Surgical treatment: Prostate artery embolization: The Big Prostate

Prostate artery embolization (PAE) induces peri-urethral prostate tissue necrosis relieving the urethral obstruction with an overall reduction in prostate size associated with lower smooth muscle tone. These changes lead to symptomatic relief and increase of peak urinary flowrate (Qmax) in patients with symptomatic benign prostatic hyperplasia (BPH). Knowledge of the male pelvic and prostatic arterial anatomy is relevant to perform PAE safely. The number of independent prostate arteries, their origins and the presence of anastomoses are key aspects to perform a selective embolization of the prostate avoiding untargeted embolization of the bladder, rectum or penis. Prostate volume failed to be a predictor of technical or clinical outcome. Thus, large prostates do no translate into easier PAE procedures or better clinical outcomes after embolization. PAE has shown to be safe and effective for patients with BPH and prostates larger than 100 cm3, with a mean prostate volume reduction from 110-140 cm3 down to 71-91 cm3 (31-58%). Mean international prostate symptom score (IPSS) improvement ranging from 13-20 points (49-85%); mean Quality-of-life (QoL) improvement ranging from 1.8-3.5 points (40-73%) and mean Qmax increase ranging from 4-9.6 mL/s (40-132%). PAE is a safe and effective technique to treat symptomatic BPH, with durable results up to at least 4 years that can be used in patients that are unwilling or unfit to undergo surgery, regardless prostate size. PAE can also be used as a downsizing technique for large prostates to avoid open prostatectomy and allowing safer endoscopic prostatic surgery. © Springer International Publishing AG 2018.