Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications

Abstract

Benign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as α-blockers and 5α-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre-and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre-and postprocedural settings.

Prostatic artery embolization using reflux-control microcatheter: prospective experience addressing feasibility

“…All patients underwent PAE according to previously described methods (Carnevale et al, 2020a ; Dias Jr et al, 2021 ). All procedures took place in a dedicated interventional radiology suite (Innova 3D CT; GE Healthcare, USA), using a nonionic contrast medium (320 mg/mL iodixanol; Visipaque; GE Healthcare, USA).…”

“…After selective injection of vasodilator in each PA, (isosorbide mononitrate 5 mg, Eurofarma, Brazil) embolization was performed with a combination of 100-300 (until near stasis) and 300-500 (until total stasis) micrometers Embosphere microspheres (Biosphere, Roissy, France), using the PErFecTED technique (Dias Jr et al, 2021 ). Each vial was diluted to 22 mL with equal parts of saline (10 mL) and contrast media (10 mL).…”

Prostatic Artery Embolization Using Reflux-control Microcatheter: Prospective Experience Addressing Feasibility.

“…After selective injection of vasodilator in each PA, (isosorbide mononitrate 5 mg, Eurofarma, Brazil) embolization was performed using a combination of 100-300 (until near stasis) and 300-500 (until total stasis) micrometers Embosphere microspheres (Biosphere, Roissy, France), using the PErFecTED technique (15). Each vial was diluted to 22 mL with equal parts of saline (10 mL) and contrast media (10 mL).…”

“…All patients underwent PAE according to previously described methods (14,15). All procedures took place in a dedicated interventional radiology suite (Innova 3D CT; GE Healthcare, USA), using nonionic contrast medium (320 mg/mL iodixanol; Visipaque; GE Healthcare, USA).…”

3D printed model to assist endovascular prostate artery embolization for benign prostatic hyperplasia

“…Selection of an adequately distal branch of the prostate artery for embolization during PAE is often tedious given the vast anatomic variation and tortuosity of its course. This suggests that PAE may be an excellent setting for the use of patient-specific 3D-printed anatomic models [5 , 6] and is one such avenue that has yet to be extensively explored. We present a case in which a patient-specific 3D-printed model was utilized for preprocedure and intraoperative reference by interventional radiologists during PAE.…”