case_images: PMC11806513_01
case_images: Ultrasound of the kidneys, ureters, and bladder (USG KUB) showing Grade III prostatomegaly with a homogeneous echotexture.. BL: bladder.
case_images: cureus-0017-00000077182-i01.jpg
case_images: PMC11806513_01_cureus-0017-00000077182-i01.jpg
case_images: FIG1
case_images: An ultrasound of the kidneys, ureters, and bladder (KUB) revealed Grade III prostatomegaly with a prostate volume of 62 cc and significant post-void residual urine volume (PVRV) of 180 cc, as shown in Figure 1.
case_images: Angiographic assessment of the iliac vessels and prostate arteries.. (A) Pelvic angiography showing the iliac vessels. (B) Angiographic image of the left internal iliac artery, revealing the left inferior vesical artery (prostate artery) originating from the anterior division of the left internal iliac artery, consistent with the type II variant. (C) Angiographic image of the right internal iliac artery, demonstrating the right inferior vesical artery arising from the right internal pudendal artery, corresponding to the type IV variant. These images (blue arrows) highlight the anatomical variations in the vascular supply to the prostate between the two sides of the pelvis.
case_images: cureus-0017-00000077182-i02.jpg
case_images: PMC11806513_01_cureus-0017-00000077182-i02.jpg
case_images: FIG2
case_images: The procedure began with a CT pelvic angiography to assess the iliac vessels (Figure 2A). Specifically, Figure 2B shows that the left inferior vesical artery (which supplies the prostate) originated from the anterior division of the left internal iliac artery, consistent with the type II variant. Conversely, Figure 2C illustrates that the right inferior vesical artery arose from the right internal pudendal artery, representing the type IV variant.
case_images: Embolization and post-procedure imaging.. (A) Embospheres are used to embolize the inferior vesical artery and its intraprostatic branches. (B) Ultrasound of the kidneys, ureters, and bladder (USG KUB) showing the prostate with a volume of 42 cc, homogenous echotexture, and a significantly decreased post-void residual volume (PVRV) of 40 ml.
case_images: cureus-0017-00000077182-i03.jpg
case_images: PMC11806513_01_cureus-0017-00000077182-i03.jpg
case_images: FIG3
case_images: The procedure was repeated on the right side, where the right inferior vesical artery was found to arise from the right internal pudendal artery (type IV variant) (Figure 3A). Follow-up imaging showed a reduction in prostate volume to 42 cc, a decrease in PVRV to 40 ml, and an improvement in peak flow rate to 13 ml/s (Figure 3B).