CLINICAL INVESTIGATION Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates Antonio Rampoldi 1 • Fabiane Barbosa 1 • Silvia Secco 2 • Carmelo Migliorisi 1 • Antonio Galfano 2 • Giovanni Prestini 2 • Sardis Honoria Harward 3 • Dario Di Trapani 2 • Pietro Maria Brambillasca 1 • Vercelli Ruggero 1 • Marco Solcia 1 • Francisco Cesar Carnevale 4 • Aldo Massimo Bocciardi 2 Received: 28 October 2016 / Accepted: 17 January 2017 Ó Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017 Abstract Purpose To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign pro- static hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates. Methods Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters. Results A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome. Conclusions PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without sur- gical treatment options. Keywords Prostatic artery embolization Á Acute urinary retention Á Lower urinary tract symptoms Á Benign prostatic hyperplasia Á Indwelling bladder catheterization Introduction Bladder outlet obstruction (BOO) is among the most common causes of lower urinary tract symptoms (LUTS) in aging male patients and is often associated with benign prostatic hyperplasia (BPH), a highly prevalent, age-related condition estimated to affect 6% of the male population worldwide [1, 2]. A wide variety of medical and surgical options are currently available for the management of BOO, but the populations suitable to each are limited by patient selection criteria and contraindications. While sur- gical approaches are the treatment of choice for patients refractory to medical management with 5a-reductase inhibitors, anticholinergics, and a1-adrenergic receptor antagonists, these procedures may not be appropriate for excessively comorbid patients [3, 4]. & Fabiane Barbosa fabiane001@hotmail.com 1 Department of Interventional Radiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20100 Milan, Italy 2 Department of Urology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20100 Milan, Italy 3 The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA 4 Department of Interventional Radiology, University of Sao Paulo Medical School, Av. Dr. Ene ´as de Carvalho Aguiar, 255, Sao Paulo, SP 05403-001, Brazil 123 Cardiovasc Intervent Radiol DOI 10.1007/s00270-017-1582-8