Impact of Prostatic Artery Embolization in Patients with Enlarged True Middle Lobes

Background : Prostatic artery embolization (PAE) is an emerging minimal-invasive therapy of benign prostatic hyperplasia (BPH), able to reduce the prostatic volume (PVol) and the IPP. The presence of a true middle lobe (TML) is associated with bladder outlet obstruction (BOO), causing lower urinary tract symptoms (LUTS). In this study we investigate the effect of PAE in TML improvement in patients with LUTS. Methods : A retrospective analysis was done of 47 men treated with PAE from April 2015 to September 2021. The volume of the TML, IPP, and PUA were measured on MRI prior and 2 months after PAE. Successful devascularization of the TML was evaluated by contrast-enhanced MRI (ceMRI) 48 hours after therapy. Results : The TML was successfully embolised technically in 72%. After two months, the total volume of the prostate (PVol) was reduced by 25.8 ± 13.3% (from 72.1 ± 39.8 cc to 52.5 ± 27.9 cc; p < 0.000). Following a technically successful PAE of the TML, the TMLVol decreased by 32.1 ± 21.5% (from 10.6 ± 16.1 cc to 7.2 ± 13.1 cc; p < 0.000), and the IPP was reduced by 29.3 ± 15.5% (from 16.3 ± 7.4 mm to 11.9 ± 6.6 mm; p < 0.000). In contrast, after a technically incomplete devascularisation of the TML the TMLVol decreased by only 7.2 ± 17.7% (from 8.4 ± 9.3 cc to 7.5 ± 8.9 cc; p = 0.089), and the IPP was reduced by only 10.9 ± 8.8% (from 16.4 ± 7.3 mm to 14.6 ± 6.7 mm; p = 0.003). The currecture of the PUA after a successful and after an incomplete embolization of the TML was comparable with 11.6 ± 7.6 and 12.2 ± 9.4, respectively (in both p < 0.001). Conclusions : Our study firstly shows that PAE is able to reduce TML volume. Furthermore, PAE is able to reduce the IPP even if caused by a TML.