Prostatic Artery Embolization for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a common condition in ageing men characterised by non-malignant enlargement of the prostate gland, leading to lower urinary tract symptoms (LUTS) such as urinary frequency, nocturia, weak stream and incomplete bladder emptying. Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative to transurethral resection of the prostate (TURP), aiming to induce prostate volume reduction through targeted occlusion of prostatic arterial branches. Under local anaesthesia and image guidance, microcatheters are navigated via a femoral or radial approach to selectively embolize prostatic arteries with calibrated particles or liquid agents. The resulting ischaemia causes stromal and glandular shrinkage, improvement in urinary flow rate and relief of LUTS. Advantages of PAE include avoidance of general anaesthesia, reduced peri-operative morbidity, preservation of sexual function and suitability for patients unfit for surgery. Technical success depends on detailed mapping of pelvic vascular anatomy and choice of embolic material, while clinical success is judged by validated measures such as the International Prostate Symptom Score (IPSS), peak urinary flow (Qmax) and prostate volume on imaging.

Research from Nature Portfolio

Recent studies have demonstrated the value of pre-interventional magnetic resonance angiography (MRA) for detailed visualisation of prostatic arterial anatomy. By accurately identifying the origin and course of prostatic arteries in over 85 % of cases, MRA has been shown to reduce catheterisation time, fluoroscopy exposure and contrast media dose. Analysis of vessel elongation and bifurcation angles has further correlated specific anatomical configurations with procedural metrics, enabling personalised procedural planning and potentially obviating additional intra-operative imaging modalities.

Prostatic Artery Embolization for Benign Prostatic Hyperplasia publication trend

The graph below shows the total number of articles in prostatic artery embolization for benign prostatic hyperplasia across all publications each year (not limited to Nature Index journals).

Technical terms

Benign prostatic hyperplasia (BPH): Non-malignant enlargement of the prostate gland causing urinary symptoms.

Prostatic artery embolization (PAE): Minimally invasive procedure that blocks prostatic blood flow to induce gland shrinkage.

Magnetic resonance angiography (MRA): Imaging technique that visualises blood vessels without ionising radiation.

N-butyl cyanoacrylate (NBCA): Liquid embolic agent that rapidly polymerises to occlude target vessels.

Lower urinary tract symptoms (LUTS): Range of voiding and storage urinary complaints associated with prostatic enlargement.

References

1. Value of magnetic resonance angiography before prostatic artery embolization for intervention planning. Scientific Reports (2024).
2. Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis. BMC Urology (2019).
3. Radiological Findings of Prostatic Arterial Anatomy for Prostatic Arterial Embolization: Preliminary Study in 55 Chinese Patients with Benign Prostatic Hyperplasia. PLOS ONE (2015).
4. The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia. International braz j urol (2013).
5. Prostate Artery Embolization for Lower Urinary Tract Symptoms in Men Unfit for Surgery. Diagnostics (2019).
6. Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?. Journal of Clinical Medicine (2021).
7. Influence of Interventionists’ Experience on Radiation Exposure of Patients Who Underwent Prostate Artery Embolization: 4-Year Results from a Retrospective, Single-Center Study. CardioVascular and Interventional Radiology (2020).
8. Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia. BMC Urology (2020).