Prostate Artery Embolization—Review of Indications, Patient Selection, Techniques and Results

Abstract

Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.

Transradial Prostatic Artery Embolization as a Salvage Procedure in a Patient With Severe Deformities and Refractory Hematuria of Prostatic Origin

“…Its primary advantage lies in its safety, which is particularly observed in patients with multiple comorbidities, contraindications to surgical procedures, bleeding risk, and frailty [13]. To date, most PAE complications have been reportedly minor and include urinary tract infections, urinary retention, dysuria, hematuria, and hematospermia, while major complications, such as non-target embolization with subsequent organ ischemia are rare [1]. TURP is also reported to carry a small risk of complications such as blood loss requiring transfusion, clot retention, bladder neck stenosis, and urethral stricture, whereas there are no such reports associated with PAE [2].…”

“…It is a minimally invasive alternative to transurethral resection of the prostate (TURP) in the management of symptomatic benign prostate hyperplasia (BPH). PAE serves as a viable therapeutic option for patients exhibiting moderate to severe lower urinary tract symptoms (LUTS), who are deemed unsuitable candidates for surgical interventions primarily due to concurrent comorbidities and contraindications to anesthesia [1].…”

Controversies in Prostate Artery Embolization: Future Best Practice

“…14,25 Additionally, PAE appears to mildly improve erectile function and maintain ejaculatory function, whereas surgical therapies significantly diminish such functions. 3 Given the side effects of medical management and surgical treatment, along with age-related erectile dysfunction, This paradigm of comparing PAE to medical management and as a precursor to invasive treatment will be a clearer pathway for patients, and lead to increased collaboration with the authors' urologic colleagues. Presenting PAE as a direct alternative to TURP or MISTs will likely confuse patients and create unwanted competition.…”

“…IPSS with QoL is a validated eight-question subjective assessment for LUTS, and arguably a surrogate for overall patient satisfaction. 3 Gland size assessments can be made via formulas using transrectal ultrasound (TRUS) imaging, or contouring from magnetic resonance imaging (MRI) or computed tomographic (CT) images, although it remains unclear whether variability in estimated sizes among these modalities impacts patient treatment choice. 4 Since its initial deployment for the treatment of refractory hematuria, prostate artery embolization (PAE) has transformed into a minimally invasive treatment option for LUTS due to BPH.…”

“…14 25 Additionally, PAE appears to mildly improve erectile function and maintain ejaculatory function, whereas surgical therapies significantly diminish such functions. 3 Given the side effects of medical management and surgical treatment, along with age-related erectile dysfunction, patients should be given the option to individually weigh symptomatic management of BPH alongside maintenance of sexual function. In that regard, PAE should be considered alongside other first-line treatment options.…”