A 57-year-old male presented with lower urinary tract symptoms refractory to medical therapy. He was referred for transradial prostate artery embolization as an alternative to transurethral resection of the prostate due to risks of complications. Bilateral prostatic arteries were selectively catheterized and embolized using Embozene particles via a microcatheter system. Cone beam CT confirmed treatment. The patient experienced decreased symptoms with no complications. Prostate artery embolization is a promising minimally invasive option for patients seeking to avoid surgery or retrograde ejaculation.

1. Transradial prostate artery
embolization for benign prostate
hyperplasia (BPH)
Amir Noor, MD
Acknowledgements: Aaron Fischman, MD
Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai,
New York, New York. E-mail: amir.noor@mountsinai.org.
Financial disclosures: None.

2. History
• Patient A.C. is a 57 y.o. male with a history of HLD and
BPH presenting with lower uterine tract syndromes
(LUTS) including: urinary frequency/urgency, weak
stream, and hesitancy.
• The patient is now refractory to medical therapy with
avodart (Dutasteride), a 5-Alpha reductase inhibitor.
• Urology was consulted for transurethral resection of
the prostate (TURP) although the patient refused the
procedure given the risks for refractory ejaculation.
• Interventional radiology was consulted for alternative
treatment with transradial prostate artery
embolization.

3. History
• Past Medical History: HLD and BPH
• Past Surgical History: Hernia repair
• Family History: N/a
• Social History: Nonsmoker, no alcohol/drug
use
• Allergies: codeine
• Medications: Avodart
• Physical exam
– General: No acute distress
– Respiratory: clear to auscultation bilaterally
– Cardiovascular: regular rate and rhythm
– Gastrointestinal: normal bowel sounds
without distention
– Musculoskeletal: no lower extremity edema
– Neurological: normal reflexes, sensation and
movement intact bilaterally
LABS
Complete blood count (CBC):
WBC 8.5
HGB 8.3
HCT 25.5
PLT 327
Chemistry (BMP):
Na 139
K 4.4
Cl 107
CO2 23.6
BUN 10
Cr 0.59
Coagulation:
PTT 32.5
INR 1.0
PT 13.8

4. Challenge
• Reaching the bilateral prostatic arteries from
the upper extremity and selecting out each
artery to prevent reflux and potential adverse
effects.
• Confirming embolization of the prostate given
variable pelvic vascular anatomy.

5. Procedure
• The left wrist was
evaluated with ultrasound
and the patient had a
modified Allen test
(Barbeau test) with a
Barbeau C wave form.
• Using a 4 French 125cm
Aqua Tempo VERT we
catheterized the distal
aorta and used a .035 wire
to advance our catheter to
the left hypogastric artery
for road mapping and
digital angiography.

6. Procedure
• A microcatheter and
microwire system were
advanced and used to
select the left internal
pudendal artery.
• Following angiography
the prostatic branch
was demonstrated
arising off of the distal
left internal pudendal
artery.

7. Procedure
• The microcatheter was
advanced into the this
prostatic branch and
angiogram was preformed
demonstrating a
parenchmal blush
involving the prostate.
• Embolization was
preformed through the
microcatheter using
approximately 2cc of
dilute 400 micron
Embozene particles

8. Procedure
• The microcatheter was
withdrawn and
subsequently used to
select the left inferior
vesicular artery where
another prostate branch
supplying the prostate and
left seminal vesicle.
• This branch was
catheterized and
embolization was
performed again using the
same concentration of
particles.

9. Procedure
• The catheter was pulled
back and angiogram of the
anterior division of the
hypogastric artery was
preformed demonstrating
the prostatic artery arising
from the right internal
pudendal artery.
• The right prostate was
catheterized and
embolized with same
concentration of particles.

10. Procedure
• Cone beam CT
was utilized to
confirm
catheterization of
the prostatic
arteries with
contrast injected
to the left
prostatic lobe.

11. Conclusion
• Successful bilateral embolization of the
prostate arteries with no wrist hematoma
following transradial access.
• The patient continued experienced interval
decrease in the previously described lower
uterine tract syndromes with no retrograde
ejaculation.

12. Closing comments
• Prostate artery embolization is a promising minimally
invasive procedure for patients who prefer to avoid
surgery or the consequence of retrograde ejaculation.
• Radial access for the procedures provide minor
challenges based on distance to the prostatic arteries.
However, the postoperative benefits of performing this
procedure transradially versus using femoral access
provides an added preference for patients who prefer
prostate artery embolization as a minimally invasive
alternative to TURP or open prostatectomy.