Prostate Artery Embolization: Challenges, Tips, Tricks, and Perspectives

Area of Science:

• Interventional Radiology
• Urology
• Vascular Anatomy

Background:

• Benign prostate hyperplasia (BPH) affects a significant portion of the aging male population.
• Urinary symptoms associated with BPH can severely impact quality of life.
• Prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for BPH.

Purpose of the Study:

• To review the anatomical and technical key points for successful prostatic artery embolization (PAE).
• To highlight the importance of understanding prostatic arterial anatomy to prevent nontarget embolization and associated complications.
• To provide a step-by-step guide for achieving technical and clinical success in PAE while minimizing adverse events.

Main Methods:

• Review of existing literature on prostatic artery embolization (PAE) and prostatic arterial anatomy.
• Analysis of potential complications, including nontarget embolization and its causes.
• Step-by-step description of anatomical landmarks and technical considerations for PAE.

Main Results:

• PAE demonstrates efficacy in improving urinary symptoms and flowmetric parameters in BPH patients.
• The procedure is associated with a low rate of urinary and sexual sequelae.
• Knowledge of arterial anatomy is critical for preventing complications such as nontarget embolization of rectal, bladder, or pudendal arteries.

Conclusions:

• Prostatic artery embolization (PAE) is an effective and safe treatment for benign prostate hyperplasia (BPH).
• Thorough understanding of prostatic arterial anatomy is essential for procedural success and complication avoidance.
• Careful attention to anatomical variations and technical execution minimizes risks and optimizes patient outcomes.