How Does Prostate Artery Embolization Work
PAE is a treatment that helps improve the symptoms of benign prostatic hyperplasia , a noncancerous enlargement of the prostate gland. BPH usually affects men as they age, starting in the 40s and progressing with each decade. It is estimated that 90% of men over the age of 80 years have this condition.
Instead of surgically cutting into the prostate gland, interventional radiologists can use vascular catheters to deliver tiny particles into the prostate glands blood vessels. The particles inhibit blood flow to the areas of the prostate most impacted by the enlargement, reducing the size of the prostate by causing the prostate to shrink.
The procedure can take up to three hours depending on the needs of the patient, such as the size and location of the arteries to be embolized.
Comparison Of Prostatic Artery Embolisation Versus Transurethral Resection Of The Prostate For Benign Prostatic Hyperplasia: Randomised Open Label Non
- Accepted 6 May 2018
Everything You Need To Know About Prostate Artery Embolization
At least half of all men in America have an enlarged prostate by the time they reach age 60. And the numbers keep rising, with over 90% having the condition by eighty. Enlarged prostates may be common, but that doesnt mean they cant disrupt your life.
Enlarged prostate, or benign prostatic hypertrophy , usually occurs with age. The condition affects your prostate, the small gland under your bladder and around the urethra that produces seminal fluid. Symptoms of BPH include:
- Inability to urinate or empty your bladder
- Dribbling after urination and incontinence
- Frequent nighttime urination
- Pain or straining with urination
- Delayed start or weak or slow urine stream
- Strong and sudden urge to urinate
- Increased risk of urinary tract infections
If youre struggling to live with the symptoms of an enlarged prostate, board-certified radiologist, Dr. Andrew Doeat Alate Health in Houston, Texas, can help. Our practice offers one of the safest treatments for enlarged prostate available: prostate artery embolization .
You dont have to live with the uncomfortable and sometimes painful symptoms of an enlarged prostate. Keep reading to learn what you need to know about PAE and how it can help you!
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Prior To The Procedure
- Talk to your doctor about any medications/vitamins/herbs/inhalers you are taking or use as you may need to stop certain ones before the test.
- Discuss any possible bleeding or clotting disorders, liver or kidney disease or a thyroid condition.
- Do not drink anything for 12 hours prior to your test.
- Talk to your doctor about taking any required medications .
- Please tell your doctor if you are pregnant, nursing or are trying to become pregnant.
- You will have blood samples taken in case you need a blood transfusion.
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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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.
Prostatic Artery Embolization Eliminates Side Effects Associated With Traditional Treatments
For men over 60, benign prostatic hyperplasia more commonly known as prostate enlargementis a common and uncomfortable condition. Most patients experience urinary frequency, urgency, and even retention. Until recently, treatments involved either medication or surgery, both of which come along with a host of side effects that include dizziness, bleeding, erectile dysfunction, and urinary incontinence.
Refined over the past decade, there is a little-known third option offered by interventional radiologists for men with prostrate enlargement. Called prostatic artery embolization , the procedure involves little more than a skin nick and catheterization.
PAE is an image-guided procedure, which means that interventional radiologists use X-ray and other imaging techniques to guide catheters to the exact area of the body being treated. With PAE, a catheter is inserted through a tiny incision in the patient’s wrist or groin and guided to the blood vessels that feed the prostrate. Then, tiny round particles are injected into the blood vessels, reducing the blood flow to the prostate. The entire procedure takes about one hour to perform and patients go home the same day.
With blood supply reduced, the prostate begins to shrink, relieving pressure on the urethra. Men usually see their symptoms relieved within days of the procedure.
Recovery time is minimal because there is no invasive surgery involved.
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About The Treatment And Evaluation Procedures
The prostate is an organ of the male reproductive system. Its primary purpose is to produce the seminal fluid that helps to preserve sperm after ejaculation. Located under the bladder, the prostate is normally about the size of a walnut, and surrounds the urethra. In older men, the prostate can become enlarged, which exerts pressure on the urethra and hinders the proper flow of urine and semen through the urethra to the penis.
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
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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.
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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How Does Pae Work
PAE begins with a tiny incision in the wrist or groin that provides the physician access to arteries that feed the prostate. Using specialized X-ray equipment, the physician passes a catheter into the prostatic artery, and guides it near the location of the enlarged prostate. Small spheres are injected through the catheter and into the blood vessels feeding the enlarged prostate, reducing the flow of oxygenated blood, thus shrinking the prostate.
Once treated, the microscopic tools are removed and a Band-AidÂ® is applied. The entire PAE treatment typically lasts 3-4 hours. Patients return home the same day. After a couple of daysâ rest, patients can return to work and normal activities.
Mayo Clinic Sends Team To Learn The Procedure
Thatâs right, the world famous Mayo Clinic, was so impressed with the results of this huge sample of successful procedures that they just sent their elite team of specialists to learn how to do it from the originator in Portugal.
Dr Martins Pisco from a small private hospital in Portugal has pioneered a revolutionary treatment for men who suffer from an enlarged prostate commonly known as BPH. Dr Pisco of St Louis Hospital in Lisbon Portugal developed this simple but effective local anaesthesia procedure as a result of his brotherâs death from a prostectomy surgical procedure. He wanted to find a safer alternative so other men would not suffer so terribly from an enlarged prostate or risk complications as a result.
Dr Pisco is 3rd from the left with the Mayo Clinic urologists and radiologists during their recent visit in January 2015.
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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.
Prostate Artery Embolization Explained
Performed as an outpatient procedure, prostate artery embolization uses X-ray technology to treat your enlarged prostate. During the process, an interventional radiologist, like Dr. Doe and Dr. Maneevese at Alate Health, makes a small incision in your wrist or groin and inserts a small catheter with a balloon at the end.
Your provider releases microspheres, or microscopic plastic beads, into the artery where they travel to the vein that brings blood and nourishment to your prostate. As they lodge in place, they restrict the supply of blood to the gland. Your provider uses imaging technology to ensure the correct placement of the beads.
Your provider then repeats the procedure on the other side. The entire process takes about 2-3 hours. You wont need general anesthesia, so you can go home when your PAE is complete, and you can expect to recover within 1-2 days.
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Uterine Artery Embolization Or Uterine Fibroid Embolization :
Uterine fibroids are the most common tumor found in women. Approximately 25% of premenopausal women suffer from fibroids. Medical treatment of the uterine fibroids using Gonadotropin Releasing Hormone Analogue such as Lupron, has been employed in some cases however, its effect to reduce the fibroid size is reversible . Surgery is another treatment option and the presence of symptomatic fibroids is the most common indication for hysterectomy . Myomectomy is another surgical treatment option that leaves the uterus in place and may therefore preserve the fertility. Currently, uterine fibroid embolization is a well-established minimal invasive treatment for symptomatic uterine fibroids.
Schematic of the various locations of fibroids within the uterus:
Submucosal fibroids indent into the uterine cavity.
Intramural fibroids are located within the wall of the uterus.
Subserosal fibroids extend from the surface of the uterus.
- Prolonged and intensive cyclical menstrual bleeding is the most frequent clinical presentation of submucosal fibroids.
- Bulk symptoms are usually caused by subserosal fibroids that compress the nearby pelvic structures, resulting in the associated symptoms of pain, urinary frequency and constipation.
- Uterine fibroids may impact fertility usually due to a submucosal fibroid distorting the endometrial cavity.
Uterine artery embolization is a minimal invasive procedure to treat uterine fibroids with comparable results to surgery and faster recovery time.
Who Is A Candidate For Pae
All men whove been diagnosed with BPH, who experience symptoms that are not controlled well by medications and who are not able to or do not want to undergo invasive surgical treatments, are candidates for PAE. Patients must have reasonable kidney function and not be allergic to the contrast dye used during the procedure.
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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.
Will I Be Sedated
The benefits from PAE normally persists for years, however, if the symptoms recurred after several years, a second procedure can be performed searching for new or re-canalized vessels supplying the prostate gland for further embolization treatment. On the other hand, if PAE failed, the transurethral/surgical treaments can still be performed by urology to treat the BPH obstructive symptoms.
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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.
Can Prostate Artery Embolization Treat My Enlarged Prostate Without A Long Recovery Time
Are you putting off treating your enlarged prostate because you fear a difficult recovery from prostate surgery or post-surgical side effects which could affect your quality of life? If so, Prostate Artery Embolization may be the answer for you.
Prostate Artery Embolization is a minimally invasive, non-surgical outpatient treatment for enlarged prostate with a much shorter recovery time than traditional procedures. PAE involves blocking off the blood vessels that feed the prostate. Over time, the prostate shrinks, thereby helping to relieve BPH symptoms.
Because the PAE procedure does not involve surgery or physical removal of part of the prostate, your recovery will consist of post-procedural symptoms that last about two to four days compared to traditional prostate surgery that may take between 3 and 6 weeks for you to fully recover. Traditionally no urinary catheter is required.
With Prostate Artery Embolization, you may feel tired after the procedure and for a few days. We recommend that you limit activities for a week. Full benefits from PAE happen gradually over 6-12 weeks as the gland shrinks. Typically, the earliest results are experienced one month after the procedure.
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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
- No retrograde ejaculation
- 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
- Inability to empty the bladder fully
- Post-urination dribbling
- 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.
Who Are Good Candidates For Pae
The best candidates for PAE are men who:
- Suffer from the most common symptoms related to enlarged prostate
- Have tried drug therapy but did not benefit from it
- Have a prostate size over 40 grams
- Cannot have general anesthesia
A patients doctor will also determine if they are a good candidate based on the results of various diagnostic tests, including:
- PSA levels
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