LAUSR

A 62-year-old man with severe LUTS/BPH presented for PAE after inadequate response to medical therapy. He underwent embolization after written informed consent using 250 μm Embozene microspheres (Boston Scientific, Natick, Massachusetts, USA) as part of an institutional review board-approved, prospective trial (NCT02592473, IDE#G150021). Baseline International Prostate Symptom Score (IPSS) was 29; Quality of Life (QoL) score of 4; postvoid residual (PVR) of 66 cc, and a Qmax of 7.9 cc/s; International Index of Erectile Function (IIEF) and UCLA Prostate Cancer Index Short-Form (UCLA-PCI-SF) were 16 and 83, respectively; prostate-specific antigen (PSA) was 3.63 ng/ml. Computed-tomography angiography revealed an 89 cm3 prostate and large median lobe (22 cm3; Figure 1). After discharge on post-procedure day 1, the patient reported bladder spasms on day 2, which improved after resuming tamsulosin 0.4 mg. He returned to clinic fourweeks post-procedure, complaining of weak stream, dysuria, and frequency. Urinalysis revealed no bacteria. During uroflowmetry, he was unable to void until he passed fragments through the urethra with scant hematuria. The specimen consisted of two irregularly shaped soft-tissue pieces measuring 1.7×1.1×0.2 cm3 and 3.1×1.0×0.5 cm3 (Figure 2). Microscopy (Figure 3) demonstrated necrotic prostate with variably-sized, irregular hyperplastic nodules surrounded by abundant stroma with corpora amylacea, and granular material (microspheres) that stained poorly with hematoxylin and eosin (H&E), but enhanced under polarized light. The 250 μm microspheres penetrated variably Expulsion of prostatic tissue fragments after prostatic artery embolization