CLINICAL STUDY Ef ficacy of Prostatic Artery Embolization for Catheter-Dependent Patients with Large Prostate Sizes and High Comorbidity Scores Shivank Bhatia, MD, Vishal K. Sinha, BS, Bruce R. Kava, MD, Christopher Gomez, MD, Sardis Harward, MPH, Sanoj Punnen, MD, Issam Kably, MD, Jeffrey Miller, MD, and Dipen J. Parekh, MD ABSTRACT Purpose: To evaluate efficacy and safety of prostate artery embolization (PAE) in urinary catheter–dependent patients with large prostate volumes and high comorbidity scores. Materials and Methods: A retrospective single-center review was conducted of 30 patients with urinary retention at time of PAE from November 2014 through February 2017. Mean (range) age was 73.1 years (48–94 y), age-adjusted Charlson comorbidity index was 4.5 (0–10), duration of urinary retention was 63.4 days (2–224 d), International Prostate Symptom Score quality-of-life (IPSS-QOL) was 5.3 (3–6), and prostate volume was 167.3 cm 3 (55–557 cm 3 ). These parameters were collected at 3, 6, and 12 months after PAE. Trials of voiding were performed approximately 2 weeks after PAE and, if failed, every 2 weeks thereafter. Adverse events were graded using the Clavien-Dindo classification. Results: At a mean (range) of 18.2 days (1–72 d), 26 (86.7%) patients were no longer reliant on catheters. Follow-up was obtained in all patients eligible at 3 and 6 months and 17 of 20 (85.0%) patients eligible at 1 year. Mean (range) IPSS-QOL improved significantly to 1.2 (0–5), 0.7 (0–4), and 0.6 (0–4) at 3, 6, and 12 months (all P < .001). Mean (range) prostate volume decreased significantly to 115.9 cm 3 (27–248 cm 3 ) at 3 months (P < .001). Two patients experienced grade II urosepsis complications, which were successfully treated with intravenous antibiotics. All other complications were self-limited grade I complications. Conclusions: PAE represents a safe and effective option for management of patients with urinary retention, especially patients with large prostates who are not ideal surgical candidates. ABBREVIATIONS BPH ¼ benign prostatic hyperplasia, BPO ¼ benign prostatic obstruction, CCI ¼ Charlson comorbidity index, CIC ¼ clean inter- mittent catheterization, IIEF ¼ International Index of Erectile Function, IPSS ¼ International Prostate Symptom Score, LUTS ¼ lower urinary tract symptoms, PAE ¼ prostate artery embolization, PO ¼ per os, PVR ¼ postvoid residual, QOL ¼ quality of life, TURP ¼ transurethral resection of the prostate Traditionally, the standard of care for patients with urinary retention has been urethral catheterization followed by a trial of voiding without catheterization (1). Most of these patients may be managed conservatively and ultimately void with or without the assistance of pharmacotherapy (2,3). However, select patients may progress to chronic retention with catheter dependence necessitating surgical intervention (4). In patients who have large prostate volumes and patients who have serious medical comor- bidities, there is a reduced likelihood of successfully passing a trial of voiding without catheterization (1) and an increased risk of perioperative complications (5,6). Hence, these patients are not considered to be ideal surgical can- didates (7,8). Prostate artery embolization (PAE) has proven effective in the treatment of benign prostatic From the Departments of Vascular and Interventional Radiology (S.B., I.K.) and Urology (B.R.K., C.G., S.P., D.J.P.), Jackson Memorial Hospital, University of Miami Miller School of Medicine (V.K.S.), 1150 NW 14th Street, Suite 511, Miami, FL 33136; Miami VA Healthcare System (S.B., B.R.K.), Miami, Florida; The Dartmouth Institute for Health Policy and Clinical Practice (S.H.), Lebanon, New Hampshire; and Department of Urology (J.M.), Boca Raton Regional Hospital, Boca Raton, Florida. Received June 27, 2017; final revision received and accepted August 29, 2017. Address correspondence to S.B.; E-mail: drshivankbhatia@gmail.com S.B. and S.H. are paid consultants for Merit Medical Systems, Inc (South Jordan, Utah). None of the other authors have identified a conflict of interest. Figure E1 is available online at www.jvir.org. © SIR, 2017 J Vasc Interv Radiol 2017; ▪:1–7 https://doi.org/10.1016/j.jvir.2017.08.022