The prostate gland is known for its potential implications, particularly prostate cancer and benign prostatic hyperplasia. It is supplied by the prostatic artery, which shows considerable anatomical variation, directly implicating prostatic artery embolization, an emerging minimally invasive therapy for benign prostatic hyperplasia. Identifying prostatic artery origin variation is essential in order to optimize embolization and improve clinical outcomes. The objective was to investigate the anatomical variation of the prostatic artery using cadaveric dissection and angiographic evaluation, and to assess the impact of this variation on clinical outcomes following prostatic artery embolization. A bilateral cadaveric dissection was conducted on five male pelvis specimens to identify prostatic artery origin. The radiological arm included 54 symptomatic benign prostatic hyperplasia patients undergoing prostatic artery embolization, with prostatic artery origin variation and symmetry documented. IPSS recorded pre-procedure and at 3 and 6 months post-embolization, and statistical analysis was performed.
Cadaveric analysis showed that the prostatic artery most commonly originated from vesical arteries (60%), followed by the obturator (20%) and internal pudendal arteries (20%). Radiologically, vesical origin was also the most frequent (41.7%), followed by obturator (23.1%), internal pudendal (21.3%), and internal iliac artery (13.9%). Symmetrical prostatic artery origin was observed in 83.3% of patients. Prostatic artery embolization produced a significant reduction in mean IPSS, from 24.53 pre-procedure to 16.31 and 11.56 after 3 and 6 months respectively (p<0.001). Neither patient age nor prostatic artery origin impacted clinical improvement. The prostatic artery shows marked anatomical variability, with vesical arteries representing the most frequent origin. Prostatic artery embolization is an effective treatment for benign prostatic hyperplasia, producing significant improvement regardless of prostatic artery origin or patient age.
