Prostatic artery embolization

Prostatic artery embolisation (PAE) is a minimally invasive procedure utilised to treat benign prostatic hyperplasia (BPH). 

Indications

PAE has been used for controlling prostatic haemorrhage (such as that associated prostate cancer) since 1970. However, its use in the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hypertrophy in humans was first published in 2010 by Carnevale et al. ³ following several articles on PAE based on animal studies.  

Procedure

The prostate receives its blood supply from the prostatic arteries, which arise as a single or paired vessels on each side of the pelvis. PAE is usually performed via a single common femoral artery puncture. Super-selective embolization of the prostatic arteries result in ischaemic necrosis of the gland followed by its shrinkage and subsequent reduction in the symptoms of LUTS. 

Equipment

Three embolising materials have been used in the published articles of PAE for the use in human ⁵. Trisacryl gelatin microspheres, nonspherical polyvinyl alcohol particles and hydrogel microspheres. 

Complications

Recognised complications include⁶:

• Painpain
• Dysuria⁶dysuria
• Haematuria,haematuria and/or haematospermia⁶
• Acuteacute urinary retention⁶
• Urinaryurinary tract infection⁶
• prostate infarction
• Complicationscomplications of femoral artery puncture: haematoma or femoral artery pseudoaneurysm
• Non target embolizationnon-target embolisation: vessels supplying the bladder, rectum and penis⁶

Outcome

Symptomatic relief starts to occur within days in most cases of LUTSlower urinary tract symptoms⁵, and side effects are generally mild. The typical urosurgical complication such as bleeding requiring transfusion, bladder incontinence, and erectile dysfunction, have not been reported with PAE. Quality of life scores suggest that patients are satisfied with their urinary symptoms following the treatment ⁵.