Standardized Technique for Prostatic Artery Embolization: A Delphi Consensus Study on Optimized Methods and Emerging...

Prostatic artery embolization (PAE) is a safe and effective treatment for management of lower urinary tract symptoms in men with benign prostatic hyperplasia. Despite its clinical effectiveness, PAE remains technically demanding, necessitating standardized procedural steps to optimize outcomes. Although complete standardization is limited by patient-specific anatomical variations and operator-dependent factors, this paper is aimed at establishing a consensus.

Following Delphi methodology, a panel of 14 international experts conducted a consensus study to establish evidence-based technical recommendations for PAE. The panel focused on 6 key procedural domains: preprocedural imaging requirements, antibiotic prophylaxis before and after PAE, arterial access, techniques for identification and cannulation of prostatic artery, embolization techniques and materials, and strategies to prevent nontarget embolization.

This article synthesizes expert opinion and current literature to provide a structured framework for performing PAE. Preprocedural imaging requirements are assessed, and their values are explained. Periprocedural antibiotic prophylaxis is described in different practices. The pros and cons of different arterial access sites are presented. Details on recommended supplies and angiographic techniques are outlined. The available embolic agents and technical details to achieve complete embolization are discussed. Furthermore, the established techniques to avoid nontarget embolization are discussed in stepwise fashion and their safety profiles are presented. Finally, emerging concepts such as the use of liquid embolic agents and coil-out technique for adjunctive coil occlusion of prostatic artery are discussed.

While acknowledging procedural heterogeneity, the panel presents the most effective technical methods. Large-scale studies are warranted to validate or modify these recommendations.