Efficacy of Prostatic Artery Embolization (PAE) in Patients With Severe Benign Prostatic Hyperplasia (BPH)

Inclusion Criteria: * Male * Age \> 40 * Prostate gland measures between 80 and 150 grams * Have previously taken BPH medication for 6 months without desired improvement of LUTS or has started medication and stopped due to unwanted side effects * Moderate to severe LUTS as defined by IPSS score \>18 * Peak urine flow rate (Qmax) \<12 ml/sec * Capable of giving informed consent * Life expectancy greater than 1 year Exclusion Criteria: * Severe cardiac or pulmonary disease * Uncontrolled diabetes mellitus * Immunosuppression * Neurogenic bladder and/or sphincter abnormalities secondary to Parkinson's disease, multiple sclerosis, cerebral vascular accident, diabetes, etc. * Acute urinary retention * Glomerular filtration rate less than 45 as approximated using using serum creatinine levels. * Confirmed or suspected bladder cancer * Recent (within 3 months) cystolithiasis or gross hematuria * Urethral strictures, bladder neck contracture, or other potentially confounding bladder pathology * Active urinary tract infection * Previous rectal surgery or history of rectal disease if PAE, anoscopy or transrectal ultrasound are thought to potentially cause injury to the rectum due to the previous surgery or disease * Previous pelvic radiation or radical pelvic surgery * Confirmed or suspected malignancy of the prostate based on DRE, TRUS or PSA. (\> 10 ng/ml or \> 2.5 ng/ml and \< 10 ng/ml with free PSA \< 25% of total PSA without a negative biopsy) * Uncorrectable coagulopathy including INR \> 2.5 or platelets \< 30,000