Subscribe to RSS
DOI: 10.1055/s-0045-1804908
Anatomy for Prostatic Artery Embolization
Funding None.
Abstract
Prostatic artery embolization (PAE) is a minimally invasive treatment for patients with moderate to severe lower urinary tract symptoms and/or urinary retention due to benign prostatic hyperplasia (BPH), as well as hematuria secondary to prostatic bleeding. PAE achieves its therapeutic effect by inducing ischemic necrosis and reducing prostatic volume, while also decreasing neuromuscular tone. This dual mechanism addresses both the static and dynamic components of bladder outflow obstruction associated with BPH. PAE is technically challenging and necessitates in-depth knowledge of the complex and variable anatomy of the pelvic vasculature. Successful outcomes depend on precise identification of the prostatic artery and recognition of anastomoses to surrounding structures to minimize the risk of nontarget embolization and associated complications. This article reviews the prostatic arterial anatomy and explores the role of advanced imaging techniques for preprocedural planning and intraprocedural guidance to optimize procedural safety and efficacy.
Keywords
prostate artery embolization - benign prostatic hypertrophy - internal iliac artery - cone beam computed tomography - interventional radiologyAuthors' Contribution
All authors have a role in writing the manuscript.
Data Sharing Statement
Not applicable.
Publication History
Article published online:
03 April 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Pisco JM, Bilhim T, Pinheiro LC. et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol 2016; 27 (08) 1115-1122
- 2 Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E. Long-term outcome of prostatic artery embolization for patients with benign prostatic hyperplasia: single-centre retrospective study in 1072 patients over a 10-year period. Cardiovasc Intervent Radiol 2022; 45 (09) 1324-1336
- 3 Tapping CR, Little MW, Macdonald A. et al. The STREAM Trial (prostatic artery embolization for the treatment of benign prostatic hyperplasia) 24-month clinical and radiological outcomes. Cardiovasc Intervent Radiol 2021; 44 (03) 436-442
- 4 Cunha GR, Vezina CM, Isaacson D. et al. Development of the human prostate. Differentiation 2018; 103: 24-45
- 5 McNeal JE. Normal histology of the prostate. Am J Surg Pathol 1988; 12 (08) 619-633
- 6 Ali A, Du Feu A, Oliveira P, Choudhury A, Bristow RG, Baena E. Prostate zones and cancer: lost in transition?. Nat Rev Urol 2022; 19 (02) 101-115
- 7 Mitterberger M, Horninger W, Aigner F. et al. Ultrasound of the prostate. Cancer Imaging 2010; 10 (01) 40-48
- 8 Zaunbrecher N, Arbor TC, Samra NS. Anatomy, Abdomen and Pelvis: Internal Iliac Arteries. StatPearls; 2024
- 9 Yamaki K, Saga T, Doi Y, Aida K, Yoshizuka M. A statistical study of the branching of the human internal iliac artery. Kurume Med J 1998; 45 (04) 333-340
- 10 Bilhim T, Pereira JA, Fernandes L, Rio Tinto H, Pisco JM. Angiographic anatomy of the male pelvic arteries. AJR Am J Roentgenol 2014; 203 (04) W373-W382
- 11 de Assis AM, Moreira AM, de Paula Rodrigues VC. et al. Pelvic arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovasc Intervent Radiol 2015; 38 (04) 855-861
- 12 Wang MQ, Duan F, Yuan K, Zhang GD, Yan J, Wang Y. Benign prostatic hyperplasia: cone-beam CT in conjunction with DSA for identifying prostatic arterial anatomy. Radiology 2017; 282 (01) 271-280
- 13 Bilhim T, Pisco JM, Rio Tinto H. et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 2012; 23 (11) 1403-1415
- 14 Zhang JL, Wang MQ, Shen YG. et al. Effectiveness of contrast-enhanced MR angiography for visualization of the prostatic artery prior to prostatic arterial embolization. Radiology 2019; 291 (02) 370-378
- 15 Bhatia S, Sinha VK, Abdul-Rahim O, Harward S, Narayanan G. Rare prostatic artery origins and the importance of collateral circulation in prostate artery embolization: a pictorial essay. Can Assoc Radiol J 2018; 69 (02) 220-229
- 16 Xuan HN, Huy HD, Bich NNT. et al. Anatomical characteristics and variants of prostatic artery in patients of benign hyperplasia prostate by digital subtraction angiography. Open Access Maced J Med Sci 2019; 7 (24) 4204-4208
- 17 Bilhim T, Tinto HR, Fernandes L, Martins Pisco J. Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol 2012; 15 (04) 276-285
- 18 Bhatia S, Sinha V, Bordegaray M, Kably I, Harward S, Narayanan G. Role of coil embolization during prostatic artery embolization: incidence, indications, and safety profile☆ . J Vasc Interv Radiol 2017; 28 (05) 656-664.e3
- 19 Gonçalves OM, Carnevale FC, Moreira AM, Antunes AA, Rodrigues VC, Srougi M. Comparative study using 100-300 versus 300-500 μm microspheres for symptomatic patients due to enlarged-BPH prostates. Cardiovasc Intervent Radiol 2016; 39 (10) 1372-1378
- 20 Bilhim T, Costa NV, Torres D, Pisco J, Carmo S, Oliveira AG. Randomized clinical trial of balloon occlusion versus conventional microcatheter prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2019; 30 (11) 1798-1806
- 21 Moschouris H, Dimakis A, Anagnostopoulou A, Stamatiou K, Malagari K. Sonographic evaluation of prostatic artery embolization: far beyond size measurements. World J Radiol 2020; 12 (08) 172-183
- 22 Gerberding S, Golzarian J. Prostate artery embolization for lower urinary tract symptoms attributed to benign prostatic hyperplasia-radiology in training. Radiology 2022; 304 (01) 31-37
- 23 Lin YT, Amouyal G, Thiounn N. et al. Intra-vesical prostatic protrusion (IPP) can be reduced by prostatic artery embolization. Cardiovasc Intervent Radiol 2016; 39 (05) 690-695
- 24 Maclean D, Maher B, Harris M. et al. Planning prostate artery embolisation: Is it essential to perform a pre-procedural CTA?. Cardiovasc Intervent Radiol 2018; 41 (04) 628-632
- 25 Isaacson AJ, Burke LM. Utility of pelvic computed tomography angiography prior to prostatic artery embolization. Semin Intervent Radiol 2016; 33 (03) 224-230
- 26 Kim AY, Field DH, DeMulder D, Spies J, Krishnan P. Utility of MR angiography in the identification of prostatic artery origin prior to prostatic artery embolization. J Vasc Interv Radiol 2018; 29 (03) 307-310.e1
- 27 Boschheidgen M, Ullrich T, Al-Monajjed R. et al. Value of magnetic resonance angiography before prostatic artery embolization for intervention planning. Sci Rep 2024; 14 (01) 7758
- 28 Mathevosian S, Cusumano LR, Moradzadeh N, Ranade A, Plotnik AN, McWilliams JP. Crossing obturator sign: angiographic feature to aid prostatic artery identification. J Vasc Interv Radiol 2020; 31 (11) 1904-1908.e1
- 29 Carnevale FC, McClure T, Cadour F. et al. Advanced image guidance for prostatic artery embolization - a multicenter technical note. CVIR Endovasc 2021; 4 (01) 63
- 30 Desai H, Yu H, Ohana E, Gunnell ET, Kim J, Isaacson A. Comparative analysis of cone-beam CT angiogram and conventional CT angiogram for prostatic artery identification prior to embolization. J Vasc Interv Radiol 2018; 29 (02) 229-232
- 31 Schott P, Katoh M, Fischer N, Freyhardt P. Radiation dose in prostatic artery embolization using cone-beam CT and 3D roadmap software. J Vasc Interv Radiol 2019; 30 (09) 1452-1458
- 32 Bürckenmeyer F, Diamantis I, Kriechenbauer T. et al. Prostatic artery embolization: influence of cone-beam computed tomography on radiation exposure, procedure time, and contrast media use. Cardiovasc Intervent Radiol 2021; 44 (07) 1089-1094
- 33 Rostambeigi N, Crawford D, Golzarian J. Benefits and advances of cone beam CT use in prostatic artery embolization: review of the literature and pictorial essay. CVIR Endovasc 2024; 7 (01) 46
- 34 Șerbănoiu A, Nechifor R, Marinescu AN. et al. Prostatic artery origin variability: five steps to improve identification during percutaneous embolization. Medicina (Kaunas) 2023; 59 (12) 2122