BERKELEY, CA (UroToday.com) - Prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH) has been shown to be safe and effective, relieving LUTS and treating patients with acute urinary retention. PAE is a new interventional radiology procedure that is technically very challenging. Finding the prostatic arteries and learning about the vascular anatomy of the prostate is essential for PAE. Before the studies published by our group, little was known on how the prostatic arteries looked on angiography. We struggled in our first treated patients to find the best tube angulations on digital subtraction angiography (DSA), and experienced great difficulties on finding the correct arteries and identifying all internal iliac artery collaterals. We knew from the beginning that pre-procedural vascular imaging planning was essential to study the pelvic arterial anatomy, plan PAE, and exclude patients with severe atherosclerotic disease.
Initially we tried MR angiography but failed to achieve enough resolution to correctly identify the 1-2mm in diameter prostatic arteries. Then we used CT angiography and found the perfect match for DSA. In this study we provide the major anatomical variations of the prostatic arteries that can be found during PAE, focusing on the best CTA and DSA protocols, tube angulations, and technical details. We use CTA to guide DSA and hope that everyone will do the same after reading this study and when performing PAE or any other invasive vascular and non-vascular procedure on the prostate.
Written by:
Tiago Bilhim, MD, PhD, EBIR as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Anatomy, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisbon, Portugal
Department of Radiology, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisbon, Portugal
Department of Interventional Radiology, Hospital Saint Louis, Lisbon, Portugal
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