Prostatic Artery Embolization and the Median Lobe: Stuck in the Middle with You?

Abstract

We read with great interest the study by Yu et al. ( 1 Yu S.C.H. Cho C.C.M. Hung E.H.Y. et al. Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol. 2019; 30: 1807-1816 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar ) that provides in-depth knowledge on the implications of the median lobe for patients with benign prostatic hyperplasia (BPH) treated with prostatic artery embolization (PAE). Frequently, physicians and patients ask if the median lobe is a contraindication for PAE in patients with BPH and if results are worse in these patients. The present study sheds some lights on this specific topic, proving that not all median lobes are the same, but many questions arise. What is the median lobe? What type of imaging classification can we use to assess it? What is the impact of the median lobe on the natural progression of disease in patients with BPH? Does the median lobe also limit the efficacy of other minimally invasive surgical techniques such as prostatic urethral lift (PUL) or water vapor thermal therapy? What do we know already about the effect of PAE for the median lobe? Can we target the median lobe during PAE? Is PAE effective when treating patients with BPH and a median lobe? Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic HyperplasiaJournal of Vascular and Interventional RadiologyVol. 30Issue 11PreviewTo evaluate the presence of intravesical prostatic protrusion (IPP) and its thickness-to-height (T/H) ratio as a predictor for the clinical outcome and morbidity of prostatic artery embolization (PAE) for benign prostatic hyperplasia. Full-Text PDF