Ep. 619 Clinical Insights: Managing LUTs in BPH Patients with Dr. Art Rastinehad

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Feb 24, 2026

Dr. Art Rastinehad, an interventional urologist with IR training known for work in prostate artery embolization and fusion biopsy. He describes a urology-grounded consult playbook, imaging and anatomic pitfalls, strategies for large or challenging glands, and why he moved from particles to liquid embolics. The conversation also covers periprocedural workflow, recovery plans, and the future of PAE training and collaboration.

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ADVICE

Run Full Urologic Workup Before Offering PAE

Follow AUA-guided BPH workup: IPSS, uroflow/PVR, behavioral measures, trial alpha blockers before procedural options.
Obtain prostate MRI pre-procedure to rule out cancer and assess anatomy like median lobe or bladder-neck relationship.

INSIGHT

Sagittal Anatomy Predicts PAE Success

Prostate-bladder sagittal anatomy predicts response: a high bladder-neck ramp or median lobe can cause ball-valve obstruction.
MRI sagittal view helps identify anatomical obstruction that shrinking the gland may not fix.

ANECDOTE

Glue Adoption Sparked By White Packing After Open Simple

Art describes first glue PAE experience after reading Romeric LaFoy's paper and trying glue on a very large gland.
The OR pack stayed white after simple prostatectomy, convincing him glue reduced bleeding and worked well.

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Prostate artery embolization may be performed by interventional radiologists, but its indications are rooted in urologic evaluation. In the second installment of our 2026 PAE University Series, Dr. Chris Beck is joined by Dr. Art Rastinehad of Northwell Health, a urologist with formal interventional radiology training, to share how his dual background informs both when to offer PAE and how to execute it thoughtfully.

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This podcast is supported by an educational grant from Guerbet.

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SYNPOSIS

Dr. Rastinehad discusses his path from urology into IR and how that combined training shapes his current hybrid practice. He outlines a practical BPH consult framework grounded in urologic evaluation, emphasizing appropriate imaging, careful patient selection, and the importance of ruling out malignancy before proceeding with embolization. From his perspective, durable outcomes begin with disciplined workup and clear counseling around expectations, including sexual side effects and alternative treatment options.

The conversation then turns to procedural strategy. Dr. Rastinehad reviews anatomic considerations, large-gland and technically challenging cases, and his experience incorporating liquid embolics into PAE. He compares glue and particles, detailing workflow decisions, medication strategy, and post-procedure management. Throughout, he highlights scenarios where PAE may not be the most appropriate intervention and how other BPH tools may better serve the patient.

The episode concludes with a discussion of the future of PAE, including questions of training, collaboration between specialties, and reimbursement; underscoring the value of cross-specialty insight in contemporary BPH care.

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TIMESTAMPS

00:00 - Introduction
01:26 - Interventional Urologist with IR Roots
04:13 - Leaving Urology for IR: Fellowship Life, Case Volume & Mentors
08:45 - Building a Hybrid Urology/IR Practice
14:32 - PAE Benefits, Sexual Side Effects & Why MRI Matters
17:39 - BPH Consult Playbook
22:17 - Anatomy Deep Dive
24:27 - Edge Cases & Big Glands
28:24 - Why Glue?
35:39 - Glue vs Particles
39:40 - Post-PAE Follow-Up
41:28 - Antibiotics and Medications
46:18 - Tough Cases
50:53 - The Future of PAE

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RESOURCES

Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Study
https://pubmed.ncbi.nlm.nih.gov/39074551/

Dr. Rastinehad’s Website
https://drrastinehad.com/