Predictors of treatment failure, second-line therapy outcomes, and patient satisfaction after prostatic artery embolization : a retrospective study in benign prostatic hyperplasia

Introduction: This study aims to evaluate the effectiveness of prostatic artery embolization (PAE) in treating benign prostatic hyperplasia (BPH), focusing on identifying the predictors of treatment failure and assessing patient satisfaction and second-line therapies for patients who undergo reoperation. Methods: We conducted a monocentric, retrospective study involving 344 patients who underwent PAE from 2017 to 2022. The minimum follow-up time was 12 months. Baseline data were retrospectively collected. A single follow-up questionnaire was administered at the time of the study. Included patients were ≥50 years, with a prostate volume ≥40 mL, an International Prostate Symptom Score (IPSS) ≥8 and were unresponsive to medical therapy. Results: Among 156 participants, the reoperation rate at 5 years was 28.2%. Baseline IPSS and post-void residual volumes (PVR) were significant predictors of therapy failure. Higher satisfaction was associated with younger age (p = 0.01), larger prostate volume (p = 0.02), and lower PVR (p = 0.03). Patients with higher satisfaction had better reoperation-free rates at 60 months (p = 0.002). Conclusions: PAE is effective in reducing symptoms in patients with BPH; however, the reoperation rate emphasizes the importance of careful patient selection. Study limitations include potential selection bias, missing data, the single-center setting, and the use of a single follow-up questionnaire.