Prostate Artery Embolization for the Treatment of Symptomatic Benign Prostatic Hyperplasia

Inclusion Criteria: 1. Prostate volume between 40 and 300 cm3 2. Diagnosis of BPH with moderate to severe lower urinary tract symptoms (LUTS) defined as at least one of the following: * a. IPSS greater than 18 * b. IPSS Quality of Life (QoL) assessment greater than 3 * c. Qmax less than 12 mL/sec 3. Refractory or intolerant to medical management 4. Ineligibility for or refusal of surgical management 5. One of the following criteria: * a. Baseline prostate specific antigen (PSA) ≤2.5 ng/mL * b. Baseline PSA \>2.5 ng/mL and ≤10 ng/mL AND free PSA ≥25% of total PSA * c. Baseline PSA \>2.5 ng/mL and ≤10 ng/mL AND free PSA \<25% of total PSA AND negative 12 core prostate biopsy in the past 12 months * d. Baseline PSA \>10 ng/mL AND negative 12 core biopsy within the past 12 months. Exclusion Criteria: 1. History of prostate, bladder or rectal malignancy. Biopsy proven urethral cancer. 2. History of rectal disease 3. Neurogenic bladder disorder due to multiple sclerosis, Parkinson's disease, spinal cord injury, diabetes, etc., as demonstrated on urodynamic testing. 4. Detrusor muscle failure, urethral stenosis, or urinary obstruction due to causes other than BPH, as demonstrated on urodynamic testing 5. Bladder diverticula greater than 5 cm or bladder stones greater than 2 cm 6. Cystolithiasis within the past three months 7. Baseline serum creatinine greater than 1.8 8. Evidence of tortuous or atherosclerotic blood vessels 9. Presence of collateral vessel pathways potentially endangering normal territories during embolization that cannot be bypassed with the microcatheter 10. Active urinary tract infection, interstitial cystitis, or prostatitis within the last 5 years 11. Coagulation disturbances not normalized by medical treatment 12. Allergy to iodinated contrast agents not responsive to steroid premedication regimen 13. Previous radical pelvic or rectal surgery, or pelvic irradiation 14. Prior surgical prostate intervention 15. Treatment with beta-blocker, antihistamine, anticonvulsant, or antispasmodic medication within 1 week of treatment UNLESS there has been a stable voiding pattern while medicated with the drug(s) for 6 months 16. Use of prostate active medications, including alpha blockers, anti-cholinergics, androgens, anti-androgens, gonadotropins-releasing hormonal analogs, PDE5-inhibitors, 5-alpha reductase inhibitors within 2 months of intervention, unless the medication is necessary to avoid symptom exacerbation and disability, in this case medication should not be initiated or dose adjusted within 1 month of study enrollment and dose should not be adjusted during the study period 17. Interest in future fertility 18. Mental condition or disorder that interferes with participants' ability to provide written informed consent 19. Current severe or uncontrolled disease (metabolic, hematologic, renal, hepatic, pulmonary, neurologic, cardiac, infectious or gastrointestinal) that in the Investigator's judgment makes the patient unsuitable for trial inclusion due to increased risk of complications 20. Known immunosuppression 21. Life expectancy less than 6 months