Benign prostatic hyperplasia (BPH) represents a serious public health issue as it affects about 50% of men aged between 50 and 60 years, and 90% of men aged 85 years or older [1]. Enlargement of the prostatic transitional zone due to the proliferation of glandular and fibromuscular elements results in the formation of androgen-dependent nodules [2]. It causes lower urinary tract symptoms (LUTS) related to obstruction, with great impact on the patients’ health-related quality of life [3,4]. A variety of surgical and medical options are currently available and standard management of symptomatic BPH depends on the severity of the symptoms and the global patient's health state. When medical treatments fail to treat LUTS and thus attenuate it associated symptoms, more invasive treatments are indicated [5]. Among surgical techniques, transurethral resection of the prostate is currently considered the gold standard for these patients. However, even though it is considered the gold standard treatment in patients with failed medical treatment or disease progression, patient eligibility to surgery is limited by selection criteria and potential contra-indications. Short- and long-term complications of transurethral surgery were reported, including hematuria, blood transfusion, urinary retention and urinary tract infection, erectile dysfunction (10%), ejaculatory disorder (65%), urethral stricture (7%), urinary incontinence (2%), and reoperation [6], [7], [8].

Prostatic artery embolization (PAE) is an interventional radiological technique with demonstrated efficacy for patients with symptomatic BPH resulting in improved voiding symptoms, prostate volume reduction with no or minimal complications [9], [10], [11]. PAE is now a well-known technique and was shown to be safe in several studies [9,[12], [13], [14]]. In this regard, Pisco et al. reported only one PAE-related major complication (i.e., bladder wall ischemia), in 630 patients who underwent PAE [9]. PAE efficacy was also demonstrated in several studies with a short-term efficacy close to that of transurethral resection of the prostate [10,11]. PAE aims at inducing necrosis of the prostatic gland and consequently prostate shrinkage. It has recently been validated by the Society of Interventional Radiology as a minimally invasive alternate option to surgery for benign prostatic obstruction for patients with comorbidities and contraindications to surgery [15]. However, previous studies were performed in centers with great experiences in PAE, known in the field to be a complex procedure.

The purpose of this multicenter study was to evaluate PAE clinical success at three months and assess PAE safety in centers of various experiences, and identify factors associated with PAE success.