Bilateral Arterial Embolization of the Prostate Through a Single Prostatic Artery: A Case Series

Abstract

Peri-prostatic shunts are frequent during PAE, carrying the risk of non-target embolization of penis/corpus cavernosum or rectum but also the potential advantage to irrigate the contralateral lobe. Sometimes, bilateral embolization is impossible, carrying the risk of limited clinical success. The possibility to reach contralateral prostatic territory from the ipsilateral prostatic artery (PA) and embolize it via peri/intra-prostatic anastomoses could be of interest in this situation. We describe a series of three consecutive patients (among 89 consecutive patients treated by PAE for symptomatic BPH) who underwent successful embolization of both prostatic lobes through catheterization of a PA on only one side. All patients had clinical success after a mean follow-up of 3.3 months. Dosimetry of these three procedures indicates that there may be radiation dose savings.

Benign Prostatic Hyperplasia Treated Entirely by Unilateral Prostate Artery Embolization

“…Three months after the operation, the patient reported significant improvement, with IPSS of six and estimated prostate volume of 61 cc (44% volume reduction assessed by transabdominal ultrasound). example, severe atherosclerosis and tortuous anatomy which are frequently encountered in elderly population, [6] because we assume that unilateral embolization of the entire prostate blush is more effective than unilateral embolization of hemi-prostate only. More studies are required to consolidate our observation, bearing in mind that bilateral PAE is the standard practice and should always be attempted.…”

“…This is invaluable for patients who can only be catheterized unilaterally due to atherosclerosis or tortuous anatomy. [6]…”

State of the art of prostatic arterial embolization for benign prostatic hyperplasia

“…This clinical suspicion has been investigated by Bilhim et al (8) in a retrospective analysis: poor outcomes were observed in the unilateral group compared to the bilateral one, even if no statistical significance was seen between the two groups. Bilateral PAE is feasible from a single-sided approach, due to intraprostatic anastomoses and the possibility to cross from one side to the other one (34). This technique may be considered in patients with occluded internal iliac artery on one side.…”

Rare Prostatic Artery Origins and the Importance of Collateral Circulation in Prostate Artery Embolization: A Pictorial Essay

“…Additionally, Figure 6C shows significant cross-filing of the right PA from the left PA. This allows for nearly complete embolization of the prostate from one side but can make identification of the contralateral PA difficult once the vessel is embolized [13].…”