To evaluate the clinical efficacy and safety of prostatic artery embolization (PAE) using glue (n-butyl cyanoacrylate, NBCA) in patients with benign prostatic hyperplasia (BPH) presenting with lower urinary tract symptoms (LUTS) due to obstruction or chronic urinary retention managed with an indwelling catheter (IUC). A total of 101 patients (median age 79years) were included, of whom 67 had LUTS and 34 had an IUC. All were treated with PAE with glue between 2021 and 2024. Clinical success was defined as either a ≥ 25% reduction in the International Prostate Symptom Score (IPSS) and a ≥ 3-point improvement in the quality of life (QoL) score or stable catheter removal. Technical success was achieved in 100% of cases, with bilateral embolization in 93% of patients. Among symptomatic patients, clinical success was observed in 92.5%, with a reduction in IPSS from 25.3 ± 8.1 to 15.3 ± 7.8 and in QoL from 4.5 ± 1.1 to 2.3 ± 1.4 at 36months (p < 0.001). Mean prostate volume decreased by 37.6%. In patients with an IUC, 73.5% resumed spontaneous voiding within an average of 29days. All complications (13.9%) were minor and managed conservatively. Embolization with acrylic glue is a safe and effective minimally invasive alternative to surgery for BPH, with sustained long-term results. It is particularly suitable for elderly patients with comorbidities or those unfit for surgery presenting with LUTS or chronic urinary retention.

Updates on Prostate Arterial Embolization.

Standardized Technique for Prostatic Artery Embolization: A Delphi Consensus Study on Optimized Methods and Emerging Concepts.

Prostatic artery embolization (PAE) has emerged as a minimally invasive option for the palliative control of hematuria in locally advanced or metastatic prostate cancer. This systematic review focuses on the efficacy and safety of PAE for this indication, while also synthesizing available data on secondary outcomes such as urinary retention and pain. A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science identified eight primary studies (four retrospective case series, one prospective cohort, and three case reports). Methodological quality was assessed using Joanna Briggs Institute (JBI) checklists and the Newcastle-Ottawa Scale (NOS). PAE demonstrated high technical success (89-100%) and immediate hemostatic control (67-100%), with durable symptom relief in most patients. Functional improvements in urinary retention (50-80% catheter-free rates) and pain (≈ 70% improvement) were observed, though outcomes varied. Major complications were rare (< 3%), supporting PAE's safety over traditional options like TURP (higher bleeding risk) or EBRT (delayed response). PAE offers rapid, low-risk palliation for advanced prostate cancer symptoms. While it is a valuable alternative for high-risk patients, comparative trials are needed to define its role in obstruction and pain management.

Pre- and Periprocedural Imaging Predicts Technical but not Clinical Success of Prostatic Artery Embolization Using Non-spherical PVA Particles-Insights From the Prospective PROEMBO Trial.

Abstract Aims: To assess the safety and efficacy of prostatic artery embolization (PAE) using n-butyl cyanoacrylate (n-BCA) for symptomatic benign prostatic hyperplasia (BPH). Settings and Design: It is retrospective analysis of 17 consecutive patients with symptomatic BPH who underwent PAE using n-BCA at the Department of Peripheral Vascular and Endovascular Sciences, Medanta – The Medicity, Gurugram, Haryana, between January 2020 and December 2023. Subjects and Methods: The primary outcome assessed was improvement in the International Prostate Symptoms Score (IPSS) from baseline to 12 months. The secondary outcomes assessed were improvements in IPSS-associated quality-of-life score (IPSS-QoL), maximum flow rate on uroflowmetry (Qmax), prostate gland volume (PGV), residual void volume (RVV), and serum prostate-specific antigen (PSA). Adverse events that occurred at any time during the 12-month follow-up were reported according to the Clavien−Dindo grading system. Results: A total of 17 patients underwent PAE with n-BCA with 100% technical success. There were statistically significant improvements from baseline to 12 months for the IPSS (from 18.41 to 6.35, P &lt; 0.001), IPSS-QoL (from 4.94 to 1.76, P &lt; 0.001), Qmax (from 6.05 to 14.97, P &lt; 0.001), RVV (from 179.7 to 44.7, P &lt; 0.001), PSA level (from 4.06 to 2.06, P &lt; 0.001), and PGV (from 72.2 to 30.5, P &lt; 0.001). There were no major adverse events. Conclusions: The findings support the safety of PAE using n-BCA, with excellent technical and mid-term clinical outcomes. Randomized trials with longer follow-ups are needed to solidify n-BCA’s role in the evolving landscape of PAE.

Benign prostatic hyperplasia is one of the main causes of urinary symptoms in older men and has a considerable impact on quality of life. Although transurethral resection of the prostate remains the standard treatment, minimally invasive options with lower morbidity and shorter recovery times have emerged in recent years. This article provides an update on emerging therapies such as prostate artery embolization, ClearRing prostate implant, and holmium laser enucleation. The available evidence on their clinical efficacy, safety profile, and applicability in different contexts, including patients withhigh surgical risk or large prostates, is analyzed. These alternatives allow for progress toward more individualized treatment, with a focus on functional preservation and patient well-being.

Identifying the best candidates to prostatic artery embolization: indications and best practice across guidelines.

Penile glans necrosis is a rare, debilitating condition with significant cosmetic and functional consequences. Despite its clinical importance, no standardized treatment protocol exists owing to a lack of robust evidence and variability in management practices. This systematic review aims to evaluate therapeutic interventions for penile glans ischemia and necrosis, identify gaps in current knowledge, and propose a framework for future clinical practice. In accordance with the PRISMA2020 statement, a systematic search of PubMed was performed from March2024 to May2025 using predefined search terms related to penile glans ischemia and necrosis. The inclusion criteria focused on cases of ischemia caused by reduced blood flow, excluding those linked to infections, calciphylaxis, priapism, or immediate surgical interventions. Outcomes were classified by lesion extent and type (gradesI-III, A-B), and statistical analyses explored associations between treatment modalities and outcomes. Risk of bias was assessed with the JBI and Risk Of Bias In Non-randomized Studies-of Interventions tools. Data from 48 studies encompassing 79 patients were analyzed. Circumcision (n = 55) and prostatic artery embolization (n = 13) were the most common etiologies. Treatments varied widely, including hyperbaric oxygen therapy (44.94%), antibiotics (43.82%), surgical interventions (43.82%), and pentoxifylline (40.45%). While gradeA ischemia was significantly associated with better outcomes (P < .001, odds ratio = 182.77), no single treatment modality demonstrated statistically superior efficacy when compared pairwise. Antibiotic therapy and surgical interventions were associated with worse outcomes, likely reflecting their use in more severe cases. Publication bias and heterogeneity in case descriptions posed challenges to definitive conclusions. Early recognition of ischemia significantly improves outcomes, highlighting the importance of prompt diagnosis and intervention, and the combination of pentoxifylline, hyperbaric oxygen therapy, anticoagulation, and topical agents may offer synergistic benefits. The findings of this review underscore the critical need for evidence-based protocols, standardized classification systems, consistent therapeutic strategies, and robust clinical trials; future research should focus on prospective studies with standardized methodologies to optimize care and improve functional and aesthetic outcomes for affected patients.

The aim of this review was to evaluate the outcomes of the various surgical techniques available today, focusing on their applicability to frail and/or elderly patients. Transurethral resection of prostate (TURP) allowed a reduction of hemorrhagic complications compared to open simple prostatectomy. However, laser surgery show the best safety profile among the standards techniques. Importantly, most of studies demonstrate no difference in efficacy of LUTS management in frail or elderly population compared to younger patients. Recently, mini invasive surgical therapies (MIST) emerged, allowing a reduction in complication and a potential feasibility under general anesthesia. Prostatic artery embolization (PAE) showed longer procedures but equivalent efficacy compared to younger population. Data remains scarce regarding prostatic uretral lift (PUL) and water vapor thermal therapy (WVT), but studies suggest promising results, particularly for trial without catheter at 12 months for elderly population. In frail and elderly patients, laser surgery significantly reduces the hemorrhagic complications compared to traditional techniques. In addition, laser surgery shows equivalent efficacy in elderly and young population, reinforcing the indication of laser in elderly when feasible. The option of MISTs is rising, but validation is needed with further studies.

Fragile patients with indwelling bladder catheter (IBC) represent a category at high risk of morbidity and overall quality of life decline. The goal for these patients is to remove the bladder catheter and avoid surgical stress, complications and long hospitalisation. Prostatic artery embolisation (PAE) has been developed as a minimally invasive procedure for the treatment of benign prostatic obstruction (BPO)-related lower urinary tract symptoms. We evaluated the results of PAE in patients unfit for surgery with IBC. We retrospectively reviewed data on fragile patients unfit for surgery due to comorbidities with IBC secondary to BPO who underwent PAE in three centres. Our objective was to remove urinary catheter and maintain patients free from bladder catheter. We divided patients into two groups: Those with successful (Group A) or unsuccessful (Group B) procedure after 1 year. A total of 74 patients with IBC receiving PAE were included. No PAE failure occurred due to tortuous or atherosclerotic vessels. After 1 year, 49 patients (66.20%) were without bladder catheter. We found no differences in age (75.30 vs 78.70), Charlson comorbidity index (6.00 vs 6.60), prostate volume (94.70 vs 94.70), hospital stay (1.90 vs 3.90 days), catheterisation time after the procedure (17.20 vs 20.80 days) or complication rate (11.20% vs 8.30%) between Groups A and B. One patient developed postembolisation partial penile necrosis, two had penile skin ischemia (conservatively managed), and four developed urinary tract infection following the procedure. The history of IBC was longer in Group B than in Group A (9.70 vs 6.20 months, p = 0.018). Multivariate logistic regression confirmed a significant reduction in the probability of unsuccessful procedure based on an increased postoperative catheterisation time (odds ratio = 0.91; 95% confidence interval: 0.83-0.99). PAE is a minimally invasive surgical treatment for BPO. This procedure should be considered in elderly and fragile patients, based on its favourable safety profile. In our series, PAE was a safe procedure for patients with IBC affected by BPO. In our experience, the success of this treatment is correlated with postoperative catheterisation. Patient's selection and counselling are key for optimising the results.

Benign prostatic hyperplasia (BPH) is common in men over 50 years of age and often causes urinary tract obstruction, which can lead to urinary retention and reliance on a permanent catheter. In cases where medical treatment fails or it is contraindicated, surgical treatment is recommended. This study explored an alternative: prostatic artery embolization (PAE), evaluating its effectiveness in weaning patients off a catheter. In this retrospective study, data was collected on patients who underwent PAE at our institution, by the same physician, from August 2018 to November 2023, to treat persistent urinary retention or had contraindications to catheter weaning. A statistical analysis was conducted. A total of 115 patients underwent PAE, 29 patients for weaning off a catheter. Their average age was 73.4 years (SD - 10.19). The average prostate volume was 167.44 grams (SD - 85.4). The majority, 62%, had significant comorbidities (ASA of 3-4). After PAE, 28 patients (97%) weaned off the catheter. The side effects were mostly mild (17%) with a Clavien-Dindo score of 1 to 2 and resolved spontaneously. More serious side effects were observed in two patients and included partial necrosis of the glans penis and renal failure. Both side effects resolved completely during follow-up. PAE is a good solution for weaning off a urethral catheter in patients with significant comorbidities. This procedure has a high success rate in catheter weaning and mostly mild and transient side effects.

New Frontier for Prostate Artery Embolization: Neoadjuvant PAE before Radiation Therapy in Patients with Prostate Cancer.

Background/Objectives: Prostate artery embolization (PAE) has emerged as a relatively new, minimally invasive alternative for the treatment of benign prostatic hyperplasia. We aimed to compare the perioperative outcomes and trends of PAE versus transurethral resection of the prostate (TURP) and laser enucleation. Materials and Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics, and performed multiple patient-level analyses. Patients with prostate cancer, acute hematuria, and emergent referral to the hospital were excluded. Results: Between 2017 and 2022, a total of 3665 PAEs were performed in Germany compared to 218,388 TURPs and 50,863 laser enucleations. Patients selected for PAE were slightly younger and presented with fewer comorbidities at baseline. The number of laser enucleations increased exponentially in these years, PAEs remained stable, whereas TURPs slightly decreased. Compared to PAE, laser enucleation was associated with higher odds of in-hospital incontinence (4.2% versus 2.7%, OR: 1.6, 95%CI: 1.3–1.9, p < 0.001). On the contrary, PAE was associated with lower odds of in-hospital urinary retention and shorter length of hospital stay compared to TURP (3.2% versus 7.1%, OR: 2.2, 95%CI: 1.8–2.6, p < 0.001, and a 2.6-day difference, 95%CI: 2.5–2.7, p < 0.001, respectively) and laser enucleation (3.2% versus 5%, OR: 1.5, 95%CI: 1.3–1.8, p < 0.001, and a 1.5-day difference, 95%CI: 1.4–1.6, p < 0.001, respectively). Conclusions: PAE offers more favorable perioperative outcomes compared to TURP and laser enucleation, but the use of this relatively new procedure has remained nearly stable in recent years.

To assess 12-month outcomes of prostate artery embolization (PAE) using N-butyl cyanoacrylate (NBCA) glue in patients with incapacitating lower-urinary-tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Retrospective single-center observational study of patients evaluated 12 months after PAE done in 2018-2023 using methacryloxysulfolane-NBCA mixed with ethiodized oil. Glue injection was under free- or blocked-flow conditions, depending on artery size and real-time assessment of penetration. Both distal embolization and proximal prostatic-artery occlusion were achieved without filling of collaterals. The 12-month outcomes were the International Prostate Symptom Score (IPSS) and associated Quality-of-Life score (IPSS-QoL), prostate volume, International Index of Erectile Function form 5 (IIEF5), and prostate-specific antigen (PSA) level. A total of 186 patients with a mean age of 67.5 ± 6.0 years were included. All procedures were technically successful. Minor adverse events occurred in 35/186 (18.8%) patients. There were no major complications. At 12 months, significant improvements vs baseline were noted for the IPSS (10 ± 6.6 vs 20.1 ± 6.4, p = 0.0001), IPSS-QoL (2.2 ± 1.6 vs 5.1 ± 0.9, p = 0.0001), and prostate volume (81.1 ± 47.0 mL vs 118.1 ± 67.4 mL, p = 0.0001). The IIEF5 and PSA levels were not significantly different at 12 months vs baseline (16.2 ± 7.2 vs 15.8 ± 6.9, p = 0.814; and 4.9 ± 3.3 vs 4.8 ± 4.2, p = 0.286; respectively). Our data support the feasibility, safety, and sustained effectiveness at 12 months of PAE with NBCA to treat BPH-related LUTS. Question NBCA glue may have advantages over other agents for prostatic artery embolization in BPH, but data on long-term outcomes are scarce. Findings Prostatic artery embolization using glue led to significant decreases in the International Prostate Symptoms Score, quality of life score, and prostate volume at 12-month follow-up. Clinical relevance NBCA glue for prostatic artery embolization in patients with symptomatic BPH is safe and provides sustained symptom relief for at least one year.

Clinical case description: the case of an 84-year-old male is presented, who developed penile glans necrosis over several days following prostatic arterial embolization. Due to the progression of the condition, a partial penectomy had to be performed for resolution. Relevance: prostatic arterial embolization represents an effective approach for benign prostatic hyperplasia, although it is not without risks. As embolization of non-target areas is a very unusual but serious complication, there is a need of knowing and describing this kind of results. Clinical implications: despite the unusual nature of penile glans necrosis, early recognition and diagnosis is crucial to prevent the worse outcomes. There are several clinical treatments before a surgical option that includes hyperbaric oxygen therapy or phosphodiesterase 5 inhibitors wich have a short opportunity window. Conclusion: gland necrosis is a rare but serious condition that requires intensive and constant management to try to achieve its reversal. Ultimately, its treatment consists of partial or total penectomy.

Long-term Outcomes of Prostatic Artery Embolisation: A Nationwide Prospective Cohort Study.

Neoadjuvant prostate artery embolization prior to prostate radiation therapy: A single institution experience on the durability of clinical urinary improvement after radiation

Minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) provide effective alternatives to traditional surgery. At the same time, long-term reintervention rates and industry sponsorship influence remain critical in clinical decision-making. We systematically assessed surgical reintervention rates, medical therapy initiation following MISTs, and the impact of industry sponsorship on study outcomes. We systematically reviewed prospective and retrospective studies in MEDLINE, EMBASE, and Cochrane Library (up to December 2024) according to PRISMA guidelines (CRD42024617974). Risk analysis evaluated conflicts of interest (COI) and sponsor influence. Of 99 studies, surgical reintervention rates were 13.6% for Prostatic Urethral Lift(PUL) (5 years), 11.1% for Water Vapor Thermal Therapy(WVTT)(5 years), 4.4%-6% for Aquablation (5 years), 21% for Prostatic Artery Embolization(PAE) (2 years), 2.5% for Optilume BPH Catheter System(OBCS) (2 years), 11.1% for Temporarily Implantable Nitinol Device (iTIND) (4 years), 13.8%-26.4% for Transurethral Needle Ablation(TUNA) (5-10 years), and 67% for Transurethral Microwave Therapy (TUMT) (5 years). Medical therapy initiation rates reached 10.7% for PUL (5 years), 11.1% for WVTT (5 years), 4.4% for Aquablation (5 years), 2.5% for OBCS (4 years), and 24.5% for TUMT (5 years). Industry sponsorship was high-risk in 65% of studies, and sponsor influence was 52%, raising objectivity concerns. Variability in follow-up durations and therapy initiation rates limits comparability. PAE, TUMT, and TUNA show higher reintervention rates, while OBCS (4 years) and both Aquablation and WVTT (5 years) demonstrate lower rates. Industry-sponsored studies often apply restrictive inclusion, yielding favorable results that may not fully translate to broader, real-world populations. Caution is needed when integrating these findings into clinical guidelines, particularly given potential COI.

To describe and test a scoring system for grading embolic penetration in prostate artery embolization (PAE). Multicenter retrospective study of 62 patients undergoing glue-PAE (n-butyl cyanoacrylate methacryloxysulfolane and ethiodized oil). Baseline angiograms and post-embolization radiographs were assessed by four consultant interventional radiologists on two occasions 6 weeks apart, grading depth and density of embolic, according to the described Glue Penetration Index Score (GPIS) and extended GPIS (eGPIS). GPIS (0-3) and eGPIS (0-3.5) scores of each hemigland were summed and whole-gland scores reported. Inter- and intra-observer variability were quantified. Clinical outcomes were assessed at 3 months. Mean reduction in IPSS was 12.9 ± 8.2. Mean whole-gland GPIS was 4.1 ± 1.0 (16.1% ≤ 3; 83.9% > 3). Inter-observer agreement was moderate for GPIS (Fleiss' κ = 0.50, p < 0.0001) and fair for eGPIS (κ = 0.37, p < 0.0001). GPIS scores showed no significant intra-observer variability on repeat scoring (Cochran's Q, p = 0.39), whereas eGPIS did (p = 0.02). Only baseline IPSS correlated with 3-month clinical outcomes. GPIS is a repeatable and reproducible score which may assist standardization of the description of extent of glue penetration during PAE in future studies.