The etiology of Benign Prostatic Hyperplasia (BPH) is intricate and a definitive agreement has not been achieved. Modern studies have shown that the occurrence of BPH is affected by adjacent organ lesions, physical and chemical factors, immunological factors, pathogen infection and other factors [1]. Due to the deep location of the prostate and the special structure of its lipid envelope, it has special anatomical and physiological characteristics, which makes it difficult to deliver drugs deep into the lesion and easy to relapse [2]. However, $\alpha$1A adrenoceptors, which are mainly distributed in the human prostate, bladder neck, bladder base, prostatic urethra and prostatic bursa, can act selectively on prostate $\alpha$1 receptor and thereby treating BPH without affecting other systems [3]. As a novel highly selective $\alpha$1A receptor blocker, cellodoxin is significantly more selective against prostate tissue than blood vessels and has an obvious diastolic effect on the smooth muscle of the lower urinary tract [4].

The precision prostate artery embolization (PPAE) is performed under the guidance of digital subtraction angiography, which can achieve necrosis and atrophy of prostate tissue, thereby alleviating clinical symptoms caused by BPH [5]. Its clinical application is a minimally invasive treatment technology that can directly reach the lesion with a high absorption rate, obvious therapeutic effect, minimal trauma, low side effects, fast patient recovery and fewer complications which is especially suitable for elderly BPH patients who are not suitable for surgical treatment [6].

This research aimed to assess the effectiveness of PPAE in combination with silodosin for treating elderly individuals with benign prostatic hyperplasia (BPH), and to evaluate the clinical outcomes of different treatment approaches.

The research found that the observation group had a considerably greater effective rate compared to the control group. After therapy, both groups showed a substantial decrease in their IPSS and BS levels compared to prior therapy. Additionally, the observation group had lower scores than the control group. The occurrence of negative responses and complications in the observation group was drastically reduced compared to the control group. This study demonstrated that following therapy, there was a significant increase in the Q_max and a significant decrease in the resistance to RU in both groups (p 0.05). Additionally, the PV and the ratio of ischemic events in the bladder were significantly reduced at 2 weeks, 1 month, 6 months and 1 year after treatment compared to before treatment. Furthermore, the observation group exhibited significant changes compared to the control group.

Finally, follow-up revealed no recurrence in the observation group. Then 1 month after treatment, 1 case recurred in 3 months, 3 cases recurred in 6 months and 5 cases recurred in 12 months. In the control group, 10 cases recurred 1 month after treatment, 13 cases recurred 3 months after treatment and 23 cases recurred 12 months after treatment. Patients with recurrence were treated with follow-up treatment in the study group and the treatment effect was the same in the study group. All patients in this study had no serious complications, only mild complications such as low-grade fever, burning sensation at the urethral orifice, blood in the urine, transient hematuria, mild pain in the pubic region and so on. The occurrence rate in the observation group was considerably reduced compared to the control group and the imaging results of the observation group indicated a favourable prognosis before, during and after follow-up. This further illustrates that precise prostatic artery embolization combined with high selectivity $\alpha$1 receptor blockers have good efficacy and high safety in the treatment of BPH in the elderly.

The BPH is more prevalent in older men and its incidence has been increasing in recent years as the population gets older. The purpose of BPH treatment is to prevent and delay the progression of hyperplasia to alleviate symptoms and improve quality of life [7]. However, as organs age and various physiological functions deteriorate, the tolerance of many patients to surgery is significantly reduced. The BPH is often accompanied by increased blood supply to the prostate, which provides an important theoretical basis for the treatment of precise prostatic artery embolization [8].

Silodosin for $\alpha$-receptor blockers can relax the smooth muscle of the posterior urethra, prostate and bladder neck and have the advantages of convenient administration. However, the curative effect of some patients is not ideal and they have certain adverse reactions [9]. Although the mechanism of prostatic artery embolization is not yet fully understood, the short and medium-term results of many studies show that clinical parameters routinely used to quantify BPH-related lower urinary tract symptoms have been significantly improved [10]. The clinical efficacy of prostatic artery embolization, combined with the generally low incidence of minor complications, makes it more suitable for the treatment of older patients [11]. Prior research has demonstrated that the clinical success percentage of BPH after transprostatic arterial embolization is 79.1–85.7%, while the short to medium-term success rate is 72.1–98%, which is derived from the statistically significant improvement in all outcome parameters, supporting the role of PAE as an effective alternative to standard operation urological treatment, especially in patients who are not candidates for operation [12]. Precise prostatic artery embolization may be performed under local anesthesia and does not harm the central nervous system, which may explain the reason for its effectiveness [13, 14]. It can obstruct the blood flow to the prostatic artery, leading to the shrinkage of the prostatic artery, a notable improvement in clinical symptoms [15], low damage to the surrounding tissue, faster recovery after surgery, a substantial therapeutic benefit and few negative side effects [16, 17].

Increased blood supply is the basic condition of BPH and the arterial source of the prostate is abundant [18]. Under the condition of cutting off the blood supply and nutrition of the tumor, the local tumor will atrophy or necrosis, which provides a theoretical basis for embolization treatment. Silodosin is a prostate $\alpha$1 receptor blocker, which has the function of relaxing the smooth muscle of the prostate, stopping congestion and improving clinical symptoms [19]. It is suggested that embolization combined with silodosin can effectively relieve the adverse symptoms of elderly patients with BPH and the current studies show that precise prostatic artery embolization can also reduce sympathetic nerve excitability, relieve pelvic floor muscle spasms, relieve congestion and reduce pain [20, 21, 22]. In summary, PPAE and highly selective $\alpha$1 receptor blockers can relieve clinical symptoms and improve urinary function in elderly benign prostatic hyperplasia patients, making it a promising clinical treatment.

Overall, this study demonstrates that precise prostatic artery embolization combined with highly selective $\alpha$1 receptor blockers is highly effective and safe in treating elderly patients with BPH. The observation group showed superior treatment outcomes, symptom improvement, lower recurrence rates and fewer complications compared to the control group. This method effectively alleviates clinical symptoms, improves urinary function and holds promising clinical application prospects.

This study demonstrates that precise prostatic artery embolization combined with highly selective $\alpha$1 receptor blockers shows significant efficacy and high safety in treating elderly patients with benign prostatic hyperplasia (BPH). The observation group outperformed the control group in overall effective rates, IPSS and BS scores, changes in Q_max and residual urine (RU), as well as reductions in prostate volume and ischemia ratio, with a lower incidence of complications. This approach significantly improves clinical symptoms and quality of life, providing an effective alternative treatment option for elderly patients who are not suitable candidates for surgery.

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

QW and HZ designed and supervised the research and WH drafted the initial version of the article. KY, JZ and JL examined unprocessed data. YB, LZ, FG, WH, JC and FL conducted statistical and bioinformatics analysis. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

The Ethics Committee of the General Hospital of Huabei Petroleum Administration Bureau is approved the probe (Reg No: 2023/BPH/345). Informed consent was obtained from all participants prior to enrollment. This manuscript describes a clinical intervention involving human subjects and was conducted in full accordance with the ethical principles set forth in the Declaration of Helsinki.

The authors appreciate the amenities provided by the institution.

The research was funded by Medical Science Research Project Plan of Hebei Provincial Health Commission (20212736).

The authors declare no conflict of interest.