Reintervention Through Five Years After Prostatic Artery Embolization for Benign Prostatic Hyperplasia: A National Claims Analysis.

PURPOSE: To evaluate reintervention patterns after prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH) using a U.S. claims database. MATERIALS AND METHODS: This retrospective cohort study used the MarketScan Commercial and Medicare Databases (2017-2025) to identify men aged ≥50 years who underwent PAE as their first BPH procedure. The primary outcome was time to first BPH-directed reintervention of any type. Cumulative incidence at 1, 3, and 5 years was estimated using Kaplan-Meier methods; cumulative incidence by reintervention type was estimated using Aalen-Johansen methods. Multivariable Cox proportional hazards regression assessed associations between patient characteristics and reintervention hazard. RESULTS: 959 patients (median age 68 years, IQR 61-77; 55% Medicare) underwent index PAE for BPH. The cumulative incidence of any reintervention was 7.5% (95% CI 5.4-9.5) at 1 year, 17.1% (12.7-21.2) at 3 years, and 25.8% (16.2-34.3) at 5 years (numbers at risk: 455, 107, 23, respectively). Transurethral resection of the prostate (TURP) was the most common reintervention (n=28, 34.6% of reinterventions), followed by laser enucleation (n=13, 16.0%), repeat PAE (n=12, 14.8%), and laser vaporization (n=11, 13.6%). The 5-year cumulative incidence of TURP-specific reintervention was 9.1% (4.92-16.86), highest among reintervention types. No predictor for reintervention was statistically significant in multivariable Cox regression. CONCLUSIONS: 5-year reintervention rates after PAE for BPH in routine U.S. practice were comparable to those reported in specialized academic centers and trial settings. TURP accounted for the largest share of reinterventions after PAE. These findings are relevant for patient counseling and motivate further PAE technique optimization to improve treatment durability.