World Journal of Urology

, Volume 36, Issue 4, pp 575–584 | Cite as

Prostatic artery embolization for benign prostatic obstruction: assessment of safety and efficacy

  • Daniel ChristidisEmail author
  • E. Clarebrough
  • V. Ly
  • M. Perera
  • H. Woo
  • N. Lawrentschuk
  • D. Bolton
Topic Paper



Prostatic artery embolization (PAE) has seen a recent increase in interest as a treatment for men with benign prostatic obstruction (BPO). The appeal of this intervention lies in reported reduction in morbidity and its minimally invasive nature. The purpose of this review is to assess the safety and efficacy of PAE as a new treatment in BPO and explore risks surrounding its performance.


A review of the literature was performed. Medical databases searched included PubMed, EMBASE, and Cochrane databases, limited to English, peer-reviewed articles. Search terms included prostatic artery embolization, lower urinary tracts symptoms, minimally invasive therapies, interventional radiology prostate, and benign prostatic hyperplasia. Articles were screened by two independent reviewers for content on development, methods, outcomes, and complications of PAE.


Suitability of patients to undergo PAE depends on review of patient history, pre-procedure visualisation of appropriate vascular anatomy and clinical parameters. Despite this selection of candidates favourable for procedural success, PAE is not without risk of complications, some of which can significantly affect patient quality of life.


Although initial findings show promise regarding safety and efficacy of PAE in improving symptom and quality-of-life scores, further investigation is required to establish durability of effect and the appropriate use of this experimental modality. There is currently limited robust evidence for the beneficial outcomes of PAE. Long-term follow-up studies will add to the evidence base to help further assess the feasibility of this procedure as an alternative to TURP.


Prostatic artery embolization Benign prostatic hyperplasia Lower urinary tracts symptoms Minimally invasive therapies Interventional radiology prostate 


  1. 1.
    Lawrentschuk N, Perera M (2000) Benign prostate disorders. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM et al (eds) Endotext., Inc., South Dartmouth (MA)Google Scholar
  2. 2.
    Perera M, Roberts MJ, Doi SA, Bolton D (2015) Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol 67(4):704–713. (PubMed PMID: 25466940) CrossRefPubMedGoogle Scholar
  3. 3.
    Daniel Christidis SM, Perera M, Manning T, Bolton D, Lawrentschuk N (2017) Minimally invasive surgical therapies for BPH: the rise in MIST. Prostate Int. PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kahokehr A, Gilling PJ (2014) Landmarks in BPH–from aetiology to medical and surgical management. Nat Rev Urol 11(2):118–122. (PubMed PMID: 24445912) CrossRefPubMedGoogle Scholar
  5. 5.
    Thoma C (2017) BPH: making a splash against LUTS. Nat Rev Urol 14(4):200. (PubMed PMID: 28169995) CrossRefPubMedGoogle Scholar
  6. 6.
    Magistro G, Stief CG, Gratzke C (2015) New intraprostatic injectables and prostatic urethral lift for male LUTS. Nat Rev Urol 12(8):461–471. (PubMed PMID: 26195444) CrossRefPubMedGoogle Scholar
  7. 7.
    DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS (2000) Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol JVIR 11(6):767–770 (PubMed PMID: 10877424) CrossRefPubMedGoogle Scholar
  8. 8.
    Pisco JM, Pinheiro LC, Bilhim T, Duarte M, Mendes JR, Oliveira AG (2011) Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol JVIR 22(1):11–19. (quiz 20, PubMed PMID: 21195898) CrossRefPubMedGoogle Scholar
  9. 9.
    Pisco J, Campos Pinheiro L, Bilhim T, Duarte M, Rio Tinto H, Fernandes L et al (2013) Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology 266(2):668–677. (PubMed PMID: 23204546) CrossRefPubMedGoogle Scholar
  10. 10.
    Shim SR, Kanhai KJ, Ko YM, Kim JH (2017) Efficacy and safety of prostatic arterial embolization: systematic review with meta-analysis and meta-regression. J Urol 197(2):465–479. (PubMed PMID: 27592008) CrossRefPubMedGoogle Scholar
  11. 11.
    Bilhim T, Pisco J, Campos Pinheiro L, Rio Tinto H, Fernandes L, Pereira JA et al (2013) Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol JVIR. 24(11):1595 e1–1602 e1. (PubMed PMID: 23916874) CrossRefGoogle Scholar
  12. 12.
    Li Q, Duan F, Wang MQ, Zhang GD, Yuan K (2015) 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 128(15):2072–2077. (PubMed PMID: 26228221; PubMed Central PMCID: PMC4717949) CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Carnevale FC, Moreira AM, Harward SH, Bhatia S, de Assis AM, Srougi M et al (2017) Recurrence of lower urinary tract symptoms following prostate artery embolization for benign hyperplasia: single center experience comparing two techniques. Cardiovasc Interv Radiol 40(3):366–374. (PubMed PMID: 28074310) CrossRefGoogle Scholar
  14. 14.
    Carnevale FC, Moreira AM, Antunes AA (2014) The “PErFecTED technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Interv Radiol 37(6):1602–1605. (PubMed PMID: 24943914) CrossRefGoogle Scholar
  15. 15.
    Bagla S, Martin CP, van Breda A, Sheridan MJ, Sterling KM, Papadouris D et al (2014) Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol JVIR 25(1):47–52. (PubMed PMID: 24176946) CrossRefPubMedGoogle Scholar
  16. 16.
    McWilliams JP, Kuo MD, Rose SC, Bagla S, Caplin DM, Cohen EI et al (2014) Society of Interventional Radiology position statement: prostate artery embolization for treatment of benign disease of the prostate. J Vasc Interv Radiol JVIR 25(9):1349–1351. (PubMed PMID: 24993818) CrossRefPubMedGoogle Scholar
  17. 17.
    Bilhim T, Pisco J, Rio Tinto H, Fernandes L, Campos Pinheiro L, Duarte M et al (2013) Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Interv Radiol 36(2):403–411. (PubMed PMID: 23232858) CrossRefGoogle Scholar
  18. 18.
    Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC, Furtado A et al (2012) Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol JVIR 23(11):1403–1415. (PubMed PMID: 23101913) CrossRefPubMedGoogle Scholar
  19. 19.
    Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C et al (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109. (PubMed PMID: 25613154) CrossRefPubMedGoogle Scholar
  20. 20.
    Jones P, Rai BP, Nair R, Somani BK (2015) Current status of prostate artery embolization for lower urinary tract symptoms: review of world literature. Urology 86(4):676–681. (PubMed PMID: 26238328) CrossRefPubMedGoogle Scholar
  21. 21.
    Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L et al (2013) Embolisation 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 23(9):2561–2572. (PubMed PMID: 23370938) CrossRefPubMedGoogle Scholar
  22. 22.
    Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M et al (2014) Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate–a prospective, randomized, and controlled clinical trial. Radiology 270(3):920–928. (PubMed PMID: 24475799) CrossRefPubMedGoogle Scholar
  23. 23.
    Schreuder SM, Scholtens AE, Reekers JA, Bipat S (2014) The role of prostatic arterial embolization in patients with benign prostatic hyperplasia: a systematic review. Cardiovasc Interv Radiol 37(5):1198–1219. (PubMed PMID: 25005565) CrossRefGoogle Scholar
  24. 24.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–979. (discussion 80, PubMed PMID: 16469429) CrossRefPubMedGoogle Scholar
  25. 25.
    Perera M, Lawrentschuk N, Perera N, Bolton D, Clouston D (2016) Incidental prostate cancer in transurethral resection of prostate specimens in men aged up to 65 years. Prostate Int 4(1):11–14. (PubMed PMID: 27014658; PubMed Central PMCID: PMC4789333) CrossRefPubMedGoogle Scholar
  26. 26.
    Russo GI, Kurbatov D, Sansalone S, Lepetukhin A, Dubsky S, Sitkin I et al (2015) Prostatic arterial embolization vs open prostatectomy: a 1-year matched-pair analysis of functional outcomes and morbidities. Urology 86(2):343–348. (PubMed PMID: 26199151) CrossRefPubMedGoogle Scholar
  27. 27.
    Wang MQ, Guo LP, Zhang GD, Yuan K, Li K, Duan F et al (2015) 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 15:33. (PubMed PMID: 25887036; PubMed Central PMCID: PMC4403829) CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Wang M, Guo L, Duan F, Yuan K, Zhang G, Li K et al (2016) Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a comparative study of medium- and large-volume prostates. BJU Int 117(1):155–164. (PubMed PMID: 25851432) CrossRefPubMedGoogle Scholar
  29. 29.
    Leite LC, de Assis AM, Moreira AM, Harward SH, Antunes AA, Carnevale FC (2017) Prostatic tissue elimination after prostatic artery embolization (PAE): a report of three cases. Cardiovasc Interv Radiol 40(6):937–941. (PubMed PMID: 28175975) CrossRefGoogle Scholar
  30. 30.
    Kisilevzky N, Laudanna Neto C, Cividanes A (2016) Ischemia of the glans penis following prostatic artery embolization. J Vasc Interv Radiol JVIR 27(11):1745–1747. (PubMed PMID: 27926408) CrossRefPubMedGoogle Scholar
  31. 31.
    Wang M, Zhang G, Yuan K, Duan F, Yan J, Wang Y (2015) Seminal vesicle ischemia: an unusual complication occurring after prostatic artery embolization for the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol JVIR 26(10):1580–1582. (PubMed PMID: 26408222) CrossRefPubMedGoogle Scholar
  32. 32.
    Moreira AM, Marques CF, Antunes AA, Nahas CS, Nahas SC, de Gregorio Ariza MA et al (2013) Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol 36(6):1690–1694. (PubMed PMID: 24091752) CrossRefGoogle Scholar
  33. 33.
    Andrade G, Khoury HJ, Garzon WJ, Dubourcq F, Bredow MF, Monsignore LM et al (2017) radiation exposure of patients and interventional radiologists during prostatic artery embolization: a prospective single-operator study. J Vasc Interv Radiol JVIR 28(4):517–521. (PubMed PMID: 28259503) CrossRefPubMedGoogle Scholar
  34. 34.
    Laborda A, De Assis AM, Ioakeim I, Sanchez-Ballestin M, Carnevale FC, De Gregorio MA (2015) Radiodermitis after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol 38(3):755–759. (PubMed PMID: 25799951) CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, Austin HealthUniversity of MelbourneMelbourneAustralia
  2. 2.Young Urology Researchers OrganizationMelbourneAustralia
  3. 3.Department of SurgerySt. Vincent’s HospitalMelbourneAustralia
  4. 4.Sydney Adventist Hospital Clinical SchoolUniversity of SydneySydneyAustralia
  5. 5.Department of Surgical OncologyPeter MacCallum Cancer CentreMelbourneAustralia
  6. 6.Olivia Newton-John Cancer Research InstituteMelbourneAustralia

Personalised recommendations