LAUSR

available at http://www.ncbi.nlm.nih.gov/pubmed/30128781 Editorial Comment: Prostatic artery embolization (PAE) has achieved traction in some circles as a therapeutic option in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. Notwithstanding my own reservations regarding this technology, it seems that there is a high degree of variability in the results reported. The current study may shed light, given the heterogeneous nature of the vascular supply to the prostate. The authors propose a classification based on an analysis of 143 solitary prostatic arteries from 199 hemipelves. Pattern A (62% of cases) is defined as an artery feeding the prostate only, while patterns B and C are defined as a prostatic artery with a concomitant large supply to the penis (pattern B, 12%) or the rectum (pattern C, 26%). It is noteworthy that protection of a concomitant penile/rectal component has important safety considerations. But does it also have a downstream consequence on efficacy, ie do different patterns allow for enough targeted and/or complete embolization? That said, reports on PAE have a discordance with the magnitude of decrease in prostate volume (around 20%) and improvement in LUTS with other therapeutic interventions that have similar reduction in prostate volume, eg 5alpha-reductase inhibitors, and much less impressive subjective change. Prostate specific antigen decrease is similarly discordant. We can agree that refractory hematuria is a good landing spot for PAE. In addition, volume reduction of large prostates either as monotherapy or as a prelude to a secondary surgical procedure may be another vertical for PAE. Until then the prostatic artery route appears to be a tertiary approach in the management of LUTS secondary to benign prostatic hyperplasia. Steven A. Kaplan, MD Suggested Reading Foster HE, Barry MJ, Dahm P et al: Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol 2018; 200: 612. Re: Polypharmacy, Chronic Kidney Disease, and Benign Prostatic Hyperplasia in Patients with Chronic Obstructive Pulmonary Disease Newly Treated with Long-Acting Anticholinergics F. Savaria, M. F. Beauchesne, A. Forget and L. Blais Facult e de Pharmacie, Universit e de Montr eal, Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health and Centre de Recherche, Hôpital du Sacr e-Coeur de Montr eal, Montreal and Centre de Recherche, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada Respir Med 2017; 132: 195e202. doi: 10.1016/j.rmed.2017.10.023