Prostate artery embolisation is a minimally invasive interventional radiology procedure performed without the use of general anaesthesia. This technique involves selective catheterisation of the prostate arteries and occlusion of the intra-prostatic arteries by embolisation causing ischaemic necrosis and thereby inducing prostate atrophy. This is typically performed via percutaneous access from the radial or common femoral artery. PAE has seen minimal adoption in New Zealand. The Urological Society of Australia and New Zealand position statement regarding prostate artery embolisation is that it should not be performed outside the context of clinical trials. A literature search has been performed on Ovid and Pubmed with (“Prostate artery embolisation” and (“New Zealand” OR “Aotearoa”)) revealed no published data. Auckland City Hospital is one of two hospitals with established PAE programs in New Zealand.

All cases of prostate artery embolisation that were performed at Auckland City Hospital were identified and records analyzed retrospectively. A total of 25 patients were identified. Median age was 70, median prostate size was 161cc. The primary endpoints of this study were safety, feasibility and efficacy. Safety was measured by adverse events Feasibility was defined by technical success Efficacy was defined by outcomes: Indication of prostatic bleeding: successful discharge from hospital without significant haematuria and further acute hospital presentations. Indication of lower urinary tract symptoms (LUTS): further procedures for LUTS

19 patients received PAE for LUTS, and 6 for prostatic bleeding. 97% were technically successful. There were no complications of Clavien-Dindo grade III or above. 83% of patients were day-stays or discharged day 1 post-procedurally. The short term efficacy of PAE for LUTS was 83% at 12 months, longer term efficacy dropping to 58% at 36 months. The short term efficacy of PAE for prostatic bleeding was 100%, longer term efficacy was 60%, with 3/5 patients not requiring any further hospitalisation for haematuria. The 2 patients who required further hospitalisation were successfully treated with ward based measures and did not require further invasive intervention.

PAE is a technically feasible and safe procedure. It is effective in the setting of prostatic bleeding. PAE for LUTS caused by benign prostatic hypertrophy (BPH) shows good short-term efficacy up to 12 months, but medium-term symptom recurrence is significantly higher than previously reported in the literature. This is likely confounded by the larger prostate sizes.