What is Prostate Arterial Embolization (PAE)?
A minimally invasive outpatient procedure performed under X-Ray guidance by an Interventional Radiologist (a board certified minimally invasive physician) designed to shrink an enlarged prostate, thereby improving lower urinary tract symptoms, with less risk of sexual side effects, compared to traditional procedures.
What is Benign Prostatic Hyperplasia (BPH)?
Non-cancerous enlargement of the prostate gland which can constrict or block the urethra, causing lower urinary tract symptoms (LUTS) which include urinary frequency, dribbling, inability to urinate, incomplete emptying, incontinence, straining, weak stream, or frequent urination during the night (nocturia). Greater than 50% of men over the age of 60 have symptoms related to prostatic enlargement. This number approaches 90% for men in the 70-89 age group.
Procedure Specifics?
PAE is an outpatient procedure performed with X-Ray guidance under conscious sedation by an Interventional Radiology physician. A small catheter is inserted into the artery in your groin and advanced into the pelvic blood vessels. The physician will then inject contrast dye into the blood vessels to visualize the blood vessels which supply the prostate gland. Tiny round particles are then injected through the catheter into the prostatic blood vessels to reduce its blood supply. A short period of bedrest follows removal of the catheter from the artery. In the days and weeks following the procedure, the prostate will begin to shrink, leading to improvement in the lower urinary tract symptoms.
Is PAE safe and effective?
More than 20 studies including over 2,000 patients with moderate to severe lower urinary tract symptoms due to BPH show that PAE has shorter recovery and fewer complications than traditional surgery and improves symptoms and quality of life to a greater degree than medical therapy. https://www.sirweb.org/patient-center/conditions-and-treatments/enlargedprostate/
PAE Benefits?
- Shorter hospital stay and recovery time
- Low risk of sexual side effects (retrograde ejaculation, impotence)
- Low risk of urinary incontinence
- Significant improvement in urinary tract symptoms and quality of life
Potential PAE Risks?
Minor complications
- Hematoma at puncture site
- Pelvic pain
- Post-PAE syndrome including nausea, vomiting, fever, painful/frequent urination
- Bladder spasm
- Acute urinary retention
- Urinary tract infection (UTI)
- Blood in urine, semen, or stool
Major complications
- Non-target embolization which can damage the bladder, rectum, or skin of perineum/penis (less than 1%).
Is PAE for you?
The PAE procedure is for patients who are intolerant of current medications, are ineligible for or are not interested in traditional surgery. The procedure is an excellent option for older patients with multiple conditions, patients with markedly enlarged prostate glands, patients with bleeding from the prostate, patients who have had long-term bladder catheters, patients who cannot stop anticoagulation medications, and patients who desire preserved sexual function. A consultation with an Interventional Radiologist can determine if you are a candidate for PAE.