The role of prostatic artery embolization in the management of benign prostatic enlargement in patients with chronic liver disease: a prospective single-center clinical trial

Abstract Purpose To evaluate the efficacy and safety of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH) in patients with chronic liver disease, with subgroup analysis according to Child–Pugh classification. Materials and methods This prospective single-center clinical study enrolled thirty-four male patients (median age, 65 years; IQR 57–71) with symptomatic BPH and chronic liver disease who were refractory to ≥6 months of medical therapy. Baseline clinical, laboratory, and imaging parameters were recorded. Bilateral or unilateral PAE was performed using calibrated microspheres (100–300 µm and/or 300–500 µm). Functional outcomes, including International Prostate Symptom Score (IPSS), prostate volume, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and quality-of-life (QOL) scores, were assessed at 1 and 6 months. Outcomes were analyzed overall and stratified by Child–Pugh classification. Results Technical success was achieved in all patients, with bilateral embolization in 27 patients (79.4%). Median IPSS decreased from 24.0 at baseline to 18.0 at 1 month (22.2% reduction, p < 0.001) and 12.0 at 6 months (51.7% reduction, p < 0.001), and Qmax increased from 7.4 mL/s to 14.2 mL/s at 6 months (91.9% increase, p < 0.001). PVR and QOL scores also improved significantly ( p < 0.001). Both Child–Pugh A (n = 22) and Child–Pugh B (n = 12) improved significantly. Prostate volume decreased more in Child–Pugh B at 1 and 6 months (between-group p < 0.001), while IPSS reduction was greater in Child–Pugh B at 1 month ( p = 0.013) and comparable by 6 months ( p = 0.435). Minor transient adverse events were observed in most patients, while mild, self-limited procedure-related events occurred in 44% of cases, with no major complications or procedure-related mortality. Conclusions PAE is a safe and effective minimally invasive option for managing symptomatic BPH in patients with chronic liver disease. Clinically meaningful improvements in symptom scores, urinary flow, and prostate volume were observed across all Child–Pugh classes, supporting the feasibility of PAE in this high-risk population.