Prostatic artery embolization (PAE) is a minimally invasive procedure utilized to treat benign prostatic hyperplasia (BPH).
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Indications
PAE has been used for controlling prostatic hemorrhage (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 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 results in ischemic necrosis of the gland followed by its shrinkage and subsequent reduction in the symptoms of LUTS.
Equipment
short 5-6F sheath catheter
20 G angiocath or a micropuncture needle (19- 21G)
"radial cocktail"
For internal iliac artery catheterization
For prosttic artery subselection
navigation microguidewire: Fathom or Whisper guidewire
For embolization
Three embolization agents can be used 5
Complications
Recognized complications include 6:
pain
dysuria
hematuria and/or hematospermia
acute urinary retention
complications of femoral artery puncture: hematoma or femoral artery pseudoaneurysm
non-target embolization: vessels supplying the bladder, rectum and penis
Outcome
Symptomatic relief starts to occur within days in most cases of lower urinary tract symptoms 5, 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.