Interventional Radiology Treatments For Prostate Enlargement
Columbia’s interventional radiologists are experts in prostate artery embolization, a relatively new treatment for benign prostatic hyperplasia also known as prostate enlargementthat eliminates many of the side effects associated with medications and surgical treatments.
Using image guidance and minimally-invasive tools, our interventional radiologists perform thousands of procedures each year to treat BPH and other conditions that would otherwise require open surgery. Most of the time, this means that patients go home on the day of their procedure with a Band-Aid instead of an incision.
A consultation with an interventional radiologist can help determine whether prostate artery embolization is the right treatment for you.
Why Choose New York Urology Specialists For Treatment Of Enlarged Prostate Problems
- All treatment is performed by a board-certified urologist experienced in treating men with symptoms of frequent urination, urinary urgency, urinary incontinence, and bladder pain using medical therapy, minimally invasive therapies, lasers, and open surgery.
- We are one of the few practices in the region to offer a full range of options for the treatment of urinary problems caused by an enlarged prostate in men.
- We offer treatment options for enlarged prostate, overactive bladder, UTI, and urinary incontinence in our office, which avoids the risks, costs, and recovery from general anesthesia.
- Extensive experience: Thousands of men have been treated successfully using medical therapy, surgery, and minimally invasive procedures such as Urolift procedure, Rezum surgery, Botox for overactive bladder, Interstim for frequent urination, and tibial neuromodulation.
- We also offer laser surgery for BPH , Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
- We offer diagnostic testing in our office, which avoids hospital costs.
- Confidential and Understanding Care. We understand that most of our patients desire privacy. We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
- We are conveniently located within a 30-60 minute commute to men who are seeking BPH treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.
Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists
We offer affordable appointment prices with or without insurance. We offer weekday, weekend, and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist and specialist in the treatment of urinary problems in men. He is one of the few urologists who offers a full range of treatment options for BPH . He specializes in all aspects of care for men with an enlarged prostate and urinary problems, including frequent urination at night, difficulty emptying the bladder, urinary urgency, and incontinence. He has successfully treated thousands of men with urinary problems, including urinary retention, painful urination, and frequent urination.
What Is Prostate Artery Embolization
PAE is a minimally invasive procedure performed for men with an enlarged prostate gland or benign prostatic hyperplasia . More than half of all men in their 60s and as many as 90% of men aged 70-89 years have symptoms of BPH. Symptoms include:
- Urinary frequency
- Dribbling at the end of urinating
- Inability to urinate
- Difficulty starting urination
- Straining to urinate or weak urine stream
These symptoms are not only disruptive to a mans life, but also may be interrupting the spouses sleep. Many men avoid treatment because they do not want to undergo surgery, especially with the risk of sexual side effect.
Prostate Tissue Ischemia And Infarction
PAE-induced prostate tissue ischemia contributes to a pivotal mechanism in relief of BOO and associated clinical symptoms by affecting on both the static and dynamic pathological components of BPH . On the one hand, the prostate tissue ischemia rapidly leads to ischemic necrosis or infarction, evoking the local inflammatory reactions and the subsequent tissue repair, and finally debulking the enlarged prostate in order to achieve the therapeutic purpose. Thus, early detection of prostate tissue ischemia or infarction has been deemed as a potential predictor for future clinical outcomes . On the other hand, the prostate tissue ischemia also plays a role under other mechanisms by reducing prostate smooth muscle tone or inducing prostate apoptosis . These additional mechanisms may enhance the therapeutic effects when a large prostate infarction occurs after PAE. However, even if no significant prostatic infarction is identified after PAE, some patients still show substantial clinical improvement due to the additional mechanisms. This may explain in part the current discrepancy in evaluation of prostate tissue ischemia or infarction as predictors for clinical outcomes after PAE.
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Would I Need To Use Medications After Urolift Or Prostate Enucleation
After your procedure for the treatment of enlarged prostate is performed by the urological surgeons at New York Urology Specialists, we advise continuing using the medications as instructed. Typically we advise our patients to stop medications such as Flomax 1 month after treatment with Urolift, Greenlight laser, TURP, prostate enucleation, and Rezum.
Medicare and major insurances accepted. We offer affordable rates and financing options.
What Are The Causes Of Enlarged Prostate And Bph
Over time, under the hormonal influence , the prostate increases in size. The prostate gland has a volume of 15-20 ml in young men . , it is not uncommon for the prostate gland to grow to 40-60 grams. Some men appear to have a genetic predisposition to enlarged prostate and can develop symptoms earlier in life in their mid-to-late 30s and 40s.
Almost all men develop an enlarged prostate as they get older. Some men have minimal to no symptoms of prostate enlargement other men develop symptoms as early as age 30-35.
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What Is Bph Or Enlarged Prostate
BPH refers to benign prostatic hypertrophy, a medical term that means enlarged prostate. The prostate is an organ that is present only in men. The prostate sits in the pelvis. The prostate surrounds the urethra and can affect urination if it grows by blocking urine flow. The prostate is also involved in producing semen .
Dr. Alex Shteynshlyuger has extensive experience having treated hundreds of men for symptoms of enlarged prostate and has personally performed hundreds of procedures and surgeries for treatment of enlarged prostate including Urolift, Rezum, Laser enucleation of the prostate, Greenlight Laser, Holmium laser HOLEP, and other minimally invasive procedures as well as open and robotic surgery. He specializes in the second opinion for men who had treatment for enlarged prostate but have not experienced expected results or developed treatment complications.
Prostate Median Lobe And Intravesical Prostatic Protrusion
In imaging diagnosis of BPH, the enlarged lateral lobe and median lobe represent hyperplastic glands arising from the transition zone and periurethral zone, respectively . It is commonly believed that the enlargement of median lobe may result in one or more pedunculated nodules protruding into the urinary bladder, causing mechanical bladder outlet obstruction although the lateral lobe hyperplasia may also be involved in IPP . It has been postulated that IPP creates a ball-valve type of obstruction, disrupting the funneling effect of the bladder neck, and causing dyskinetic movements of the bladder during voiding . IPP is common in aging men and documented with a prevalence of 27% in healthy Caucasian men between 4188 years . The measure of IPP or IPP index is defined as the vertical distance from the tip of the intravesical protrusion to the circumference of the bladder at the bladder neck . IPP has been widely used as a biomarker in clinical diagnosis of BOO, evaluation progression of LUTS, and prediction of treatment outcomes. Urodynamic studies demonstrated that significant IPP in patients with LUTS or BPE was associated with a higher BOO index and there was a moderate correlation between IPP and BOO index . In clinical trials on medical therapies, significant IPP has been validated as a reliable predictor for poor responses to -blocker, 5-reductase inhibitors, or combination therapy .
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What Is Prostate Artery Embolization Used For
PAE is for men who have enlarged prostates. While not life-threatening, an enlarged prostate can negatively impact a mans day-to-day life. Men with this condition can encounter sexual and urinary issues. Urine flow can become very slow and frequent. Typical medical and surgical treatments for enlarged prostates can cause severe sexual dysfunction, and a condition called retrograde ejaculation.
Whats Involved In Prostatic Artery Embolization
Prostatic artery embolization is a minimally invasive same-day treatment that requires no surgery. This treatment is effective for reducing the size of an enlarged prostate by blocking off blood flow to the area and causing the prostate gland to shrink.
At the start of your embolization, your Vein and Vascular Solutions NYC physician uses ultrasound or MRI imaging technology to evaluate the blood supply to your prostate. To block this flow of blood, they insert a catheter into the artery of the prostate through a small puncture in your skin.
Through this catheter, your Vein and Vascular Solutions NYC doctor introduces tiny microsphere particles to obstruct blood flow.
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News From Gest 2012 Us: First
Francesco Carnevale, São Paulo, Brazil, told delegates about the specifics of the case in New York. The embolization was performed in Brazil by Joaquim Mauricio da Motta-Leal-Filo, Airton Mota Moreira and Octavio Galvao.
The patient is a 60-year-old with no comorbidities who had taken medication for BPH for the past five years. He has refractory lower urinary tract symptoms but no urinary infection or acute urinary retention. The main lower urinary tract symptoms include urinary hesitancy, weak urinary stream, urinary urgency and nocturia . The patient has a severe International Prostate Symptom Score of 26 and a low quality of life score of five, he said.
He also noted that a digital rectal exam had revealed a 70g prostate with no nodules urodynamic testing had shown an infravesical obstruction and that the Qmax was 6.5mL/second.
In this case, the a 5F sheath pigtail and vertebral catheter , a microcatheter, the Renegade STC angled , a microwire, Fathom 0.016, and 300-500m Embospheres were the materials used for embolization. The endpoint was slow flow, or near stasis in the prostatic vessels, Carnevale noted.
Concept And Classification Of Clinical Predictors In Pae
Clinical predictors refer to biomedical factors known to influence diagnosis or predict health outcomes . Clinical research on predictors in PAE is for prognostic prediction to determine possible outcomes after intervention. In comparison to the diagnostic prediction models, the main difference is the time point on evaluation. In diagnosis, predictive factors are evaluated at the same time in prediction of a suspected disease, thus these studies usually involve cross-sectional analyses . Since prediction models in PAE estimate the clinical responses to therapy, such as changes in international prostate symptom score , quality of life , and maximal flow rate , which occur in a certain period after PAE prediction in PAE is typically a longitudinal study.
Type I predictors: baseline clinical data collected before PAE, including patient demography, clinical signs and symptoms, pathological features, lab tests, etc., for example, age, IPSS score, uroflowmetry data, prostate volume and associated imaging parameter , etc. Type I predictors serve to optimize patient selection for PAE.
Type II predictors: acute clinical data obtained from 1 day to 1 week after PAE, for example, 24 h-PSA, C-reactive protein level, prostate ischemia etc., which are used in prediction of short- or medium-term outcomes.
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How Is Prostatic Artery Embolization Used In The Treatment Of Benign Prostatic Hyperplasia
The incidental discovery that the use of selective prostatic arty embolization to control bleeding secondary to BPH resulted in improved LUTS led to investigation of its direct use in the relief of LUTS in patients with BPH. Although a growing body of evidence supports its safety and efficacy, PAE has yet to be established as a standard-of-care treatment option. A systematic review that included 16 studies concluded that PAE should still be considered experimental. The 2018 AUA guideline does not recommend PAE outside the context of a clinical trial.
What Happens During A Prostatic Artery Embolization Procedure At The American Hospital Of Paris
First you will have a preoperative consultation with an interventional radiologist and an anesthesiologist.
On the day of the procedure, you will be taken to the vascular suite, where an intravenous catheter will be inserted.
While the procedure is totally painless, an anesthesiologist will remain next to you should you require sedation. In most cases, a urinary catheter is not required.
On average, this entirely painless procedure lasts 90 minutes. You can choose to be conscious, or to receive a mild sedative from the anesthesiologist.
After the procedure, you will be monitored for four hours before returning home. The recovery time after an embolization is much shorter than for surgery.
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What Are The Risks Involved With Pae
PAE has been shown to have fewer side effects than other widely used treatments for BPH such as transurethral resection of the prostate surgery, which is associated with incontinence, impotence, retrograde ejaculation and erectile dysfunction issues in men. When the procedure is performed by an experienced physician, the complication rate is extremely low and the procedure is incredibly safe and effective. According to the World Journal of Urology, the following side effects can occur following PAE: transient blood in urine , rectal bleeding, and acute urinary retention. In fact, with PAE, some men may actually experience improved sexual function following the procedure.
Why Choose Weill Cornell Medicine Interventional Radiology
Convenient, individualized care:Our physicians offer personalized care, tailoring your treatment to your medical history, lifestyle and wellness goals. We are especially skilled in minimally invasive procedures, which eliminate the need for open surgery and allow for shorter and less painful recovery times.
As a patient, you will receive around-the-clock coverage, as well as access to in-person, video or phone consultations. We strive to get our patients in quickly with minimal wait time.
Multidisciplinary care from leading experts: Weill Cornell Medicine is a leader in the field of interventional radiology, with a long tradition of expertise, innovation and leadership.
When you choose Weill Cornell Medicine, you have access to a network of doctors and specialists. Often, we work as part of a team of specialists, which may include radiologists, urologists, oncologists or other specialists. This ensures that you receive the most expert and comprehensive treatment possible.
Weill Cornell Medicine also partners with NewYork-Presbyterian, one of the top hospital systems in New York City and the U.S.
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Treatment Of Enlarged Prostate Top
Our board-certified urologists specialize in evaluating men with symptoms of an enlarged prostate. We also offer second opinion services for men with prostate and urinary problems. We care for men in NYC as well as visitors both from neighboring states and international patients.
We offer affordable prices with or without insurance. We speak Spanish and Russian languages.
What Are The Risks Of Prostatic Artery Embolization
PAE should only be performed by knowledgeable and trained interventional radiologists. Patients may experience âpost-PAE syndromeâ for days following the procedure, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.
Other risks include hematoma at the incision site blood in the urine, semen, or stool bladder spasm or infection of the puncture site or prostate.
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Board Certified Vascular And Interventional Radiologist & Vascular Center Located In Midwood Brooklyn Ny
Getting older can affect the health of your prostate. If youre finding it difficult to urinate normally because of an enlarged prostate, board-certified physician Mohammed Islam, MD, and his team at Vein and Vascular Solutions NYC can provide nonsurgical prostatic artery embolization procedures on-site at their offices in the Midwood area of Brooklyn and Staten Island, New York. The painless same-day treatment can quickly resolve your symptoms and improve your urinary tract health. To find out if youre a candidate for prostatic artery embolization, call Vein and Vascular Solutions NYC today or request a consultation online now.
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:
- Urine test
- 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.
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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.
Our Approach to PAE
Johns Hopkins board-certified interventional radiologists diagnose and treat complex conditions with less risk, less pain and less recovery time, compared to open surgery and with unprecedented precision.