J Korean Soc Radiol.  2019 Jul;80(4):656-666. 10.3348/jksr.2019.80.4.656.

Prostate Artery Embolization: Treatment of Symptomatic Benign Prostatic Hyperplasia

• Hwang JH
• Park SW

• KMID: 2457445
• DOI: http://doi.org/10.3348/jksr.2019.80.4.656

Abstract

Prostatic artery embolization (PAE) is an emerging treatment option for lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). PAE is a minimally invasive technique and provides good results in BPH patients with moderate-to-severe LUTS. Most patients with BPH are old and have atherosclerosis. PAE can be technically challenging in these patients because of the tortuosity and small diameters of prostatic arteries. Therefore, patient selection is essential for successful results. To perform a safe procedure with no non-target embolization, precise knowledge of the prostatic arterial anatomy and meticulous techniques are important. A multidisciplinary approach by interventional radiologists and urologists is essential to achieve better outcomes.

MeSH Terms

Arteries*
Atherosclerosis
Embolization, Therapeutic
Humans
Lower Urinary Tract Symptoms
Patient Selection
Prostate*
Prostatic Hyperplasia*

Figure

• 

  Fig. 1 An ipsilateral oblique view of the right internal iliac arteriogram demonstrates the anterior and posterior branches. GPT = gluteal-pudendal trunk, IGA = inferior gluteal artery, IPA = internal pudendal artery, OA = obturator artery, PA = prostatic artery, SGA = superior gluteal artery

• 

  Fig. 2 A 76-year-old man with benign prostatic hyperplasia and lower urinary tract symptoms treated with PAE. A. An ipsilateral oblique view of the left internal iliac angiogram shows the prostatic artery (white arrows) originating from the anterior division of the internal iliac artery (black arrow). B. The left prostatic artery (white arrow) originating from the common trunk (black dotted arrow) of the internal pudendal artery (black arrow) and inferior gluteal artery (white dotted arrow). C. The right prostatic artery (white arrow) originating from the internal pudendal artery (black arrow). D, E. Selective angiography of both prostatic arteries (arrows) on anterior-posterior projection shows staining of the prostate gland (asterisks) with increased vascularity. A PAE with a microsphere (300–500 µm) was performed. PAE = prostatic artery embolization F, G. Trans-rectal ultrasound before (F) and after (G) PAE shows the prostatic volumes of 213.1 cc and 112.5 cc, respectively (a reduction of 47.2% after PAE).

• 

  Fig. 3 A 58-year-old man with benign prostatic hyperplasia and lower urinary tract symptoms treated with prostatic artery embolization. A. Selective angiography of the right accessory pudendal artery (white arrows) on anterior-posterior projection shows parenchymal staining of both prostate lobes (white asterisks) supplied by fine prostatic branches (white dotted arrows). The tip of the microcatheter (black arrow) is positioned in the accessory pudendal artery just proximal to the origin of the inferior vesical artery (black dotted arrows). Arterial supply (black asterisk) to the penis is observed. B. After embolization, arterial supply to the penis and prostate gland was absent. Temporary erectile dysfunction had occurred, which improved 3 weeks later without any specific treatment.

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