Embolization Of Prostate Gland as Treatment for Benign Prostatic Hyperplasia (Bph): Review and Update

Prostatic artery embolization has been emerging as an effective and safe treatment option of symptomatic benign prostatic hyperplasia. Symptomatic benign prostatic hyperplasia is a common condition which afflicts the aging population which is ensued by the development of bothersome lower urinary tract symptoms and decreased quality of life and at times urinary retention as well as haematuria. Patients who are afflicted by BPH often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is regarded as the traditional standard of care, and in cases of extremely large prostate glands prostatectomy tend to be undertaken either as retropubic or trans-vesical prostatectomy but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) has emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients who have moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are pivotal for optimization of the outcome of PAE. In order to undertake PAE safely and to avoid non-target embolization, interventional radiologists need to be very well trained they should have a detailed understanding of the pelvic arterial anatomy. Even though the prostatic arteries often arise from the internal pudendal arteries, many anatomical variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses had demonstrated improved symptoms after PAE treatment, with serious adverse effects occurring rarely. This article has been written to provide an update on PAE which must be understood in order to develop a thriving PAE practice. These principles include careful assessment of patients, review of surgical therapies, details of the anatomy of the arteries of the pelvis including the prostate artery including its origin and branches, basic principles of embolization, and an overview of published results.