Anatomical variants in prostatic artery embolization in treatment of benign prostatic hyperplasia

Abstract

BackgroundBenign prostatic hyperplasia (BPH) is the most prevalent benign tumor in aged men, and its prevalence is rising with age reaching 8% in the fourth decade of life and up to 90% in the ninth decade. PAE has long been considered as a safe and effective minimally invasive therapy option for individuals with moderate to severe lower urinary tract symptoms caused by prostatic hypertrophy. Because of the varying degrees of atherosclerosis seen in the elderly, PAE is generally a difficult treatment that necessitates a particular amount of knowledge of anatomy and a specific set of abilities. It is critical to emphasize anatomical information about PA that is required for a successful PAE, as well as radiation exposure factors that can be helpful in such a protracted treatment. This thesis provides a pictorial review of PA anatomy and prevalence of related anatomical variants, besides additional anatomical and radiation dosage concerns, and knows the important effect of the anastomosis on non-target embolization as in our study we included large number of cases (83 patients) to cover all types of variations and different types of anastomosis all were covered.ResultsA total of 83 patients (166 sides) were analyzed. Double arterial supply on the same side was noted in 1 patient (1.2%). In 3 patients (3.6%), only a unilateral PA was identified. PA origin frequencies were computed. Penile, rectal, vesical anastomoses, and anastomosis with the other side were identified with 7 (8.4%), 3 (3.6%), 2 (2.4%), and 8 (9.6%) of PAs, respectively. Mean skin radiation dose was 479 mGy.ConclusionsWhen treating BPH with PAE, understanding PA anatomy is critical for achieving the best results. The anatomy of the PA is critical for preventing non-target embolization and is directly related to the correct identification of the anatomical pattern of the prostate arteries, and we should also take into account the presence of contralateral anastomoses; it is possible to achieve both prostate lobes through catheterization of the prostatic artery on only one side.