Internal Iliac Artery Embolization for Benign Prostatic Hyperplasia? First Read the Fine Print

Abstract

The study by Deipolyi et al titled “Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms” (1) is a retrospective review of 99 men with pelvic computed tomographic (CT) angiograms in whom the prostate size and presence of lower urinary tract symptoms (LUTS) was compared between those with and without embolization of the internal iliac artery during endovascular repair of aortic aneurysms. The authors concluded that the presence of unilateral or bilateral internal iliac artery occlusion (IIAO) was associated with decreased prostatic volume and significantly fewer LUTS. The manuscript underwent a rigorous review, its statistical analysis was held to a high standard, and it involved a large cohort of patients. However, a number of questions immediately arise from reading the study. Is this association nevertheless real? Is it relevant to the study of prostate artery embolization (PAE)? What does the signal contained in the positive results of the study mean in the context of actual PAE? Although the authors demonstrated a statistically significant difference in prostate size of 29%–32% (smaller) in patients with unilateral or bilateral IIAO, and significantly fewer LUTS in these patients, it is important to point out that they were not implying that iatrogenic IIAO is a viable treatment for LUTS caused by benign prostatic hyperplasia (BPH). Although it may in fact be real, the observed association is not