MRI assessment of prostatic ischaemia: best predictor of clinical success after prostatic artery embolisation for benign prostatic hyperplasia

AIM: To identify predictive factors of clinical success after prostatic artery embolisation (PAE) for patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Twenty-four patients with long-term indwelling urinary catheters (duration: 8 3 months) underwent PAE. Factors such as patient age, duration of urinary retention, prostate volume decrease, volume of ischaemic prostate tissue (assessed using magnetic resonance imaging [MRI]), and embolisation technique were studied as potential predictors of clinical success of PAE, defined as the ability to remove the urinary catheter (`allowing spontaneous voiding) within 60 days of PAE. RESULTS: Bilateral embolisation was performed in 21 patients, and unilateral embolisation was performed in three, due to technical challenges. Length of follow-up was 17 months (range: 3-29). No major complications were encountered. Clinical success was achieved in 15 patients (63%) with prostate volume decreasing 24% versus 16% (p=0.03) in the unsuccessful cases. Thirteen of the 15 successful cases (87%) showed ischaemic areas in the prostate on MRI obtained 30 days after embolisation, but only one unsuccessful case (11%) showed a very small area of ischaemia. CONCLUSION: Prostatic ischaemia observed on early post-embolisation MRI appears to be the best predictor of clinical success after PAE in patients with AUR secondary to BPH. (C) 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.