What Is Prostate Artery Embolization (PAE)?
Prostate artery embolization (PAE) is a minimally invasive treatment for symptomatic benign prostatic hyperplasia (BPH) that has failed traditional medical and/or surgical therapy. It is an alternative treatment for men who want to avoid surgery (or can’t have surgery) and its associated risks and side effects.
In a PAE procedure, Dr. Rami uses x-ray guidance (fluoroscopy) to guide a thin flexible tube called a catheter to the prostatic arteries and subsequently deliver tiny particles to the enlarged prostate. The particles block the blood flow to the enlarged prostate, causing it to shrink and relieve lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, burning, dribbling, incontinence or urinary retention. Men can expect a mean prostate volume reduction of 30-40%, dramatically improving or resolving LUTS, as well as improving quality of life.
What is Benign Prostatic Hyperplasia (BPH)?
Benign prostatic hyperplasia (BPH), also called prostate gland enlargement, is a common condition as men get older. In fact, 50% of males at age 60 will develop at least one symptom, 75% at age 70 and 90% at age 85. The prostate is a reproductive gland located below the bladder. Because the urethra goes through the gland, men often experience LUTS due to compression of the urethra.
How Does The Procedure Work?
The procedure involves delivering embolic agents to block blood flow to the specific arteries that supply blood to the prostate. As the prostate begins to shrink, patients will see a significant reduction or even resolution of symptoms in as little as 2 weeks. Patients may even reduce or come off prostate medications.
How Is The Procedure Performed?
PAE is an image-guided, minimally invasive procedure that uses a high-definition x-ray camera to introduce a catheter into the prostatic arteries to deliver the embolic particles. The procedure is performed in our accredited, state-of-the-art endovascular surgical center.
Prior to the procedure, a nurse will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate or deep sedation may be used by our board-certified anesthesiologists.
You will be positioned on the examining table with devices to monitor your heart rate and blood pressure attached to your body. The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape. The area will be numbed with a local anesthetic. A very small skin nick is made at the site.
Using x-ray guidance, a catheter is inserted into an artery in the groin or wrist area. Contrast material provides a roadmap for the catheter as it is maneuvered into your prostatic arteries. The embolic agent is released into one or both the right and left prostatic arteries.
At the end of the procedure, the catheter will be removed and the artery puncture sealed with a closure device. In the case a closure device cannot be utilized, manual pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed. This procedure is usually completed within 2 hours. You will recover in the post-operative area for 2-4 hours, receiving pain and anti-inflammatory medications through an IV. Your intravenous line will be removed prior to being discharged.
PAE Versus TURP, Open Prostatectomy
After initial medical therapy, transurethral resection of the prostate (TURP) still remains the gold standard of surgical treatment. However, its role is undermined by the associated risks of bleeding and lasting sexual dysfunction. With TURP, there are significant side effects, notably retrograde ejaculation (TURP 50%, open 80%), impotence (TURP 5-10%, open 15-20%), urethral stricture (up to 29%) and incontinence (up to 40%).
PAE has been demonstrated to have no to minimal association with ejaculatory and erectile dysfunction when compared with surgery. In fact, many patients report improved sexual function, likely due to reduction or cessation of prostate medications. Furthermore, since the procedure is performed as an outpatient with same day discharge, recovery is shorter compared to 5-7 days of recovery after surgery.
Prostate Artery Embolization FAQs
What Can I Expect During MY Initial Consultation?
A detailed history and physical exam will be performed. If imaging has not been obtained, an ultrasound, CT scan or MRI will be ordered to fully assess the size and volume of the prostate. On the subsequent visit, the imaging findings will be reviewed with you and the PAE procedure will be discussed in detail, planned and scheduled to be performed.
What Will I Experience During And After The Procedure?
With moderate or deep sedation, most patients are relaxed, sleepy and comfortable for the procedure. Injection of contrast material may cause a warm feeling in the body or legs which quickly subsides. PAE has minimal adverse effects. For patients without indwelling catheters, urethral burning during voiding and frequent urination have been the most common symptoms after PAE. These effects typically last 3-5 days and can be treated with non-opioid analgesic medications. Uncommonly, patients may experience rectal pain or blood in urine, stool or sperm. However, these are self-limited and usually resolved within a few days. All men will be prescribed analgesic, anti-inflammatory, and antibiotic oral regimens prior to and, in particular, after the procedure. The real expectations of the procedure will be discussed in detail with every patient prior to scheduling of the PAE procedure. Patients are able to resume normal activities usually less than one week after PAE.
When Can I Expect To See Improvement Of My Symptoms?
Patients can expect to see noticeable symptom relief in 2-4 weeks after PAE.
We invite you to contact our Peoria, AZ office today to learn more about PAE and to schedule your consultation with Dr. Rami.