The "PErFecTED technique": proximal embolization first, then embolize distal for benign prostatic hyperplasia

Area of Science:

• Interventional Radiology
• Urology
• Vascular Surgery

Background:

• Prostatic artery embolization (PAE) is a minimally invasive treatment for benign prostatic hyperplasia (BPH).
• Achieving optimal imaging and clinical success in PAE relies on precise technical execution.
• Previous PAE methods have shown variable efficacy in inducing prostate ischemia.

Purpose of the Study:

• To describe and evaluate the PErFecTED (Proximal Embolization First, Then Embolize Distal) technique for PAE.
• To assess the effectiveness of PErFecTED in achieving prostate ischemia and improving BPH symptoms.
• To compare the outcomes of PErFecTED with previously described PAE methods.

Main Methods:

• The PErFecTED technique involves proximal embolization followed by distal embolization within the prostatic arteries.
• Microcatheter placement is critical, targeting distal prostatic arteries before central gland and peripheral zone branching.
• Embolization prioritizes the urethral group of arteries, addressing the primary BPH development region.

Main Results:

• The PErFecTED technique resulted in greater prostate ischemia and infarction compared to prior methods.
• Clinical improvement in lower urinary symptoms and reduced recurrence rates were observed.
• Complete occlusion and stasis of blood flow to prostatic parenchyma were achieved in all patients post-PAE.

Conclusions:

• The PErFecTED technique offers a refined approach to PAE, enhancing embolic distribution and reducing risks.
• This method leads to significant prostate infarction and improved clinical outcomes for BPH patients.
• The PErFecTED technique demonstrates high efficacy, with observed infarcts in all treated patients.