Controversies in Prostate Artery Embolization: Future Best Practice

Abstract

Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.

Prostate Artery Embolization (PAE) with Small Beads for the Treatment of Benign Prostatic Hyperplasia (BPH)

“…Conversely, PAE has emerged as a compelling therapeutic avenue for the management of LUTS attributed to BPH. PAE not only yields outcomes akin to those achieved through TURP but also mitigates operative risks [ 39 , 40 , 41 , 42 ]. A salient advantage of PAE is its adaptability to prostates exceeding the volumetric threshold of 100 mL, with consistently favorable clinical outcomes [ 57 ].…”

“…According to the Society of Interventional Radiology (SIR), Prostate Artery Embolization (PAE) represents a viable therapeutic avenue for addressing LUTS attributed to BPH, exhibiting comparable efficacy to surgical interventions [ 16 , 39 , 40 , 41 , 42 ]. The allure of PAE is further accentuated by its associated benefits, including reduced hospitalization durations, diminished transfusion risks, and a low incidence of sexual dysfunction [ 16 , 41 , 43 ].…”

Choice Of treatment method for symptomatic Bladder outlet obstruction in patients with benign prostatic hyperplasia after kidney transplantation

“…При эмболизации простатических артерий осуществляется окклюзия кровеносных артерий ПЖ с помощью ввода эмболов [85,86], при этом вмешательстве более часто регистрируются эпизоды острой задержки мочи в послеоперационном периоде [87].…”