Role of Pre-procedural MRI Parameters and Urodynamic Findings in Predicting Clinical Success After Prostate Artery Embolization.

Background Prostate artery embolization (PAE) has emerged as a minimally invasive alternative for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, variability in clinical outcomes highlights the need for reliable pre-procedural predictors. This study aimed to evaluate the role of pre-procedural magnetic resonance imaging (MRI) parameters and urodynamic findings in predicting clinical success following PAE. Methods This retrospective observational study included 76 patients with symptomatic BPH who underwent PAE. Baseline clinical variables, MRI parameters (prostate volume, transition zone index, intravesical prostatic protrusion, adenomatous-dominant hyperplasia), and urodynamic parameters (maximum flow rate (Qmax), detrusor pressure (Pdet)Qmax, bladder outlet obstruction index (BOOI)) were recorded. Clinical success was defined as a ≥25% reduction in International Prostate Symptom Score (IPSS) and/or an increase in Qmax of ≥2 mL/s at 3 months. Patients were categorized into successful and unsuccessful outcome groups. Statistical analysis included group comparisons and multivariate logistic regression to identify independent predictors. Results Clinical success was achieved in 54 patients (71.1%). There were no statistically significant differences in baseline clinical, MRI, or urodynamic parameters between the success and failure groups. Prostate volume was higher in the failure group (103.3 mL vs 88.7 mL), approaching statistical significance (p = 0.093). At three months, patients with successful outcomes demonstrated significant improvements in IPSS (12.1 vs 21.8), Qmax (13.8 vs 10.1 mL/s), and post-void residual volume (51.9 vs 107.7 mL) (all p < 0.001). On multivariate analysis, prostate volume showed a borderline negative association with clinical success (β = -0.019, p = 0.051), while other variables, including transition zone index and BOOI, were not significant predictors. Conclusion PAE is an effective treatment for LUTS due to BPH, with clinical success achieved in the majority of patients. Pre-procedural MRI and urodynamic parameters demonstrated limited value in independently predicting outcomes. Prostate volume may have a potential predictive role; however, its association remains inconsistent. These findings suggest that multimodal and dynamic post-procedural factors may be more relevant in predicting treatment success.