To evaluate the safety, morbidity, and short- and intermediate-term results of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH) after failure of medical treatment. This prospective study was approved by the institutional review board, and informed consent was obtained from all participants. Men older than 50 years with a diagnosis of BPH and moderate-to-severe lower urinary tract symptoms that were refractory to medical treatment for 6 months were eligible. PAE with nonspherical 80-180-μm (mean, 100-μm) and 180-300-μm (mean, 200-μm) polyvinyl alcohol particles was performed by means of a single femoral approach in most cases. Effectiveness variables of International Prostate Symptom Score (IPSS), quality of life (QOL) score, peak urinary flow, postvoid residual volume, International Index Erectile Function (IIEF) score, prostate volume, and prostate-specific antigen level were assessed for up to 24 months after the procedure. Statistical analysis included the Kaplan-Meier method and random-effects generalized least squares regression with autoregressive disturbance. Eighty-nine consecutive patients (mean age, 74.1 years) were included. PAE was technically successful in 86 of the 89 patients (97%). Cumulative rates of clinical improvement in these patients were 78% in the 54 patients evaluated at 6 months and 76% in the 29 patients evaluated at 12 months. At 1-month follow-up, IPSS decreased by 10 points, QOL score decreased by 2 points, peak urinary flow increased by 38%, prostate volume decreased by 20%, postvoid residual volume decreased by 30 mL, and IIEF score increased by 0.5 point (all differences were significant at P < .01). These changes were sustained throughout the observation period. There was one major complication: Intraluminal necrotic tissue attached to the bladder, which was removed with simple surgery and did not necessitate wall reconstruction. PAE is a safe and effective procedure, with low morbidity, no sexual dysfunction, and good short- and intermediate-term symptomatic control associated with prostate volume reduction.

The prostate-specific antigen level 24 hours after prostate artery embolization correlates with prostate ischemia on MR images, and both correlate with clinical outcome. PurposeTo assess predictors of outcome after prostate artery embolization (PAE) for benign prostatic hyperplasia with spherical particle polyvinyl alcohol (sPVA) and compare outcomes with the use of nonspherical particle polyvinyl alcohol (nsPVA).Materials and MethodsThis was a single-center retrospective institutional review board–approved study conducted from 2009 to 2015 in patients undergoing PAE with sPVA (n = 186; mean age ± standard deviation, 65.5 years ± 7.7) and nsPVA (n = 300; mean age, 65.3 years ± 7.6). The two cohorts were compared and analyzed for predictors of outcome with a Cox proportional hazards model and linear regression. Post-PAE prostate ischemia was measured with contrast material–enhanced magnetic resonance (MR) imaging in 23 patients with nsPVA and 25 patients with sPVA. The 24-hour post-PAE prostate-specific antigen (PSA) level was registered in 133 patients with sPVA. Prognostic values of MR imaging and PSA levels 24 hours after PAE were assessed with Cox and random-effects re...