# Prostate Artery Embolisation > Prostate artery embolisation for BPH in NEET-PG Radiology: indications, pelvic anatomy, particle sizes, outcomes versus TURP and non-target embolisation risks. - Canonical URL: https://prepelephant.com/topics/neet-pg/radiology/prostate-embolisation - Exam / course: NEET-PG · Subject: Radiology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Prostate Artery Embolisation", PrepElephant, https://prepelephant.com/topics/neet-pg/radiology/prostate-embolisation ## Direct answer Prostate artery embolisation (PAE) shrinks an enlarged benign prostate by occluding both prostatic arteries with small particles — commonly in the 300-500 micron range — delivered through a microcatheter from femoral or radial access, cutting arterial inflow and producing ischaemic atrophy of the hyperplastic transition zone. It is offered to men with lower urinary tract symptoms from benign prostatic hyperplasia who have failed or cannot tolerate medical therapy (alpha blockers plus 5-alpha-reductase inhibitors) or who are unfit for, or refuse, transurethral resection, including men with chronic urinary retention carrying a catheter. Symptom scores improve in most patients, prostate volume typically falls by around 20-30 per cent, and the advantage over TURP is sexual-function preservation and day-case suitability, at the cost of slower, less complete symptom relief. ## What you must remember - **Patient selection:** moderate-to-severe LUTS with enlarged prostate and failed medical therapy, high anaesthetic risk, or refusal of surgery; particularly valuable in chronic retention and in men who wish to preserve ejaculatory function. - **Pre-procedure workup:** IPSS and quality-of-life score, urodynamics or flow rate where indicated, PSA to exclude carcinoma, MRI or ultrasound volume measurement, and CT angiography of the pelvis to map prostatic artery anatomy. - **Anatomy that decides difficulty:** prostatic arteries usually arise from the anterior division of the internal iliac artery, most commonly from the obturator or inferior vesical arteries, are tortuous in the elderly, and anastomose with penile, rectal and bladder branches — these anastomoses are the embolisation hazard. - **Technique:** bilateral embolisation is the aim (unilateral gives inferior results), with 300-500 micron particles after careful microcatheter positioning beyond non-target branches, sometimes protected by coil or gel positioning. - **Non-target embolisation:** the feared complication — ischaemia of bladder wall, rectum or penis causing pain, ulceration or erectile/glans changes; meticulous angiography and reflux control prevent it. - **Post-embolisation symptoms:** dysuria, frequency, perineal pain and low-grade fever for days, sometimes urinary retention needing a temporary catheter. - **Outcomes versus TURP:** PAE gives smaller symptom improvement on average and slower onset, but lower rates of retrograde ejaculation, incontinence and transfusion, no general anaesthesia in most cases, and same-day discharge. ## One procedure, mapped and embolised A 71-year-old man with diabetes and ischaemic heart disease has been on an alpha blocker and finasteride for two years, retains urine, and has a 110 mL prostate with an IPSS of 26. TURP is high risk under anaesthesia. CT angiography shows prostatic arteries arising from the inferior vesical branches bilaterally, with a small anastomosis to the penile artery on the left. Under local anaesthesia, a microcatheter is negotiated past tortuous iliac segments — often the hardest part in atherosclerotic vessels — and parked distal to the penile anastomosis. Angiography confirms the prostate blush; 300-500 micron particles are injected until stasis. The right side follows. He goes home the same day with dysuria and perineal discomfort for a week, passes trials without a catheter at two weeks, and at six months his IPSS has fallen from 26 to 11 with a gland of about 80 mL. The contrast case is the man whose left prostatic artery defies safe catheterisation: unilateral embolisation is a partial result, and the decision point — staged second attempt versus surgery — is the judgement the exam wants. ## Where the exam sets its traps First, indications: PAE treats benign hyperplasia, never prostate cancer, and a raised PSA must be evaluated before embolisation so a carcinoma is not silently ischaemia-treated. Second, anatomy: the question "from which artery does the prostatic artery usually arise" expects the internal iliac anterior division via obturator or inferior vesical branches, and tortuosity plus anastomoses are why the procedure demands microcatheter skill — candidates lose marks answering "external iliac". Third, counselling: compared with TURP, PAE's symptom relief is on average smaller and re-intervention more likely, and honesty about that trade-off for sexual preservation is the standard answer. In Indian practice, PAE is available in large private and a few public centres, cost sits above a TURP episode, and the exam framing is typically the comorbid man in retention unfit for anaesthesia — the single clearest indication. ## Frequently asked questions ### Which patients are ideal candidates for prostate artery embolisation? Men with bothersome LUTS or retention from benign prostatic enlargement who have failed medical therapy or are unfit for or refuse transurethral surgery, especially those wishing to preserve sexual function. ### From where do the prostatic arteries usually arise? Typically from the anterior division of the internal iliac artery, most often the obturator or inferior vesical arteries, with important anastomoses to penile, rectal and bladder branches. ### What particle size is used for prostate embolisation? Particles in the range of about 300-500 microns are standard, delivered bilaterally after microcatheter positioning beyond non-target vessels. ### What is the most feared complication of PAE? Non-target embolisation causing ischaemia of the bladder, rectum or penis, prevented by meticulous angiographic mapping and reflux control during particle delivery. ### How does PAE compare with TURP in outcomes? PAE yields smaller and slower average symptom improvement with higher re-intervention rates, but lower rates of retrograde ejaculation, incontinence and transfusion, usually without general anaesthesia.