To characterize voiding and storage symptom domain-specific outcomes after prostate artery embolization (PAE) to treat lower urinary tract symptoms (LUTS) or urinary retention caused by benign prostatic hyperplasia (BPH).

Two hundred forty patients (age = 74.5 ± 8.6 years) underwent PAE between May 2013 and March 2020 at a single center for LUTS (n = 161) or urinary retention (n = 79). Total International Prostate Symptom Score (IPSS-t), voiding domain score (IPSS-v), storage domain score (IPSS-s), and Quality of Life score (QoL) were obtained pre-PAE for LUTS patients (IPSS-t = 21.7 ± 6.2, IPSS-v = 11.9 ± 4.3, IPSS-s = 9.6 ± 3.1, QoL = 4.5 ± 1.2), and post-PAE through 36 months (mean = 22.9 ± 15.2 months) for LUTS and retention patients. Mean relative changes in IPSS-t, IPSS-v, IPSS-s, and QoL were calculated for LUTS patients. Mean voiding or storage component scores were calculated for retention patients.

For evaluable LUTS patients (n = 147), IPSS-t showed sustained substantial improvement through 36 months (6.3 ± 4.2-8.6 ± 7.6), as did QoL (1.1 ± 1.1-1.8 ± 1.5). One month after PAE, improvements in IPSS-v (69% ± 29%) were greater than in IPSS-s (46% ± 33%; P < .000001), and remained so through 36 months (68% ± 31% vs 53% ± 28%, P = .004). Among evaluable retention patients (n = 75), 84% passed voiding trials. Both IPSS-t (6.0 ± 3.9-8.2 ± 6.7) and QoL (0.9 ± 1.2-1.5 ± 1.6) remained low through 36 months. One month after PAE, mean IPSS-v component score (0.9 ± 1.3) was lower than mean IPSS-s component score (1.7 ± 1.4; P = .003) and remained so through 24 months (0.9 ± 1.2 vs 1.3 ± 1.1, P = .02), with similar trend at 36 months (0.7 ± 1.1 vs 1.1 ± 1.1, P = .07).

PAE effectively treated BPH-related LUTS and retention. IPSS-v improved more than IPSS-s in LUTS patients, and remained lower in LUTS and retention patients through 36 months.