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Objectives To evaluate the short-and medium-term results of prostatic arterial embolisation (PAE) for benign prostatic hyperplasia (BPH). Methods This was a prospective non-randomised study including 255 patients diagnosed with BPH and moderate to severe lower urinary tract symptoms after failure of medical treatment for at least 6 months. The patients underwent PAE between March 2009 and April 2012. Technical success is when selective prostatic arterial embolisation is completed in at least one pelvic side. Clinical success was defined as improving symptoms and quality of life. Evaluation was performed before PAE and at 1, 3, 6 and every 6 months thereafter with the International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), uroflowmetry, prostatic specific antigen (PSA) and volume. Non-spherical polyvinyl alcohol particles were used. Results PAE was technically successful in 250 patients (97.9 %). Mean follow-up, in 238 patients, was 10 months (range 1-36). Cumulative rates of clinical success were 81.9 %, 80.7 %, 77.9 %, 75.2 %, 72.0 %, 72.0 %, 72.0 % and 72.0 % at 1, 3, 6, 12, 18, 24, 30 and 36 months, respectively. There was one major complication. Conclusions PAE is a procedure with good results for BPH patients with moderate to severe LUTS after failure of medical therapy. Key Points • Prostatic artery embolisation offers minimally invasive therapy for benign prostatic hyperplasia.• Prostatic artery embolisation is a challenging procedure because of vascular anatomical variations.• PAE is a promising new technique that has shown good results.

Purpose: To describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH). Materials and Methods:In a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries.

PAE is a safe and effective procedure, with low morbidity, no sexual dysfunction, and good short- and intermediate-term symptomatic control associated with prostate volume reduction.

PURPOSE:To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS:Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-m polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side. RESULTS:PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P ϭ .005), quality of life improved 1.14 points (P ϭ .065), International Index of Erectile Function increased 1.7 points (P ϭ .063), and peak urinary flow increased 3.85 mL/sec (P ϭ .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P ϭ .072) and a mean prostate volume decrease of 26.5 mL (P ϭ .0001) by ultrasound and 28.9 mL (P ϭ .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm 2 ischemic area of the bladder wall) and four clinical failures (28.6%). CONCLUSIONS:In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume. ABBREVIATIONSBPH ϭ benign prostatic hyperplasia, IPSS ϭ international prostate symptom score, PAE ϭ prostatic arterial embolization, PSA ϭ prostate specific antigen, PVA ϭ polyvinyl alcohol, PVR ϭ postvoid residual volume, Q max ϭ peak urinary flow, QOL ϭ quality of life Benign prostatic hyperplasia (BPH) has a high prevalence rate in men aged 50 -79 years (1) and is ubiquitous with aging (2). BPH is a condition often associated with lower urinary tract symptoms (3), the most frequent of which are decreased urinary stream, greater frequency, and urgency (4).Surgery is performed less often now that effective pharmacotherapy is available, but it is an excellent option for improving symptoms and decreasing progression of disease in patients who develop complications or whose symptoms are inadequately controlled with medical treatment (5).Prostatectomy by open surgery or by transurethral resection of the prostate is still considered the gold standard of treatment. Alternative options include minimally invasive treatments and prostatic stent placement. Age, symptom scores, grade of obstruction, baseline prostate volume, peak urinary flow (Q max ), serum prostate specific antigen (PSA) value, and postvoid residual volume (PVR) are important predictors of clinical progression (6) and, along with individual anesthesiologist risk, are factors that should be taken into consideration when choosing an appropriate treatment (7).Urinary tract infection, strictures, postoperati...