الفهرس 
Applied Anatomy of the ProstateOnly 14 pages are availabe for public view
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Abstract
Benign Prostatic Hyperplasia refers to the increase in size of the prostate in middle aged and elderly men. Symptomatic BPH typically occurs in the sixth and seventh decades, and more than 40% of men older than this present with clinical manifestations of this disease. The most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, intermittency, sensation of incomplete emptying, nocturia, frequency, and urgency, which severely affect the patients’ quality of life.
The normal prostate is composed of a combination of glandular, stromal, and smooth muscle cells. BPH is due to a proliferation of glandular elements, fibromuscular (stromal) elements, or both, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate.
Symptomatic BPH typically occurs in the sixth and seventh decades, and more than 40% of men older than this present with clinical manifestations of this disease. The most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, intermittency, sensation of incomplete emptying, nocturia, frequency, and urgency, which severely affect the patients’ quality of life (Carnevale et al, 2010).
The standard management of BPH is based on the overall health of the patient and the severity of symptoms. Medications, specifically 5-alpha-reductase inhibitors and selective alpha blockers, can decrease the severity of voiding symptoms secondary to BPH, and minimally invasive techniques such as transurethral microwave thermotherapy, interstitial laser thermo ablation, transurethral needle ablation, and water induced thermotherapy have been indicated to treat complications of BPH. Even with the development of new therapies, prostatectomy accomplished by transurethral or open surgical means constitutes the traditional surgical treatment for BPH, but considering the comorbidities, prostatectomy in this age group is considered to be high-risk (Carnevale et al, 2010).
PAE has been used successfully, mainly to control massive hemorrhage after prostatectomy or prostate biopsy. Recent studies ly, an experimental study of PAE in pigs showed that PAE is an alternative treatment and could be performed safely, with a significant reduction of prostate volume and relief from symptoms, without compromising the sexual function and erectile function of the animals. . Due to the similarity of the cells and arterial vascular anatomy observed in the prostate, PAE could be used as an alternative treatment, with the aim of reducing the prostate size and producing relief from symptoms caused by BPH (Carnevale et al, 2010).
Patients who can undergo PAE have the following criteria: Total score of IPSS is > 18 and if QoL > 4 or if they are in acute urinary retention with bladder catheter with prostate volume more than 40 cc & refractory to medical therapy, for at least 6 months with moderate to severe lower urinary tract symptoms. Also patients with peak urinary flow rate (Qmax) inferior to 12 mL/s or with acute urinary retention (Pisco et al, 2011).
Malignancy, Advanced atherosclerosis, Bladder stone or diverticulae & Marked tortuosity of the iliac arteries are absolute contraindications to the procedure (Pisco et al, 2011).
Prior to PAE, CT or MR angiography is used to evaluate the pelvic vessels for tortuosity and atherosclerotic changes of the iliac arteries so show the possibility of embolizing prostatic blood vessels, the prostate volume is also measured by MRI (Pisco et al., 2011).
Complications were categorized as complications of angiography (related to puncture site, contrast agents, or radiation injury), pelvic infection, ischemic complications, sexual dysfunction, non prostatic embolization, adverse drug reactions, pulmonary embolism, and other (Pisco et al, 2011).
Many studies done to evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH) and the results waswere: despite the withdrawal of all prostatic medications after PAE, there was a significant improvement of the IPSS, QOL improved, The sexual function improved in some patients and remained stable in others (Pisco et al, 2011).
The benefits of PAE compared with other minimally invasive treatments are that PAE is performed under local anesthesia and can be done as an outpatient procedure. Lower urinary tract symptoms can be controlled even in patients at the end stage of the disease with acute urinary retention. Prostatic artery embolization does not manipulate the urethra, avoiding urethral stenosis, and can be performed even in large prostates and in patients with urinary retention.