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123
Key Techniques
Maoqiang Wang
Editor
Prostatic Arterial
Embolization
Prostatic Arterial Embolization
Maoqiang Wang
Editor
Prostatic Arterial
Embolization
Key Techniques
ISBN 978-981-15-6835-0 ISBN 978-981-15-6836-7 (eBook)
https://doi.org/10.1007/978-981-15-6836-7
© Springer Nature Singapore Pte Ltd. 2021
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
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neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
Editor
Maoqiang Wang
Department of Interventional Radiology
The First Medical Center of Chinese PLA General Hospital
Beijing
China
Associate Editors
Jinlong Zhang
Department of Interventional Radiology
The First Medical Center of Chinese
PLA General Hospital
Beijing
China
Jieyu Yan
Department of Interventional Radiology
The First Medical Center of Chinese
PLA General Hospital
Beijing
China
Feng Duan
Department of Interventional Radiology
The First Medical Center of Chinese
PLA General Hospital
Beijing
China
Yang Guan
Department of Interventional Radiology
The First Medical Center of Chinese
PLA General Hospital
Beijing
China
v
1 Benign Prostate Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Yang Guan, Jieyu Yan, Li Cui, and Yanhua Bai
2 The Treatment of Benign Prostate Hyperplasia . . . . . . . . . . . . . . . 7
Jieyu Yan, Xiaohui Li, and Ye Li
3 The History of Prostatic Arterial Embolization . . . . . . . . . . . . . . . 13
Jinlong Zhang, Jieyu Yan, Yang Guan, Xuedong Sun,
Xiaomei Tian, and Kan Ji
4 Prostatic Artery Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Maoqiang Wang, Kai Yuan, Guodong Zhang, Xiaojing Zhang,
and Qiang Li
5 Pre-prostatic Arterial Embolization Preparation . . . . . . . . . . . . . 39
Maoqiang Wang, Feng Duan, Jinlong Zhang, Yan Wang,
Liping Guo, and Xiuqi Wang
6 The Procedure of Prostatic Arterial Embolization . . . . . . . . . . . . 49
Maoqiang Wang, Jinlong Zhang, Kai Yuan, Chengjian Sun,
Xiaojing Zhang, Xiujun Zhang, Quanyu Wang, Duiping Feng,
and Kai Cheng
7 Post-prostatic Arterial Embolization Management . . . . . . . . . . . . 59
Maoqiang Wang, Jinlong Zhang, Feng Duan, Huiyi Ye,
Yan Wang, Hainan Xin, Zhiqiang Li, Yanguang Shen,
Hongtao Zhang, Jinhong Liu, and Jing Li
8 Comparison of PAE with Other Treatments in BPH . . . . . . . . . . . 71
Jinlong Zhang, Zhijun Wang, Yang Guan, Jinxin Fu,
Wenhao Jiang, Lili Tian, Cuiying Zhang, and Hongkai Yu
9 PAE in the Treatment of Hematuria of Prostatic Origin. . . . . . . . 77
Feng Duan, Xiujun Zhang, Zhijun Wang, Bing Yuan,
Jinxin Fu, Huan Ma, Liang Li, and Haixian Qu
10 PAE in the Treatment of Prostate Malignant Tumor . . . . . . . . . . . 85
Maoqiang Wang, Huiyi Ye, Bing Yuan, Liping Guo, Bao Cui,
Yanguang Shen, Hongtao Zhang, and Jinhong Liu
Contents
vii
Editors and Contributors
Associate Editors
JinlongZhang Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Feng Duan Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Jieyu Yan Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Yang Guan Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Contributors
Yanhua Bai, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
Kai Cheng, MD Department of Interventional Radiology, Qingdao
Municipal Hospital, Qingdao, China
BaoCui, MD Department of Radiology, The 980th Hospital Joint Logistic
Support Force of PLA, Shijiazhuang, China
Li Cui, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
FengDuan, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
DuipingFeng, MD Department of Oncology and Vascular Intervention, The
First Hospital of Shanxi Medical University, Taiyuan, China
JinxinFu, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
viii
YangGuan, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
LipingGuo, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Kan Ji, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
WenhaoJiang, MD The Second Hospital of Beijing, Beijing, China
Jing Li, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Liang Li, MD Department of Interventional Vascular Surgery, The 980th
Hospital Joint Logistic Support Force of PLA, Shijiazhuang, China
Qiang Li, MD Department of Radiology, The Eighth Medical Center of
Chinese PLA General Hospital, Beijing, China
XiaohuiLi, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Ye Li, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Zhiqiang Li, MD Interventional Department, The Afliated Hospital of
Hebei University, Baoding, China
Jinhong Liu, MD Department of Pathology, The First Medical Center of
Chinese PLA General Hospital, Beijing, China
HuanMa, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Haixian Qu, MD Department of Radiology, Hainan Hospital of PLA
General Hospital, Sanya, Hainan, China
Yanguang Shen, MD Department of Radiology, Beijing University of
Chinese Medicine Third Afliated Hospital, Beijing, China
ChengjianSun, MD Department of Interventional Therapy, The Afliated
Hospital of Qingdao University, Qingdao, China
XuedongSun, MD School of Medicine, Nankai University, Tianjin, China
LiliTian, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Xiaomei Tian, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
MaoqiangWang, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
Quanyu Wang, MD Department of Endoscopic Interventional Surgery,
Huabei Petroleum General Hospital, Renqiu, China
Editors and Contributors
ix
Xiuqi Wang, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
YanWang, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Zhijun Wang, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
Hainan Xin, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
JieyuYan, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
Huiyi Ye, MD Department of Radiology, The First Medical Center of
Chinese PLA General Hospital, Beijing, China
Hongkai Yu, MD Department of Urology, The First Medical Center of
Chinese PLA General Hospital, Beijing, China
BingYuan, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
KaiYuan, MD Department of Interventional Radiology, The First Medical
Center of Chinese PLA General Hospital, Beijing, China
GuodongZhang, MD Department of Interventional Radiology, Shandong
Medical Imaging Research Institute, Shandong University, Jinan, China
Hongtao Zhang, MD Department of Radiology, South Area of the Fifth
Medical Center of Chinese PLA General Hospital, Beijing, China
Jinlong Zhang, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
XiaojingZhang, MD Department of Radiology, The First Medical Center
of Chinese PLA General Hospital, Beijing, China
XiujunZhang, MD Interventional Department, Tianjin Hospital of ITCWM
Nankai Hospital, Tianjin, China
Cuiying Zhang, MD Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital, Beijing, China
Editors and Contributors
1
© Springer Nature Singapore Pte Ltd. 2021
M. Wang (ed.), Prostatic Arterial Embolization, https://doi.org/10.1007/978-981-15-6836-7_1
Benign Prostate Hyperplasia
YangGuan, JieyuYan, LiCui, andYanhuaBai
1.1 Introduction
Benign Prostatic Hyperplasia (BPH) is a benign
prostate disease based on the benign proliferation
of stromal cells and epithelial cells. Due to broid
hyperplasia and an increase in the glands of the
prostate, the entire prostate eventually increases
in size [1–4]. In the pathological process of
benign prostatic hyperplasia, sex hormones play
an important role, the most important of which is
the androgen secreted by the testes. Androgen is
converted into active dihydrotestosterone (DHT)
by type II 5α reductase in the prostate, and DHT
also plays an important role in the proliferation of
prostate stromal and epithelial cells [5–7].
BPH result in lower urinary tract symptoms
(LUTS), irritating urination syndromes during
urinary storage, such as increased nocturia, fre-
quent urination, involuntary urges, and difculty
in urinating, and bladder outlet obstruction dur-
ing emptying, such as delayed onset of urination,
prolonged urination time, weakened urine ow,
and incomplete bladder emptying [4–6]. LUTS
can cause complications such as urinary reten-
tion, urinary tract infections, and bladder stones.
Serious complications can include renal failure.
The patients’ quality of life (QoL) is severely
affected and even life-threatening [8].
1.2 Epidemiology
The incidence of BPH increases with age, 41% in
51–60 years old, 70% in 61–70 years old, and up
to 90% in 81–90 years old. However, the inci-
dence rate and severity of BPH vary widely in
different countries [7, 9]. In the United States, the
incidence of BPH is about 80% in men aged 80
years and above. A cross-sectional survey con-
ducted in South Korea in 2006 showed that the
total prevalence of BPH was 18% in men aged 50
years and above [10]. Compared with European
and American countries, the incidence of BPH in
Asia is slightly lower.
1.3 Pathogenesis
The prostate is located in the pelvis and sur-
rounded by the rectum, bladder, periprostatic
vein, and the urinary sphincter, wrapping the ure-
thra tightly. The shape of the prostate is similar to
a chestnut. The formation and development of
hyperplastic nodules are critical pathological
changes in BPH.The biological basis for the pro-
gression of BPH is the stromal and epithelial
hyperplasia. The symptoms of urinary obstruc-
tion in patients are closely related to the quantity
of prostate smooth muscle. The main tissue com-
ponents of the prostate organs are glands and
stroma, the gland is a composite tube vesicular
structure, and the stroma is composed of smooth
muscle, brous, vessels, nerves, and other tissues.
Y. Guan (*) · J. Yan · L. Cui · Y. Bai
Department of Interventional Radiology, The First
Medical Center of Chinese PLA General Hospital,
Beijing, China
1
2
Hyperplastic nodules are also mainly composed
of glands and stroma, the type of the nodules are
distinct depending on the tissue composition,
quantity, and cell differentiation degree [11–19].
1.3.1 Age andGonadal Hormone
The prostate has been widely recognized as an
androgen-dependent organ, 90% of the androgen
in the prostate comes from the testis. The testos-
terone and androgen are important factors in pro-
moting the mitosis of prostate cells, and have
obvious stimulatory effects on prostate growth.
However, BPH occurs mainly in aging males
with lower androgen, and rarely occurs in young
men with higher androgen. In the plasma of
young and middle-aged men, the ratio of estro-
gen and androgen is 1:150. However, the level of
androgen decreases with age, the ratio of plasma
estrogen and androgen is 1: (80–120) in males
aged 60 years and above [20]. The estrogen/
androgen ratio may be a balance point of prostate
interstitial growth at 1:10. Androgen levels are
not the only factor in the pathogenesis of BPH,
estrogen also plays a very important role at the
same time, but estrogen should be based on the
presence of androgen and synergize androgen to
promote benign prostatic hyperplasia. The inci-
dence of BPH is closely related to age and
gonadal hormones, and is mainly due to the
imbalance of the proportion of estrogen and
androgen [21].
1.3.2 Inammation
Inammatory chemokine and proteins are struc-
turally the same as soluble micro-inammatory
mediators and growth factors, and chronic persis-
tent inammation and repair of abnormal damage
can lead to BPH. Aggregation of inammatory
cells can cause changes in various inammatory
factors in the prostate, which can promote the
proliferation of prostatic epithelial cells and stro-
mal cells. Chronic prostatitis (CP) plays an
important role in the development of BPH, and
both induce each other. The incidence of inam-
matory response in the prostate of BPH patients
is up to 84–98%, and most patients with BPH
have a history of CP [22–25].
1.4 Manifestation
BPH can cause lower urinary tract symptoms
(LUTS), increased nocturia, frequent urination,
and increased urination during urinary storage,
delayed urination, prolonged urination time,
weakened urine ow, and incomplete bladder
emptying during the emptying period, etc. The
extent of the symptoms of LUTS does not have
an absolute correlation with the volume of the
prostate. The symptoms usually appear in men
aged between 60 and 70 years [1, 3, 5, 26].
Other symptoms include hematuria, urinary
tract infections, and bladder stones. Capillary
hyperemia and small blood vessel expansion on
the prostate mucosa are caused by increased
glandular traction or friction with the bladder.
When the bladder contracts, it can cause micro-
scopic or gross hematuria, which is one of the
common causes of hematuria in elderly men.
Urinary retention often leads to urinary tract
infections, which may be associated with fever,
pain, or sepsis. In addition, prolonged urine
retention in the bladder increases the risk of blad-
der stone [1, 2, 5].
1.5 Diagnosis
The diagnosis of BPH is mainly based on subjec-
tive symptom, medical history, prostate-specic
antigen (PSA), urodynamic examination, digital
rectal examination, and imaging examination,
including Doppler ultrasound, computed tomog-
raphy (CT), and magnetic resonance (MR) imag-
ing. The subjective symptoms could be evaluated
by international prostate symptom score (IPSS)
and quality of life (QoL) (Table1.1). The prostate
volume could be calculated through imaging
examination. Cystoscopy can be performed if
necessary. It is also necessary to exclude neuro-
genic bladder dysfunction, detrusor sphincter
dyssynergia by urodynamic examination.
Y. Guan et al.