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Updated: Jun 12, 2026

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Prostatic Urethral Angle and Symptom Response after Prostatic Artery Embolization: A Retrospective Study.

Kameel Khabaz1, Griffin McNamara2, Anokh Pahwa2

  • 1David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

Journal of Vascular and Interventional Radiology : JVIR
|June 10, 2026
PubMed
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The prostatic urethral angle (PUA) did not predict outcomes for all patients undergoing prostatic artery embolization (PAE). However, a larger PUA correlated with better symptom improvement in men with smaller prostates.

Area of Science:

  • Urology
  • Interventional Radiology
  • Medical Imaging

Background:

  • Prostatic artery embolization (PAE) is a treatment for benign prostatic hyperplasia (BPH).
  • Magnetic resonance imaging (MRI) is used to assess prostatic anatomy before PAE.
  • The prostatic urethral angle (PUA) is a geometric parameter of prostatic anatomy.

Purpose of the Study:

  • To investigate the association between pre-PAE prostatic urethral angle (PUA) and treatment outcomes.
  • To determine if PUA predicts symptom improvement after PAE.

Main Methods:

  • Retrospective analysis of 80 patients undergoing PAE.
  • Measurement of pre-PAE PUA by two independent readers with adjudication.
  • Comparison of PUA with baseline and post-PAE International Prostate Symptom Scores (IPSS).

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Main Results:

  • PUA was not significantly associated with baseline IPSS, post-PAE IPSS, or IPSS change in the overall cohort.
  • In patients with prostate volume < 100 mL, a larger PUA was associated with lower post-PAE IPSS (p=0.025).
  • Patients with a ≥3 point IPSS reduction had a significantly larger PUA (62.40° vs 55.05°, p=0.007).
  • A significant interaction between PUA and prostate volume indicated effect modification by prostate size (p=0.005).

Conclusions:

  • The prostatic urethral angle (PUA) may predict treatment response to PAE, particularly in patients with smaller prostates.
  • PUA measurement could be a useful imaging biomarker in selecting patients for PAE.
  • Further research is warranted to validate PUA as a predictive factor for PAE outcomes.