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

Prostatic artery embolization (PAE) may be preceded by magnetic resonance (MR) imaging to evaluate prostatic anatomy. The prostatic urethral angle (PUA), the acute angle formed by lines extending from the verumontanum to the proximal and distal urethra, has been associated with response to medical and surgical therapies. Pre-PAE PUA was retrospectively measured by 2 readers in 80 patients, with third-reader adjudication for disagreements, and compared with baseline and post-PAE international prostate symptom scores (IPSSs). PUA was not significantly associated with baseline IPSS, post-PAE IPSS, or IPSS change (all P > .05). In patients with prostate volumes < 100 mL (n = 28), larger PUA was associated with lower post-PAE IPSS (P = .025), confirmed by multivariable adjustment (P = .035); patients with ≥3-point IPSS reduction had larger PUA (62.40° vs 55.05°, P = .007). A PUA × prostate volume interaction in a full-cohort multivariable model confirmed effect modification by prostate size (P = .005).