indications for PAE as a first choice therapy for BPH include patients with special risks regarding surgery or anesthesia, sexually active men (as retrograde ejaculation is a common complication of TURP), prostate volume >65 mL, permanent bladder cathether, and recurrent bleeding caused by BPH [32].…”

“…PAE is a very safe method overall that is still accompanied by certain complications. Dysuria, hematuria, hematospermia, urinary retention, and rectal bleeding with the procedure have been noted in the literature [7,17,32]. 'Post-prostatic artery embolization syndrome' is another complication which involves the mixture of small amounts of blood with urine and stool [33].…”

Influence of Interventionists’ Experience on Radiation Exposure of Patients Who Underwent Prostate Artery Embolization: 4-Year Results from a Retrospective, Single-Center Study

“…Minimally invasive prostate artery embolization (PAE) has proven as effective and gentle alternative to transurethral resection of the prostate gland with low risk of complications such as erectile dysfunction or incontinence [ 2 – 6 ]. However, prostate arteries (PA) are small vessels with a high variability of origins [ 7 , 8 ]. Thus, identification of PA origins, duplicated PAs, contralateral perfusion of the prostate gland, and anastomoses with vesical, rectal, or penile arteries is challenging and time-consuming [ 7 – 9 ].…”