Prostate Artery Embolization (PAE)

Common Symptoms

• Difficulty starting urination

• Weak urine stream

• Inability to urinate

• Increased urinary frequency

• Dribbling at the end of urinating

• Incomplete emptying of the bladder

• Incontinence

Diagnosis

Diagnosis usually includes a physical exam including a digital rectal exam to assess the size of your prostate. A urine test known as a urinalysis and a prostate/bladder ultrasound evaluation may also be needed. In some cases, a prostate specific antigen (PSA) test is done to help rule out prostate cancer, which can have similar symptoms.

Prostate Artery Embolization (PAE) Treatment

Most patients are candidates for PAE, which is a non-surgical, outpatient, minimally invasive treatment. PAE not only treats the symptoms of BPH, but also has a lower risk of sexual side-effects (retrograde ejaculation or erectile dysfunction) compared to surgery.

PAE is performed through a small nick in the wrist or groin without a major incision. Light sedation and pain medications are given for relaxation and pain control. Most men will not feel any pain during the procedure as a result. A catheter is then inserted through the access site artery and advanced into the blood supply of the prostate gland using fluoroscopy to embolize or block off these arteries. This results in shrinkage of the prostate gland, especially around the urethra, thus alleviating the urethral narrowing. Over the course of a few months, BPH symptoms or LUTS are improved.

The procedure can take anywhere from 1 to 2.5 hours depending on the location and size of the prostatic arteries. Patients walk out of the treatment center the same day and can drive the next day.

PAE Benefits

• Can be performed on moderate or large sized prostate glands with no upper size limit

• No incisions

• No hospital stay – outpatient procedure

• Quick recovery

• No foley or bladder catheter use in most patients

• Low risk of sexual side effects such as erectile dysfunction or retrograde ejaculation compared to surgery

• No risk of urinary incontinence or leakage of urine into surrounding healthy tissue

• Minimal pain and swelling after treatment

• PSA generally drops to very low levels after PAE

• Very low complication rate (less than 1%)

PAE Risks

PAE is a complex procedure that should only be performed by experienced and properly trained interventional physicians possessing a strong understanding of the disease and pelvic vascular anatomy. Patients may experience “post-PAE syndrome” for days following the procedure, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination. Medications usually lessen these symptoms. Other risks include bleeding or infection at the incision site, blood in the urine, semen, or stool; bladder spasm; infection of the prostate; and injury to the bladder, colon/rectum, or prostate.