How Is Prostate Artery Embolization Done
The PAE procedure is carried out by an interventional radiologist. A tiny catheter is placed through the artery in the groin and directed under x-ray vision to the prostate artery, so that small particles can be placed into the prostate artery to decrease the blood supply to the prostate.
It is an outpatient procedure, carried out with sedation or a twilight sleep, and does not require general anesthetia.
What Treatments Are There For Bph
There are several treatment options for an enlarged prostate gland or symptomatic BPH depending on severity of the symptoms. Most men start with medications. Some of these have side effects. If the symptoms persist and the prostate enlarges or the patient cant tolerate the medications, urologic procedures can be performed. TURP is considered the gold standard procedure. This device is inserted through the penis and the offending portion of the prostate is removed.
Most patients who are candidates for a TURP as a BPH treatment could also benefit from a less invasive prostate artery embolization procedure .
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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How Long Does It Take For An Enlarged Prostate To Shrink
Over several months, the bodys immune system reabsorbs the dead prostate tissue and replaces it with scar tissue. The scar tissue slowly contracts, resulting in shrinkage of the prostate. Over six months, the prostate will shrink by 20 to 40 percent, resulting in improved and less frequent urination.
Are You A Candidate For Prostate Artery Embolization
Prostatic artery embolization is a proven minimally invasive procedure for men who are not satisfied with their current medications or treatment. Many are choosing PAE because they prefer not to undergo or are not a good candidate for surgery.
A visit to our interventional team can determine if you are a candidate for PAE. You may be asked how often you have urinary symptoms of BPH, the severity of the symptoms and how much they are affecting your quality of life. To learn more, visit Ask4PAW.com.
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Discover The Advantages Of Pae
As a treatment option, PAE is a safe alternative for men with BPH and, like other minimally invasive procedures, has meaningful advantages over traditional surgery.
One year after having the procedure, the average prostate size has shown to shrink by approximately 30%, easing a patient’s urinary symptoms, sparing erectile function, and improving the overall quality of life. Men who have undergone PAE have reported experiencing a high degree of satisfaction, which was also sustained during the first year following the procedure.
A number of benefits:
- Can be performed as an outpatient procedure
- 1 week recovery
- Less need for catheter use
- No sexual side effects. No risk of Erectile dysfunction or retrograde ejaculation
- No risk of incontinence leakage surrounding healthy tissue
- Minimal pain and swelling
- Lower risk of erectile dysfunction.
- Can be performed on moderate or large size prostate gland with no upper size limit
- PSA counts generally drop to very low levels after the procedure
- Less than 1% complication rate
- Relieves lower urinary tract symptoms such as feelings of urgency and frequency especially at night , incomplete bladder emptying, weak urine stream, intermittency, and straining while urinating
The Prostate Artery Embolization Procedure
The PAE procedure begins with a tiny incision in your upper thigh or wrist after a mild sedation medication is administered. The interventional radiologist uses this incision to insert a catheter into your arteries and guide it near your prostate. Embosphere® Microspheres, tiny round particles each about the size of a grain of sand, are injected through the catheter and into the blood vessels that feed your prostate, reducing its blood supply. By reducing the blood flow to the prostate with PAE, the prostate rapidly shrinks and allows for improvement urination without the surgical ricks.
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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?
Prior to the procedure, a nurse will insert an intravenous 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.
What Procedure Is Better Than Turp
Open prostatectomy This procedure may be more effective than a TURP if you have very severe prostate enlargement, although its rarely used nowadays because of modern alternatives such as HoLEP and because it carries a higher risk of long-term complications, such as erectile dysfunction and urinary incontinence.
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How Is Pae Done
PAE is an outpatient surgical procedure that involves injecting very small beads into small prostate blood vessels. The beads are placed using a flexible hollow tube called a catheter that is threaded to their target through an artery in the upper thigh. When done correctly, PAE has a good safety record. However, side effects can occur due to inflammation or misplaced beads.
What Happens During The Pae Procedure
It works by placing a tiny catheter into the arteries that feed the prostate gland. A solution containing thousands of microscopic plastic beads is injected these block the blood supply by shutting down blood flow to the gland. All of this is accomplished through a tiny quarter-inch hole in the skin. General anesthesia is not needed because the procedure is not all that painful. Most patients go home the same day with just a small bandage, requiring only a few days of recovery at home before returning to normal life. Over time, the prostate gland is starved of its blood supply, and it shrivels up, like a grape shrinking into a raisin, says Dr. Ayyagari. This allows the urethra to open up and urine to flow more normally. Amazingly, shrinking the prostate does not have any negative impact on sexual function, and indeed a small number of patients actually experience an improvement in their sexual function after the procedure.
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Prostate Artery Embolisation For Lower Urinary Tract Symptoms Caused By Benign Prostatic Hyperplasia
Interventional procedures guidance
Evidence-based recommendations on prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia in adults. This involves blocking the blood vessels supplying the prostate with tiny plastic particles.
Next review: this guidance will be reviewed if there is new evidence or safety concerns.
Over 50 Years Of Serving Fayetteville
Considering prostate artery embolization as an alternative treatment for your BPH? Our caring, knowledgeable interventional radiologists at Valley Radiology are here to provide you with the information you need to make an informed decision and start your journey to relief from BPH symptoms. Through every step of the process, well be ready to answer your questions, address any concerns you may have, and walk you through the process of your procedure. We take pride in the skills and experience of our doctors, but giving patients the most comfortable experience possible is our top priority. To schedule an appointment, call our office at or fill out our quick contact form today!
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How Long Does Prostate Artery Embolization Last
One of the main concerns men have about various BPH treatment options is how long they will last. Their concern is valid for multiple reasons:
- They want to save money
- They do not want to undergo any more treatments than they absolutely must
- If it is possible, they do not want to deal with the symptoms of BPH ever again
Since PAE is a newer form of treatment, there are not any long-term studies. However, a study by João Martins Pisco of St. Louis Hospital in Lisbon, Portugal found that patients were still experiencing good results 12 months after the procedures. Based on their findings, some estimate that the effects of the PAE procedure can last at least five years.
How Much Does Prostate Artery Embolization Cost
In 2017, researchers evaluated the average cost of PAE and compared it to the costs of TURP. The researchers found that, at first glance, PAE is more costly than the TURP procedure. The cost for prostate artery embolization at that time was between $1,472 and $1,680, whereas the TURP cost $1,080. However, since TURP is a procedure that must be done in the hospital, it is necessary to add in-hospital costs to get an accurate estimate. Once all the figures were gathered, the TURP procedure was nearly $5,500.
Regarding medical insurance coverage, that is entirely dependent on the patients insurance company and plan . Generally, if an insurance company covers prostate surgery, they are often willing to cover prostate artery embolization.
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Where Does Prostate Artery Embolization Fit In With The Other Treatment Options For Bph
The standard approaches to address urinary bother associated with the enlarged prostate are procedures that remove the part of the prostate that blocks the urinary pathway, and include TURP, greenlight laser, and HOLEP. These procedures can provide excellent outcomes for patients but are associated with potential hazards which can include sexual dysfunction, bleeding , and incontinence.
Alternative minimally invasive surgical techniques now available include Urolift and Rezum. Of note, the minimally invasive procedures are restricted by the size of the prostate, and if the prostate is too large, then the minimally invasive techniques are less likely to provide benefit.
PAE is an increasingly used treatment option for the management of lower urinary tract symptoms associated with prostate enlargement . It provides an innovative and effective alternative to surgical procedures and offers the opportunity for fewer hazards related to treatment.
Why Have Prostatic Artery Embolization
As the prostate gets bigger, it may constrict or partly block the urethra, causing lower urinary tract symptoms such as:
- Urinary incontinence, which can range from some leaking to complete loss of bladder control
- Irritative voiding symptoms
- Increased urinary frequency, urgency, and pain upon urination
For some patients, these symptoms interfere with their quality of life.
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What You Need To Know
- PAE symptoms related to Benign Prostatic Hyperplasia are present in about one in four men by age 55, and in half of 75-year-old men.
- Treatment is only necessary if symptoms become bothersome.
- The PAE procedure has a lower risk of urinary incontinence and sexual side effects , when compared with more invasive surgical procedures such as a TransUrethral Resection of the Prostate .
Meaning Of The Study Findings Unanswered Questions And Future Research
The findings of this study elucidate the efficacy and safety profile of PAE. Our findings provide valuable information regarding patient selection and counselling, and will be useful for designing further trials in this field.
Larger scale trials and long term follow-up data are needed before PAE is implemented as a routine treatment for BPH-LUTS. The large standard deviation in our trial emphasises that such trials should also include subgroup analyses to detect patients who benefit most from PAE, which was beyond the scope of our study. Future research should also focus on the technical aspects of PAE, to determine the most efficient and safe approach with this intervention. Further refinement of embolisation techniques might eventually enable an even greater treatment effect. Owing to its favourable side effect profile, trials comparing PAE with non-invasive treatments seem to be reasonable.
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Are There Any Risks
The procedure is relatively safe when performed by an experienced interventional radiologist. Major complications include:
- Post-PAE syndrome consisting of pain, nausea, low-grade fever, and/or painful urination
Please discuss all risks and benefits with your interventional radiologist during your consultation.
What Does The Procedure Entail
- Upon arrival in the Interventional Radiology department, an IV is started and pre-procedural antibiotics are administered to prevent infection, as well as a one-time dose of IV steroids to help decrease the inflammatory response to the embolization procedure. During the procedure, conscious sedation, or”twilight sleep” is administered by myself and highly trained nursing personnel with continuous monitoring of the patient’s vial signs.
- Once the patient is sedated, a Foley catheter is placed within the bladder lumen, if an indwelling catheter is not already in place. Of note, in non-catheter dependent patients, this will be removed at the end of the procedure while the patient is still sedated.
- The procedure is performed through a small, quarter inch incision in the right groin enabling access to the common femoral artery. If you are on blood thinners which may not be held pre-procedurally, due to other medical conditions, I may alternatively perform the procedure through the left wrist utilizing the radial artery.
- Patients remain in the Interventional Radiology recovery area for approximately 3 hours post-procedure and are then discharged home. Both a seven day course of oral antibiotics and a short steroid taper are routinely prescribed to prevent infection and decrease the inflammation within the prostate gland caused by the procedure, respectively.
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What Will Happen During The Procedure
After midnight on the evening before your procedure you should not eat or drink anything. Your doctor will tell you which medications you may take in the morning.
After you arrive in one of our outpatient offices and are ready for the procedure, we will administer a local anesthetic to numb your wrist or groin area, then insert a needle. This needle provides access for a catheter, which we will guide to the vessels that supply blood to the prostate. Your doctor will use an X-ray technique called fluoroscopy to guide the catheter into position.
Once the catheter is in place, we will inject a contrast dyewhich enables us to see the blood supply to the prostateinto the vessels. After this procedure, called an arteriogram, we will slowly inject an embolic agent into the artery through the catheter. The embolic agent flows with the blood toward the prostate and becomes wedged in the vessels supplying the prostate with blood. We will continue the procedure for several minutes until the blood flow is completely blocked, and then move the catheter to the other side of the prostate and repeat the process.
We routinely perform prostate artery embolization in under an hour, and you will then recover in your own private room. Most patients return to work in less than one week.
Bph Treatment At Columbia Interventional Radiology
BPH is a noncancerous, common condition in which the prostate becomes enlarged and constricts or blocks the urethra, causing urinary symptoms. More than half of men over the age of 60 have some urinary symptoms due to BPH and up to 90 percent of men aged 70 to 89 experience symptoms.
Symptoms of BPH include frequent urination, incomplete emptying of the bladder, difficulty urinating, and incontinence. For some patients, symptoms interfere with daily activity and sleep. BPH does not require treatment unless the symptoms interfere with quality of life.
Prostate artery embolization is a minimally invasive, safe, and highly effective treatment for BPH. During this procedure an interventional radiologist uses X-ray imaging to navigate a catheter to the vessels that supply the prostate with blood. Tiny round beadseach measuring the size of a grain of sandare injected into the catheter and into the prostate-feeding vessels. The tiny beads block the blood flow to the prostate, causing it to shrink.
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Strengths And Weaknesses Of The Study
Strengths of the study included its interdisciplinary study setting and the independent trial monitoring and data management. The study population and outcomes after TURP were similar to large series of real world data on TURP published previously and our results seem to represent clinical routine.7 Moreover, the study followed up all patients treated according to randomisation, and provided a detailed investigation of adverse events.
Our study has some limitations. The number of patients was not high enough to conclusively determine non-inferiority or inferiority of PAE versus TURP, despite the difference between the two procedures being less than the defined threshold of 3 IPSS points. Non-inferiority could not be demonstrated conclusively in the primary analysis because variability of the change in IPSS among patients in both groups was larger than the value of 4.6 assumed in the sample size calculation. A main cause for this discrepancy might have been different inclusion criteria and patient characteristics in the study taken as a basis.29 In addition, the difference between PAE and TURP in the additional baseline adjusted analysis was only slightly below 3 points , which further outlines a need for larger scale trials.