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Purpose To evaluate the effect of cone-beam computed tomography (CT) with automatic vessel detection software on prostate artery catheterization and fluoroscopy time in prostate artery embolization (PAE). Methods Fifty patients undergoing PAE for BPH were enrolled in this prospective study. Twenty-five PAEs were performed using automatic vessel detection software with syngo embolization guidance (study) and were compared with 25 PAEs performed using conventional two-dimensional (2D) fluoroscopy with overlay (control). PAE was performed using 300–500 μm trisacryl gelatin spherical particles. The primary outcome parameters were prostatic artery catheterization time and fluoroscopy time. Results Bilateral PAE was achieved in 24/25 cases in both groups. The median right and left prostatic artery catheterization times were similar between the two groups, (p = 0.473 and p = 0.659, respectively). The median fluoroscopy time (28.0 and 42.0 minutes, p = 0.046) and total procedure time (70.0 and 118.0 minutes, p < 0.001) were shorter in the study group. The median total dose area product (DAP) was not significantly different. However, the median CBCT DAP (11406 vs. 6248, p < 0.001) was higher in the study group, while median fluoroscopy DAP (7371 vs. 8426, p < .049) was higher in the control group. Median digital subtraction angiography (DSA), CBCT, and fluoroscopy DAP accounted for 27%, 45%, and 29% of the total DAP in the study group and 32%, 29%, and 39% in the control group (p < 0.001), respectively. All complications were Clavien–Dindo Grade 1. Conclusion Although CBCT with automatic vessel detection software had no significant effect on time-to-prostatic artery catheterization and total radiation exposure, it reduced the fluoroscopy time and procedure time.

Background Prostate artery embolization (PAE) is an emerging therapy for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Aim This retrospective study was conducted to assess the effect of prostate artery embolization (PAE) on erectile function in a cohort of patients with LUTS attributable to BPH at 3-months after the procedure. Methods A retrospective review was performed on 167 patients who underwent PAE. Data collected included Sexual Health Inventory in Men (SHIM) scores at 3, 6, and 12 months post-PAE, in conjunction with the International Prostate Symptom Scores (IPSS), Quality of Life (QoL) scores, and prostate volumes. Primary outcome was erectile function as assessed by SHIM scores at 3 months after PAE. An analysis was performed to identify patients with a ±5-point SHIM change to group them according to this minimum clinically significant difference in erectile function. Adverse events were recorded using the Clavien-Dindo (CD) classification. Outcomes At 3 months following PAE, median IPSS decreased by 16.0 [IQR, 9.0–22.0] points, median QOL decreased by 4.0 [IQR, 2.0–5.0] points, and median prostate volume decreased by 33 g [IQR, 14–55]. Results Median SHIM score was 17.0 [IQR, 12.0–22.0] at baseline, 18.0 [IQR, 14.0–23.0] at 3 months [P = .031], 19.0 [IQR, 14.5–21.5] at 6 months [P = .106] and 20 [IQR, 16.0–24.0] at 12 months [P = .010] following PAE. In patients with no erectile dysfunction (ED) at baseline, 21% (n = 9) reported some degree of decline in erectile function post-PAE. However, 38% (n = 40) of patients who presented with mild-to-moderate ED reported improvement in their erectile function 3 months following PAE. Overall, the changes in baseline SHIM score were relatively small; 82% (n = 137) of patients did not have more than 5 points of change in their SHIM scores at 3 months following PAE. Clinical Implications Our findings suggest PAE has no adverse impact on erectile function for most patients. Strengths & Limitations The study was performed at a single center with 1 operator’s experience, and is retrospective with no control group. Conclusion Findings suggest that prostate artery embolization has no adverse effect on erectile function in the majority of patients with LUTS attributable to BPH at 3 months after the procedure.

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IQR 10.0), 5.0 (IQR 2.0) and 156.0 (IQR 230.3) mL. Clinical and urodynamic outcomes were reviewed at 3, 6, and 12 months following PAE. Adverse events were recorded using the Clavien-Dindo classification. Results: At 3 months median IPSS was 6.0 (IQR 7.0) (n ¼ 178, P< 0.0001), median QOL was 1.0 (IQR 2.0) (n ¼ 191, P< 0.0001), median PVR was 50.0 mL (IQR 82.7) (n ¼ 44, P< 0.0001), mean prostate size was 94.5 g (n ¼ 206, P< 0.0001). Six months after PAE, median IPSS was 5.0 (IQR 8.0) (n ¼ 133, P< 0.0001), median QOL was 1.0 (IQR 2.0) (n ¼ 136, P< 0.0001), median PVR was 43.0 mL (IQR 143.0) (n ¼ 30, P ¼ 0.001). At 12 months median IPSS was 5.0 (IQR 8.0) (n ¼ 109, P< 0.0001), median QOL was 1 (IQR 2) (n ¼ 110, P< 0.0001), median PVR was 103.5 mL (IQR 149.5) (n ¼ 20, P ¼ 0.002), and mean prostate size was 98.2 g (Y35%, n ¼ 71, P< 0.0001). At 24 months, median IPSS was 8.0 (IQR 11.2) (n ¼ 24, P< 0.0001), median QOL was 1.0 (IQR 3.0) (n ¼ 23, P< 0.0001), and median prostate size was 109.3 g (Y29%, n ¼ 20, P< 0.0001). At 36 to 60 months median IPSS was 6.0 (IQR 10.5) (n ¼ 23, P< 0.0001), median QOL was 1 (IQR 2) (n ¼ 24, P< 0.0001), and mean prostate size was 136.2 g (Y30%, n ¼ 5, P ¼ 0.09). 4 grade II or above complications occurred, urosepsis (n ¼ 3) and stroke (n ¼ 1), all other complications were self-limited grade I. Conclusions: PAE achieved a clinically and statistically significant improvement in lower urinary tract symptoms and secondary outcome measures in patients with prostates > 80g. PAE is an effective treatment for BPH with long-term sustained benefits.