الفهرس 
Gross and radiological anatomy of theOnly 14 pages are availabe for public view
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Abstract
Summary
BPH refers to the increase in size of the prostate in
middle aged and elderly men. The normal prostate is
composed of a combination of glandular, stromal, and smooth
muscle cells. BPH is due to a proliferation of glandular
elements, fibromuscular (stromal) elements, or both, resulting
in the formation of large, fairly discrete nodules in the
periurethral region of the prostate. Symptomatic BPH
typically occurs in the sixth and seventh decades, and more
than 40% of men older than this present with clinical
manifestations of this disease. The most frequent obstructive
urinary symptoms are hesitancy, decreased urinary stream,
intermittency, sensation of incomplete emptying, nocturia,
frequency, urgency and sometime urinary retention, which
severely affect the patients’ quality of life.
The standard management of BPH is based on the overall
health of the patient and the severity of symptoms. Medications,
specifically 5-alpha-reductase inhibitors and selective alpha
blockers, can decrease the severity of voiding symptoms
secondary to BPH.
Even with the development of new therapies,
prostatectomy accomplished by transurethral or open
surgical means constitutes the traditional surgical treatment
for BPH, but considering the comorbidities , prostatectomy
in this age group is considered to be high-risk.
PAE has been used successfully, mainly to control
massive hemorrhage after prostatectomy or prostate biopsy.
Recently, studies showed that PAE could be performed safely,
with a significant reduction of prostate volume, without
compromising the sexual function and erectile function. PAE
Summary and Conclusion
64
could be used as an alternative treatment, with the aim of
reducing the prostate size and producing relief from symptoms
caused by BPH.
Most authors recommend the use of PAE in patients with
the following criteria: Total score of IPSS is > 18 and if QoL >
4 or if they are in acute urinary retention with bladder catheter
with prostate volume more than 40 cc & refractory to medical
therapy, for at least 6 months with moderate to severe lower
urinary tract symptoms. Also patients with peak urinary flow
rate (Qmax) inferior to 12 mL/s or with acute urinary retention.
(Pisco, 2012).
Malignancy, Advanced atherosclerosis, Bladder stone or
diverticulae & Marked tortuosity of the iliac arteries are
absolute contraindications to the procedure. (Pisco, 2012).
Prior to PAE, CT or MR angiography is used to evaluate
the pelvic vessels for tortuosity and atherosclerotic changes of
the iliac arteries so show the possibility of embolizing prostatic
blood vessels, the prostate volume is also measured by MRI.
Complications were categorized as complications of
angiography (related to puncture site, contrast agents, or
radiation injury), pelvic infection, ischemic complications,
sexual dysfunction, adverse drug reactions, and other.
Many studies done to evaluate whether prostatic arterial
embolization (PAE) might be a feasible procedure to treat lower
urinary tract symptoms associated with benign prostatic
Summary and Conclusion
65
hyperplasia (BPH) and the results was: despite the withdrawal
of all prostatic medications after PAE, there was a significant
improvement of the IPSS, QOL improved, The sexual function
improved in some patients and remained stable in others.
The benefits of PAE compared with other invasive
treatments are that PAE is minimally invasive, performed under
local anesthesia and can be done as an outpatient procedure.
Lower urinary tract symptoms can be controlled even in patients
at the end stage of the disease with acute urinary retention.
Prostatic artery embolization does not manipulate the urethra,
avoiding urethral stenosis, and can be performed even in large
prostates and in patients with urinary retention.
Conclusion
PAE in patients with symptomatic BPH is safe, with low
morbidity, good short and medium term results.
PAE is still a new technique that needs to be tested by
other studies and researches to evaluate its role as a long term
treatment, possible long term complications if found and to
compare its results, advantages and complications with the
corresponding results of the standard surgical treatment both
transurethral and open prostatectomy.