New Technique May Help Men’s Nighttime Urination
Procedure partially blocks blood flow to the gland and appears to ease the night need, but skeptics exist
MONDAY, April 4, 2016 — Waking often in the night to urinate is a common problem among men who have an enlarged prostate, but an innovative new treatment has shown some promise in easing the problem, researchers are reporting.
The procedure, called prostatic artery embolization , involves placing microscopic spheres in the arteries that supply blood to the prostate gland to partially block the blood flow.
Reducing blood flow to the prostate causes the gland to soften and shrink, said lead researcher Dr. Sandeep Bagla, an interventional radiologist at the Vascular Institute of Virginia, in Woodbridge.
In their new study, Bagla and his colleagues show that PAE improves symptoms in men suffering from nocturia — waking up repeatedly during the night to urinate.
“Their urinary symptoms bothered them considerably less, and their quality of life also showed marked improvement,” Bagla said. “The improvement in quality of life stems directly from the fact that these men are getting a better night’s sleep.”
The findings were scheduled to be presented Monday at the Society of Interventional Radiology’s annual meeting, in Vancouver.
The study included 68 men who had the procedure done. Researchers were able to reach 46 of these patients one month later for follow-up, and all 46 reported fewer urinary symptoms and a better quality of life.
How Successful Is Pae For Enlarged Prostate
In a 2020 study, researchers found that PAE was as effective as TURP at relieving urinary symptoms. Researchers also pointed out two areas in which PAE was a better alternative to TURP:
- PAE patients had a greater improvement in quality of life scores compared with TURP patients.
- There were fewer adverse events reported in the PAE group than in the TURP group.
Prostate Artery Embolization Relieves Urinary Symptoms Of Bph Without Causing Major Side Effects
- Society of Interventional Radiology
- A minimally invasive treatment that reduces urinary tract symptoms for men with enlarged prostates maintains its effectiveness for at least three years after patients undergo the therapy, according to new research. This study of 1,000 men is the largest of its kind to evaluate the long-term effectiveness of prostate artery embolization .
A minimally invasive treatment that reduces urinary tract symptoms for men with enlarged prostates maintains its effectiveness for at least three years after patients undergo the therapy, according to research being presented at the Society of Interventional Radiologyâs 2017 Annual Scientific Meeting today. This study of 1,000 men is the largest of its kind to evaluate the long-term effectiveness of prostate artery embolization .
Enlarged prostate, also known as benign prostatic hyperplasia , is one of the most common prostate problems occurring in men older than 50. According to the National Institutes of Health, as many as 14 million men in the U.S. had symptoms suggestive of BPH, which can affect 50 percent of men between 51 and 60 years of age and up to 90 percent of men older than 80.
Researchers also found that PAE, developed and performed by interventional radiologists, is especially effective in men with BPH who also have acute urinary retention or the inability to voluntarily urinate and in patients with very large prostates who are normally treated with open surgery.
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What Happens During Prostatic Artery Embolization
- PAE is performed by an interventional radiologist . An interventional radiologist is a doctor who uses X-rays and other imaging techniques to see inside the body and treat conditions without surgery.
- A Foley catheter may be inserted into your urethra and positioned in your bladder to provide a reference point for the surrounding anatomy.
- PAE is performed through a small catheter inserted by your interventional radiologist into the artery in your wrist or groin. The interventional radiologist will then guide the catheter into the vessels that supply blood to your prostate.
- An arteriogram is done to map the blood vessels feeding your prostate.
- Tiny round microspheres are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply.
- The interventional radiologist will move the catheter in order to treat the other side of your prostate, repeating the steps above.
- Following this procedure the prostate will begin to shrink, relieving and improving symptoms usually within days of the procedure.
What Is Prostatic Artery Embolization
The bothersome symptoms of prostatic hypertrophy can be managed with a new and revolutionary treatment strategy, known as prostatic artery embolization . This method involves blockage of the artery that is responsible for supplying the blood towards your prostate gland. The blocking is done via spheres that are microscopic in size and have the ability to partially block the blood flow due to which the prostate gets soft and shrunk as a result of ischemia or low oxygen delivery). As a consequence, the severity of urinary complaints is also reduced significantly.
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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.
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 patientâs 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 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
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What Is Prostate Artery Embolization
Prostate artery embolization is an outpatient procedure performed by an interventional radiologist that involves the release of microscopic, plastic beads into the arteries that feed the prostate gland. The beads travel to the patients prostatic arteries, and once there, they permanently block off the blood flow thats causing the swelling in the prostate. While some enlarged prostate treatments negatively impact male sexual function, thats not the case for those who opt for PAE, says Yale Medicine interventional radiologist Raj Ayyagari, MD. “Men can resume a normal, happy life again after embolization treatment,” says Dr. Ayyagari.
New Enlarged Prostate Therapy: Fewer Side Effects
âEmbolizationâ limits prostateâs blood supply, but experts say more research is needed
MONDAY, March 24, 2014 â A new noninvasive procedure may bring long-term relief from symptoms caused by an enlarged prostate, a new study suggests.
As men age, the prostate gland grows larger and may begin to press on the urethra. Enlarged prostate affects more than half of men by age 60 and causes symptoms such as frequent urination, weak urine stream and a persistent feeling of having to urinate.
Surgery is the standard treatment for the condition, but can cause complications such as sexual dysfunction and impotence, experts note.
The new treatment is called prostate artery embolization. âProstate artery embolization is a promising therapy that has been performed outside the United States to improve menâs symptoms,â explained Dr. Man Hon, chief of interventional radiology at Winthrop University Hospital in Mineola, N.Y.
âThis procedure works by closing the blood supply to the prostate,â said Hon, who was not involved in the new study. âAs a result, the prostate shrinks in size, causes less blockage, and the symptoms improve.â
The study was conducted in Portugal and included nearly 500 men, aged 45 to 89, with enlarged prostate â formally called benign prostatic hyperplasia â who underwent prostate artery embolization.
âI believe PAE could eventually become standard treatment for enlarged prostate,â he added.
What Does Prostate Artery Embolization Involve
At the Midwest Institute for Non-Surgical Therapy, prostate artery embolization occurs on-site on an outpatient basis.
At the beginning of the procedure, your provider administers moderate anesthesia. A small pinhole incision is made in the wrist or the groin. Then, a small catheter is directed into the artery supplying the prostate. After positioning the catheter, your provider injects a series of microspheres into it. The microspheres go through the catheter and reduce blood supply to your prostate. This is called embolization. The process is then repeated on the other side, through the same incision.
Following treatment, your prostate begins to shrink. Remarkably, the prostate does not die, it just gets significantly smaller in size. Most people experience a reduction in symptoms within 24-48 hours. Over a six month period, the prostate shrinks up to 40%, which results in improved urinary symptoms.
Benefits Of Prostate Artery Embolization
The benefits of the PAE procedure include:
- It is a non-invasive, outpatient procedure
- Patients can expect to see results within a few days
- Recovery time is significantly lower
- Less risk of urinary incontinence
- Less risk of sexual side effects
- Less pain/discomfort during and after the procedure
Patients who have BPH typically suffer from the following symptoms:
- Difficulty starting the urination process
- Frequent and urgent need to urinate
- Weak stream of urine or a stream of urine that stops and starts
- Increased nocturnal urination
- Blood in the urine
Once a man undergoes this procedure, it typically takes a couple of weeks to get relief and feel like his body is functioning like it did when he was younger.
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As a native Minnesotan, Ralph Mehr was familiar with Mayo Clinic. However, he hadn’t been a patient during his 74 years. Ralph and his wife, Mary Ann, live on Big Birch Lake north of Melrose, Minnesota, which is about 190 miles from Mayo Clinic in Rochester, Minnesota. He received health care close to home at the St. Cloud VA Health Care System.
Life was good for Ralph and Mary Ann on the lake where they raised their two sons, and welcomed friends and family. However, as Ralph got older, his prostate started causing issues and discomfort.
“In 2017, I had one episode of difficulty urinating. This was followed by another one in 2018,” says Ralph. “In November 2019, my BPH symptoms and problems really progressed, and I was in a lot of pain.”
Benign prostatic hyperplasia, or an enlarged prostate, is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder.
Ralph’s symptoms worsened, and he needed to travel to a local emergency department to have his bladder drained with a catheter. His Veterans Affairs care team taught Ralph to use a catheter at home to relive urine and discomfort daily.
“The day before I was supposed to go Minneapolis, COVID-19 hit and my appointment was canceled,” says Ralph.
For Ralph, Mayo Clinic now is more than just a famous Minnesota organization. It’s part of his story â and his future.
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Are There Any Side
It is a safe procedure with mild to moderate post-surgical discomfort. The only possible side effects are bleeding and infection which are reported in less than 1% men undergoing this procedure. Since it is an invasive method and the positive effects generally lasts for 36 months to 48 months at maximum, due to which few healthcare professionals think that this method is unnecessary.
In other words, there are already pills in the market that can treat enlarged prostate, which are quite effective with minimum side effects. However, in the United States there are about 25-30 medical centers which are performing PAE as part of the clinical trial and regular treatment as well. PAE is not covered under health insurance policies but in the University of North Carolinas Center for Heart and Vascular Care, the patients who enroll in clinical trials for PAE are covered by Medicare.
Speak to your doctor if you are a candidate for Prostatic Artery Embolization Procedure.
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How Do I Know If Prostatic Artery Embolization Is Right For Me
The PAE procedure is for candidates who are either ineligible or not interested in traditional surgery. An exam with an interventional radiologist can determine if you are a candidate for PAE. At this appointment, you may be asked how often you have urinary symptoms of BPH, how severe they are, and how much they affect your quality of life.
Pre-procedure workup may include:
- Digital rectal exam to help assess the size of your prostate.
- In some cases, a prostate-specific antigen test is done to help rule out prostate cancer.
- An MRI or ultrasound of the prostate gland.
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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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 .
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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Prostate Artery Embolization For The Treatment Of Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia
Prostate Artery Embolization is performed by Dr. J. Dana Dunleavy in the Windsong Interventional and Vascular Suite for Benign Prostatic Hyperplasia . This procedure is a minimally invasive treatment performed as an outpatient with zero hospital days and results include rapid symptomatic improvement, reduced recovery, and diminished risk of side effects, including erectile dysfunction.
Details Of Prostatic Artery Embolization Procedure
This procedure is performed by placing a catheter inside the femoral artery which is then directed towards the pair of prostate arteries. Then a beaded microscopic biological substance is inserted into the arteries which blocks the blood flow.
In order to check the effectiveness of this method, a research study was conducted on 68 men, out of which 46 males reported after one month of the procedure that they all had felt noticeable relief in the intensity and severity of symptoms.
At 3-month follow-up, 38 men received PAE out of which 28 reported a marked reduction in the frequency of urination episodes per night. Researchers also believe that more than the size reduction, it is the softening of the gland which helps in relieving the symptoms. Another logical reason can be less active prostate which reduces the stimulation towards sympathetic nervous system that triggers the message for urination.
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What Is An Embolization Procedure
Embolization is a therapeutic procedure to selectively block blood flow in a specific area in the body. Embolization is performed by placing medications or synthetic materials, known as embolic agents, inside a blood vessel. The embolic agents come together to form a block in the blood vessel.
Embolic agents are placed in the targeted spot in the blood vessel by inserting a thin flexible tube into the blood vessel. Catheter embolization is minimally invasive and an effective way to control abnormal bleeding or cut off blood supply to abnormal tissue.
Prostate Artery Embolization Is A Revolutionary Enlarged Prostate Treatment
Dr. Pisco was able to modify a procedure that was done successfully for women for uterine conditions and adapted that for the prostate. The first treatment was done in 2009. As of early 2015, he has just done 800 procedures with an 85-90% success rate resulting in significant improvement of symptoms, often experienced the very same day as the procedure. It takes less than an hour to do in most cases with a tiny incision in the groin to insert a miniature catheter into an artery that then is directed to the prostate arteries, one on each side of the gland. There, tiny needs are deposited that block some of the blood flow to the prostate causing it to shrink in size. Most men experience immediate relief to their astonishment. The side effects are minimal and disappear quickly.It is also known as Prostate Embolization.Since there is no cutting, burning, lasering, medicating or removal of prostate tissue, the Prostate Artery Embolization for benign prostatic hyperplasia does not negatively affect sexual function.
This has always been one of the major drawbacks that men have had to endure with existing enlarged prostate treatments.
The sexual side effects of conventional treatments are what cause the biggest concern for men who undergo standard BPH treatments as their side effects are well known:
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