The cumulative probability of clinical success at 12 months following repeat PAE was higher for patients who initially responded positively to embolization and were subsequently treated for a recurrence of initial symptoms than for patients who did not show a response at all to initial PAE: 56.7% versus 28.2%. Of these 108, 39 did not show a response to their initial PAE, and 69 had an initially favourable response in the first six months following PAE, but then experienced relapsing symptoms.Ĭlinical failure after initial PAE, as seen in the 39 non-responders, was defined as improvement in International Prostate Symptom Score (IPSS) after PAE of less than 25%, an IPSS after PAE of more than 15 points, no improvement in quality of life related to LUTS or a quality of life score greater than three points, acute urinary retention after PAE, and need for any additional medical or invasive therapy for LUTS. Costa and colleagues conducted a single-centre, retrospective study investigating 108 patients with BPH and clinical failure after PAE who then underwent repeat PAE between June 2009 and October 2018. The study investigators set out to evaluate the safety and efficacy of repeat PAE for LUTS caused by BPH, to define revascularisation patterns, and to establish predictors of outcome in larger cohort of treated patients. This is the conclusion presented by Nuno Costa (Saint Louis Hospital, Lisbon, Portugal) et al in their recent publication in Journal of Vascular and Interventional Radiology ( JVIR). However, it has limited impact in patients who did not show a response to the initial embolization procedure.

Repeat prostatic artery embolization (PAE) is safe and effective for recurrence of lower urinary tract symptoms (LUTS) or acute urinary retention caused by benign prostatic hyperplasia (BPH), and may be used as a first-line treatment option.

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