How to perform prostatic arterial embolization

Prostatic arterial embolization (PAE) is an experimental alternative treatment for benign prostatic hyperplasia, with promising preliminary results. In comparison with surgery, its main advantages are the minimally invasive nature, outpatient setting, rapid recovery, and low morbidity. To avoid complications and to achieve technical success it is important to know the procedural technique in detail. In addition, for good clinical results, it is important to perform a bilateral and complete prostatic embolization. In this article, the different technical steps, including the initial site of puncture and the catheters and guidewires to be used, are described. Identification of the prostatic arteries is crucial. Correlation between computed tomography angiography and digital subtraction angiography helps to solve the difficulty of such identification. The skills for superselective catheterization of the prostatic arteries, the amounts of contrast injected, the preparation and size of the used particles and the end point of the procedure are also described.