Bilateral Prostate Artery Embolization for Massive Benign Prostatic Hyperplasia in a Frail Elderly Patient With Recurrent Urinary Retention

Benign prostatic hyperplasia (BPH) is a highly prevalent condition among elderly men and a major cause of lower urinary tract symptoms (LUTS), urinary retention, recurrent urinary tract infections (UTIs), hematuria, and bladder outlet obstruction (BOO). Management of severe BPH in elderly patients with multiple comorbidities remains challenging, particularly in those who are poor surgical candidates. Prostate artery embolization (PAE) has emerged as a minimally invasive alternative for symptomatic relief in patients with moderate-to-severe LUTS secondary to BPH. We present the case of an 87-year-old male with massive BPH (estimated prostate volume 263 g) complicated by recurrent urinary retention, recurrent catheter-associated UTIs (CAUTIs), gross hematuria, and chronic Foley catheter dependence despite maximal medical therapy with tamsulosin and finasteride. His medical history was significant for coronary artery disease with prior cardiac stent placement, prior stroke, chronic anticoagulation therapy, hypertension, nephrolithiasis, and cognitive impairment, making him a high-risk candidate for conventional surgical intervention. Imaging and cystoscopic evaluation confirmed severe prostatomegaly with intravesical prostatic protrusion and BOO. The patient underwent successful bilateral PAE via left radial artery access using 300-500 μm embospheres without procedural complications. At follow-up, he demonstrated marked symptomatic improvement with restoration of spontaneous voiding, absence of recurrent urinary retention, and reduction of post-void residual volume to 35 mL. No further catheter obstruction or catheter-associated infections were reported. This case highlights the effectiveness and safety of PAE as a minimally invasive therapeutic option for elderly high-risk patients with giant BPH and chronic catheter dependence. The favorable clinical outcome observed further supports the growing role of PAE in complex geriatric urologic populations who are not ideal candidates for traditional surgical management.