Technical considerations in prostate artery embolization for giant benign prostatic hyperplasia: a case report and literature review.

A 76-year-old male patient presented with a 16-year history of chronic, progressive urinary hesitancy requiring intermittent catheterization. After transabdominal ultrasonography, prostate MRI, and transrectal prostate biopsy were performed, he was diagnosed with benign prostatic hyperplasia (BPH). Preoperative computed tomography angiography of the prostatic arteries was performed to assess their origins and number. Subsequently, a prostate artery embolization (PAE) was performed. During the procedure, a contrast agent was infused into the catheter balloon, and three-dimensional digital subtraction angiography, along with C-arm rotation, was used to accurately locate the prostatic arteries. Super-selective embolization of the prostatic arteries was then performed under road-mapping to reduce procedure time, radiation exposure, and the risk of inadvertent embolization. At the 1-month postoperative follow-up, the patient was able to urinate independently. In this case, the patient's prostate volume measured 238 mL, and PAE was successfully performed under local anesthesia. Compared with previously reported cases in the literature, this patient exhibited a larger prostate volume and a longer history of urinary obstruction. During the procedure, the prostatic arteries were accurately identified, and embolization was performed. Postoperatively, the patient experienced significant relief from lower urinary tract symptoms, resulting in a remarkable improvement in quality of life.