Aktueller Stand der Prostataarterienembolisation (PAE) zur Behandlung der benignen Prostatahyperplasie (BPH)

Prostatic artery embolization (PAE) has become established as a minimally invasive treatment option for benign prostatic hyperplasia (BPH) in recent years. This review aims to provide a coherent overview of the technical principles, patient selection, clinical efficacy, safety, health-economic aspects, and guideline positioning. Prospective studies and meta-analyses demonstrate a significant reduction in lower urinary tract symptoms, improvements in quality of life, and relevant prostate volume reduction. Compared with TUR-P and HoLEP, gains in maximum urinary flow are more moderate, whereas periprocedural risks are lower and preservation of antegrade ejaculation is more frequently achieved. Mid-term reintervention rates are higher and should be addressed during patient counseling. PAE is particularly attractive for patients with large prostate volumes, relevant comorbidities, or ongoing anticoagulation. From a technical perspective, non-resorbable particles (100-500 µm) are commonly used, while liquid embolic agents (e.g., Glubran) are employed in selected centers and require further clinical evaluation. Performing PAE in experienced centers with CBCT-guided navigation, standardized protocols, and interdisciplinary decision-making reduces procedural risks and improves clinical outcomes. Overall, PAE meaningfully complements the therapeutic armamentarium for BPH; its future role will depend on robust long-term data, a standardized technique, and more precise positioning within clinical guidelines.