[Prostate artery embolization-2026 update : Technique, evidence, and role in the treatment of benign prostatic hyperplasia].

Abstract

Clinical/methodical issue: Benign prostatic syndrome is the most common urologic condition in older men and substantially affects quality of life.

Standard radiological methods: Early stage disease is managed with pharmacotherapy. In advanced disease, transurethral resection is the surgical standard.

Methodical innovations: For more than 10 years, prostatic artery embolization has provided a minimally invasive alternative performed under local anesthesia.

Performance: Randomized trials and meta-analyses document a marked improvement in symptom score and quality of life with lower periprocedural morbidity than transurethral resection. Five-year data confirm durable symptom improvement, albeit with a higher reintervention rate than the surgical reference standard. Compared with combined medical therapy, embolization proved superior in a randomized trial. Unlike transurethral resection, there is no upper prostate volume limit.

Achievements: With its inclusion in national and international guidelines, prostatic artery embolization has left the experimental stage.

Practical recommendations: Detailed knowledge of the pelvic vascular anatomy and a clear imaging and navigation strategy are prerequisites. Avoidance of nontarget embolization is the central safety element. Novel embolic agents and potential expansion of indications are undergoing clinical evaluation.