312 - Does Incomplete Embolization Affect Clinical Success and Duration of Response Compared to Complete Bilateral Embolization After Prostate Artery Embolization? Retrospective Review of a Single-operator Experience

Purpose: Prostate artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH) theoretically provides maximum clinical benefit if complete bilateral embolization is achieved, but complex anatomy or severe atherosclerosis may preclude safe embolization of all branches. Case reports suggest patients may still respond despite unilateral embolization. This study evaluates whether incomplete embolization affects clinical success rate or durability of response after PAE for BPH.

Materials and Methods: After IRB approval, 75 patients who underwent 79 PAEs for BPH with obstructive symptoms by a single operator at an academic center (02/2023-08/2025) were retrospectively reviewed. Pre-procedural CTA pelvis, intraprocedural nitroglycerin, and PErFecTED technique were employed when possible; cone-beam CT was used in all cases. Embolization was performed with 100-300um and 300-500um Embospheres. Embolization was categorized as complete or incomplete (unilateral or subtotal bilateral). Technical success was defined as achieving at least unilateral embolization. Clinical success was defined as improvement in International Prostate Symptom Score (IPSS) or, in patients with retention, passing a trial of void with catheter removal or cessation of straight catheterizations. Logistic and linear regressions assessed associations between embolization completeness and outcomes.

Results: Of 79 PAEs, 69 achieved complete embolization and 10 were incomplete (4 unilateral and 6 subtotal bilateral). Reasons for incomplete embolization included atherosclerotic plaque in 6 cases and small vessel size in 4. Technical success was 100%. Overall clinical success was 91.1% (72/79): 62/69 (90%) with complete vs 10/10 (100%) with incomplete embolization (p=0.646). Mean IPSS decreased from 18 ± 7 to 8 ± 5 after PAE (p< 0.001). IPSS improvement was 10 ± 8 for complete vs 12 ± 9 for incomplete embolization (p=0.727). Among 33 PAEs performed for patients in retention who underwent subsequent TOV, 29 (88%) passed at mean 1.7 ± 2.0 mos. At mean follow-up of 7.4 ± 6.6 mos, mean duration of response was 4.9 ± 9.9 mos for complete vs 9.9 ± 9.9 mos for incomplete embolization (p=0.167).

Conclusion: Despite factors preventing complete bilateral embolization in some cases, clinical success rates and response durations were comparable between complete and incomplete embolization. When pre-procedural imaging suggests complete embolization may be limited by anatomy or atherosclerosis, patients can be counseled to expect similar outcomes. Larger multicenter studies with longer follow-up are warranted.