Practical Approach For Prostatic Arterial Embolization(Pae)


Assistant Professor of Interventional Radiology, Iran University of Medical Science


BPH refers to the increase in size of the prostate in middle-aged and elderly men .The normal prostate is composed of a combination of glandular, stromal, and smooth muscle cells.
BPH is due to a proliferation of glandular elements, fibromuscular (stromal) elements, or both, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate
Benign prostatic hyperplasia (BPH) has a high prevalence rate in men aged 50–79 years (1) and is ubiquitous with aging (2).
Prostatectomy by open surgery or by transurethral resection of the prostate is still considered the gold standard of treatment.Urinary tract infection, strictures, postoperative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are complications associated with surgical treatments.
Alternative options include minimally invasive treatments and were originally conceived as an attempt to offer equivalent efficacy without the burden and risk of operative morbidity.       
The introduction of arterial embolization to treat uterine fibroids has led to its use for Benign Prostatic Hyperplasia (BPH). Prostatic arterial embolization (PAE) is a technically demanding procedure that blocks the blood supply of the arteries that supply the prostate gland.
With CTA we define the male pelvic vascular anatomical pattern and the PA anatomy (number of independent PAs, their origin, trajectory, termination, and anastomoses with surrounding arteries). Each pelvic side should be considered separately.
It is much more difficult than performing a fibroid embolization because:
Thin tortuous atherosclerotic vessels, Difficulty of visualization superselective catheterization of the inferior vesical artery and prostate arteries, requires the use of microcatheters in all cases.     
The inferior vesical artery and finally the prostatic vessels were selectively catheterized with a 3-F coaxial microcatheter. For embolization, nonspherical 200-_m PVA particles were used.
We conclude that PAE is a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, Associated with a reduction in prostate volume.
The response to treatment was measured at 1, 3, and 6 months after the procedure. The prostate volume was also measured by MR before and 6 months after PAE.Bilateral PAE seems to lead to better clinical results; however, up to 50 % of patients after unilateral PAE may have a good clinical outcome.