Prostatic artery embolization (PAE) is a minimally invasive vascular procedure used to treat benign prostatic hyperplasia (BPH) by inducing necrosis in overgrown prostate tissue. The goal of this research was to assess the effectiveness and safety of PAE in alleviating lower urinary tract symptoms (LUTS), facilitating the removal of indwelling catheters, reducing the need of medication for BPH, and avoiding the necessity for more invasive surgical treatments.

"Data from consecutive patients who underwent PAE at our institution between December 2020 and June 2024 were prospectively gathered. The procedure was carried out in the interventional radiology suite with local anesthesia, using either polyvinyl alcohol particles or cyanoacrylate glue. Preoperative assessments included prostate volume, post-void residual volume (PVR), pharmacological treatment, International Prostate Symptom Score (IPSS), Quality of Life (QoL), and uroflowmetry measurements. These variables were then compared to baseline values at 6, 12, and 24 months during follow-up.

A total of 72 patients were included, with 9 (12.5%) having an indwelling catheter prior to PAE. The median age was 79 years (IQR 77–81), and the median follow-up duration was 24 months (IQR 10–39). Two patients (2.7%) had previously undergone transurethral resection of the prostate (TURP). Thirty-seven patients (51.4%) were receiving antiplatelet or anticoagulant therapy. Preoperative median prostate volume (PV) on MRI was 60 cc (IQR 44–76), and the median post-void residual volume (PVR) was 70 ml (IQR 30–100).  The median preoperative International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were 22 (IQR 19–27) and 4 (IQR 4–5), respectively. All patients were discharged the day following the procedure. Complications were observed in 6 patients, all classified as Clavien–Dindo grade < 2.  The median duration of catheterization was 30 days, and the median PVR at catheter removal was 50 ml (IQR 0–80). 
At 6 months, the median reduction in prostate volume on MRI was 18.5 cc (IQR 6.75–28.75). The median reduction in IPSS at 6, 12, and 24 months was 10 points (IQR 5–14), 8 points (IQR 5–11), and 8 points (IQR 4–11), respectively. Median QoL improvements at 6, 12, and 24 months were 2 points (IQR 1–3), 2 points (IQR 1–3), and 2 points (IQR 1–2), respectively. The median improvement in Qmax at 6 months was 3.5 ml/sec (IQR 2.05–8.1).
Among the 9 patients with an indwelling catheter, 6 (66.6%) achieved spontaneous micturition following catheter removal. At 6 months, 30 patients (41.6%) had discontinued all BPH medications, 12 (16.7%) had stopped one of their two medications, and 30 (41.6%) continued their treatment regimen unchanged. 
The surgical treatment-free rate at the final follow-up was 93%, with only 5 (7%) patients requiring an additional procedure, specifically TURP.

Prostate volume, Qmax, PVR, IPSS and QoL showed significant improvement after PAE.

PAE is a safe and effective treatment for symptomatic BPH and LUTS, demonstrating significant outcomes in decreasing the need of BPH medications and enabling the removal of indwelling catheters in a substantial number of patients.