Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits

Area of Science:

• Interventional Radiology
• Vascular Interventions
• Urologic Oncology

Background:

• Prostatic artery embolization (PAE) is an effective treatment for symptomatic benign prostatic hyperplasia (BPH).
• Technical challenges, including complex prostatic artery anatomy and bilateral catheterization, lead to long procedures and high radiation doses.
• Intentionally unilateral PAE (IU-PAE) is proposed to mitigate these disadvantages in selected patients.

Purpose of the Study:

• To describe the technique for intentionally unilateral PAE (IU-PAE).
• To evaluate the potential benefits of IU-PAE compared to bilateral PAE in terms of procedure efficiency and patient outcomes.

Main Methods:

• Retrospective single-center study of 13 patients undergoing IU-PAE over 2 years.
• Patient selection based on prostatic lobe opacification, asymmetric enlargement, or challenging pelvic artery anatomy.
• Intraprocedural contrast-enhanced ultrasonography (iCEUS) used for monitoring prostatic infarction.
• Comparison with a control group undergoing bilateral PAE.

Main Results:

• IU-PAE group showed significantly shorter procedure times (45.8%), fluoroscopy times (35.9%), and radiation doses (45.4%) compared to the bilateral PAE group.
• Clinical and imaging outcomes were comparable between the IU-PAE and bilateral PAE groups.
• Smaller prostatic infarction extent in clinical failures of IU-PAE, as assessed by iCEUS.

Conclusions:

• IU-PAE is a viable option in selected BPH patients, offering reduced procedure time and radiation exposure.
• Outcomes of IU-PAE are comparable to bilateral PAE.
• iCEUS can aid in patient selection for IU-PAE.