Prostate Artery Embolization: Indication, Technique and Clinical ResultsArticle in several languages: English | deutsch
13 December 2017
24 March 2018
05 July 2018 (eFirst)
Background Prostate artery embolization (PAE) is a new embolization therapy to treat benign prostate syndrome (BPS).
Materials and Methods This review article presents the rationale and impact mechanism of PAE, criteria for patient selection, and discusses the anatomy of prostate arteries. The study results are seen in the context of complications and clinical partners.
Results Important preconditions for successful prostate artery embolization are a strict indication, precise knowledge of the anatomy of the pelvic arteries and advanced interventional-radiological skills. Several studies showed that urological parameters after prostate artery embolization improve at a similar level as for established post-surgical treatments. At the same time, it could be proven that prostate artery embolization has no impact on erectile function and is associated with a relatively low complication rate.
Conclusion PAE is increasingly developing to an alternative for the established surgical treatments in BPS patients.
PAE is a new embolization method for treating BPS and represents an alternative to classic urological surgical procedure such as TURP.
Due to the low caliber of the prostate artery (0.5 – 2 mm), the presence of anatomical variations, and the arteriosclerosis seen in most older men, PAE is a technically challenging embolization method.
In patients with a high postoperative bleeding risk in classic urological surgical treatment concepts, PAE is a very gentle alternative method.
Teichgräber U, Aschenbach R, Diamantis I et al. Prostate Artery Embolization: Indication, Technique and Clinical Results. Fortschr Röntgenstr 2018; 190: 847 – 855
- 1 Carnevale FC, Antunes AA, da Motta Leal Filho JM. et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 2010; 33: 355-361
- 2 Burnett AL, Wein AJ. Benign prostatic hyperplasia in primary care: what you need to know. J Urol 2006; 175: 19-24
- 3 Berry SJ, Coffey DS, Walsh PC. et al. The development of human benign prostatic hyperplasia with age. J Urol 1984; 132: 474-479
- 4 Walsh PC, Hutchins GM, Ewing LL. Tissue content of dihydrotestosterone in human prostatic hyperplasis is not supranormal. J Clin Invest 1983; 72: 1772-1777
- 5 Saartok T, Dahlberg E, Gustafsson JA. Relative binding affinity of anabolic-androgenic steroids: comparison of the binding to the androgen receptors in skeletal muscle and in prostate, as well as to sex hormone-binding globulin. Endocrinology 1984; 114: 2100-2106
- 6 Sun F, Sanchez FM, Crisostomo V. et al. Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment--preliminary study in pigs. Radiology 2008; 246: 783-789
- 7 Zlotta AR, Raviv G, Peny MO. et al. Possible mechanisms of action of transurethral needle ablation of the prostate on benign prostatic hyperplasia symptoms: a neurohistochemical study. J Urol 1997; 157: 894-899
- 8 Nasu K, Moriyama N, Kawabe K. et al. Quantification and distribution of alpha 1-adrenoceptor subtype mRNAs in human prostate: comparison of benign hypertrophied tissue and non-hypertrophied tissue. Br J Pharmacol 1996; 119: 797-803
- 9 Carnevale FC, da Motta-Leal-Filho JM, Antunes AA. et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol 2013; 24: 535-542
- 10 Pisco JM, Rio Tinto H, Campos Pinheiro L. et al. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol 2013; 23: 2561-2572
- 11 Pisco JM, Pinheiro LC, Bilhim T. et al. Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 2011; 22: 11-19 ; quiz 20
- 12 Bilhim T, Pisco JM, Rio Tinto H. et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 2012; 23: 1403-1415
- 13 Zhang G, Wang M, Duan F. et al. Radiological Findings of Prostatic Arterial Anatomy for Prostatic Arterial Embolization: Preliminary Study in 55 Chinese Patients with Benign Prostatic Hyperplasia. PLoS One 2015; 10: e0132678
- 14 Amouyal G, Thiounn N, Pellerin O. et al. Clinical Results After Prostatic Artery Embolization Using the PErFecTED Technique: A Single-Center Study. Cardiovasc Intervent Radiol 2016; 39: 367-375
- 15 Bilhim T, Pisco JM, Furtado A. et al. Prostatic arterial supply: demonstration by multirow detector angio CT and catheter angiography. Eur Radiol 2011; 21: 1119-1126
- 16 Shim SR, Kanhai KJ, Ko YM. et al. Efficacy and Safety of Prostatic Arterial Embolization: Systematic Review with Meta-Analysis and Meta-Regression. J Urol 2017; 197: 465-479
- 17 Gao YA, Huang Y, Zhang R. et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology 2014; 270: 920-928
- 18 Russo GI, Kurbatov D, Sansalone S. et al. Prostatic Arterial Embolization vs Open Prostatectomy: A 1-Year Matched-pair Analysis of Functional Outcomes and Morbidities. Urology 2015; 86: 343-348
- 19 Carnevale FC, Iscaife A, Yoshinaga EM. et al. Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis. Cardiovasc Intervent Radiol 2016; 39: 44-52
- 20 Bilhim T, Pisco J, Pereira JA. et al. Predictors of Clinical Outcome after Prostate Artery Embolization with Spherical and Nonspherical Polyvinyl Alcohol Particles in Patients with Benign Prostatic Hyperplasia. Radiology 2016; 281: 289-300
- 21 Bilhim T, Pisco J, Campos Pinheiro L. et al. Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol 2013; 24: 1595-1602 e1591
- 22 Carnevale FC, Moreira AM, Harward SH. et al. Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques. Cardiovasc Intervent Radiol 2017; 40: 366-374
- 23 Bagla S, Smirniotopoulos JB, Orlando JC. et al. Comparative Analysis of Prostate Volume as a Predictor of Outcome in Prostate Artery Embolization. J Vasc Interv Radiol 2015; 26: 1832-1838
- 24 Uflacker A, Haskal ZJ, Bilhim T. et al. Meta-Analysis of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2016; 27: 1686-1697 e1688