A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia

  • Michelle Kuang
  • Anthony Vu
  • Sriharsha AthreyaEmail author



To summarize current evidence on outcomes and complications of prostatic artery embolization as a treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Methods and Materials

A database search of MEDLINE, Embase, Web of Science, and Cochrane Library was performed for published literature up to August 2015 concerning PAE in the treatment of BPH. Inclusion and exclusion criteria were applied by two independent reviewers, and disagreements were resolved by consensus. Peer-reviewed studies concerning PAE with BPH with a sample size >10 and at least one measured parameter were included.


The search yielded 193 articles, of which ten studies representing 788 patients, with a mean age of 66.97 years, were included. Patients had LUTS ranging from moderate to severe. At 6 months following procedure, PV, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05), while for PSA there was no significant change. At 12 and 24 months, PV, PSA, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05). IIEF was unchanged at 6 and 12 months but was significantly reduced at 24 months.


This suggests that PAE is effective in treating LUTS in the short and intermediate term.


Prostate artery embolisation BPH Quality of life 


Compliance with Ethical Standards

Conflict of interest

There are no conflicts of interest or financial disclosures to declare for M. Kuang, A. Vu, or S. Athreya.


  1. 1.
    Lepor H. Pathophysiology of lower urinary tract symptoms in the aging male population. Rev Urol. 2005;7(Suppl 7):S3.Google Scholar
  2. 2.
    Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474–9.PubMedGoogle Scholar
  3. 3.
    Raheem OA, Parsons JK. Associations of obesity, physical activity, and diet with benign prostatic hyperplasia and lower urinary tract symptoms. Curr Opin Urol. 2014;24(1):10–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Mobley D, Feibus A, Baum N. Benign prostatic hyperplasia and urinary symptoms: evaluation and treatment. Postgrad Med. 2015;127(3):301–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Bechis SK, Otsetov AG, Ge R, Olumi AF. Personalized medicine for management of benign prostatic hyperplasia. J Urol. 2014;192(1):16–23.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hollingsworth JM, Wilt TJ. Lower urinary tract symptoms in men. BMJ. 2014;349:g4474.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Marszalek M, Ponholzer A, Pusman M, Berger I, Madersbacher S. Transurethral resection of the prostate. Eur Urol Suppl. 2009;8:504–12.CrossRefGoogle Scholar
  8. 8.
    Mayer EK, Kroeze SGC, Chopra S, Bottle A, Patel A. Examining the ‘gold standard’: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int. 2012;110:1595–601.CrossRefPubMedGoogle Scholar
  9. 9.
    Mitchell ME, Waltman AC, Athanasoulis CA, Kerr WS, Dretler SP. Control of massive prostatic bleeding with angiographic techniques. J Urol. 1976;115:692–5.PubMedGoogle Scholar
  10. 10.
    DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol. 2000;11(6):767–70.CrossRefPubMedGoogle Scholar
  11. 11.
    Camara-Lopes G, Mattedi R, Antunes AA, et al. The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia. Int Braz J Urol. 2013;39:222–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Bagla S, Martin CP, van Breda A, et al. Early results from a united states trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol. 2014;25(1):47–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Bilhim T, Pisco J, Campos Pinheiro L, Rio Tinto H, Fernandes L, Pereira JA, et al. Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? J Vasc Interv Radiol. 2013;24(11):1595–602.CrossRefPubMedGoogle Scholar
  14. 14.
    Bilhim T, Pisco J, Rio Tinto H, Fernandes L, et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Interv Radiol. 2013;36(2):403–11.CrossRefGoogle Scholar
  15. 15.
    Carnevale FC, da Motta-Leal-Filho JM, Antunes AA, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24(4):535–42.CrossRefPubMedGoogle Scholar
  16. 16.
    de Assis AM, Moreira AM, de Paula Rodrigues VC, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates >90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26(1):87–93.CrossRefPubMedGoogle Scholar
  17. 17.
    Gao YA, Huang Y, Zhang R, Yang YD, et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate—a prospective, randomized, and controlled clinical trial. Radiology. 2014;270(3):920–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Kurbatov D, Russo GI, Lepetukhin A, et al. Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study. Urology. 2014;84(2):400–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Li Q, Duan F, Wang M-Q, Zhang G-D, Yuan K. Prostatic arterial embolization with small sized particles for the treatment of lower urinary tract symptoms due to large benign prostatic hyperplasia: preliminary results. Chin Med J. 2015;128(15):2072–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG. Embolization of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23(9):2561–72.CrossRefPubMedGoogle Scholar
  21. 21.
    Wang MQ, Guo LP, Zhang GD, et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population. BMC Urol. 2015;15:33.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine; 2011.Google Scholar
  23. 23.
    Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, Miyazaki H, Suzuki M, Fukuhara H, Enomoto Y, Homma Y. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score. BJU Int. 2012;109(1):1512–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30.CrossRefPubMedGoogle Scholar
  25. 25.
    Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066–96.CrossRefPubMedGoogle Scholar
  26. 26.
    Taher A. Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors. J Urol. 2004;22(6):457–60.Google Scholar
  27. 27.
    Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol. 2006;50:969–79.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  1. 1.Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonCanada
  2. 2.St. Joseph’s HealthcareHamiltonCanada
  3. 3.McMaster University Faculty of Health Sciences, Centre for Interventional Radiology and OncologyJosephs Healthcare HamiltonHamiltonCanada

Personalised recommendations