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Interventional Radiology

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Prostate Artery Embolization

 

What is it? 

This relatively new treatment option was developed for patients with Benign Prostatic Hyperplasia (BPH) of the prostate. This non-cancerous growth of the transition zone of the prostate gland, is a condition which becomes increasingly more common in men over the age of 50, to the point where close to 1 in 4 men over the age of 80 suffer from this condition.

Prostate artery embolization (PAE) is indicated if there are persistent lower urinary tract symptoms despite medical treatment, reduced urinary flow rates, and if the prostate is enlarged (>40ml).

 

What are the most common symptoms of bph?

The symptoms may be divided into 2 groups:

  • Storage Related

    • Need to urinate frequently

    • Waking at night to urinate

    • Urgent need to urinate

    • Involuntary urination, including urination at night

    • Urge incontinence (the urge to urinate, followed by the leakage of urine)

  • Voiding Related

    • Urinary hesitancy

    • Intermittent stream

    • Weak stream

    • Straining to void

    • Feeling of incomplete voiding

    • Terminal dribbling

 

How do you treat BPH?

The treatment of BPH can be complex, and usually involves lifestyle changes, as well as medical treatment, before surgical options are considered.  Many patients respond very well to these, and do not require further treatment.

If symptoms do not improve, surgical options may be considered, which include the following:

  • Open prostatectomy

    • This procedure is very effective, but comes with many side effects, and a long recovery time, and is rarely used

  • Trans-urethral resection of the prostate (TURP)

    • Currently considered the best surgical treatment, with fewer side effects than open surgery, and good results

    • Side effects remain considerable, and recovery times remain long (3-6 weeks)

  • Holmium laser enucleation of the prostate (HoLEP)

    • This is being used more and more, and will likely replace TURP as the surgical procedure of choice

    • The side effects are similar to TURP, but the recovery time is much quicker (1-2 weeks)

Prostate Artery Embolization is a relatively new procedure, with a comparable relief in symptoms, a better side effect profile, and a much quicker recovery time, and is usually performed as a day case.

 

How are you assessed for embolization?

  • Although we do welcome self referrals, you may also be referred via your Urologist for this procedure after a full physical and urological examination.

  • We will arrange a consultation with you, where one of our Interventional Radiologists will discuss the procedure, risks and any concerns you may have.

  • If you have not been assessed by a Urologist, we will refer you to one of our colleagues. It is important to establish that the symptoms are not caused by something else, such as bladder dysfunction, or prostate cancer. Many of the symptoms of these conditions overlap, and often co-exist.

  • Once all your questions have been answered, and you are happy to go ahead with the procedure, we will arrange a date which best suits you.

  • We will also arrange a CT scan to be performed a few days before the procedure, to map out the arterial system, as there is great variation from person to person.

  • On the day, you will be admitted into hospital

 

 

What happens during an Embolization?

  • The embolization is performed in the X-Ray department with the use of local anaesthetic and pain-relieving drugs. You are carefully monitored throughout the procedure by our trained Interventional nursing and radiography staff.

  • The procedure is done under X-ray guidance.

  • A small catheter is introduced into the radial artery (arm) or femoral artery (groin). In most men we will use the radial artery approach, as this is more comfortable for our patients, but also makes the procedure easier for us, leading to quicker procedure times, and less radiation exposure.

  • The catheter is advanced into the pelvic area where the Radiologist will identify which arteries need to be embolized. This requires a small amount of contrast dye to be injected.

  • Embolization is done by injecting small particles (microspheres), the size of tiny sand grains, into the identified arteries.

  • The microspheres block the arteries limiting blood supply, which causes the prostate to shrink and symptoms to reduce or disappear.

  • Most men will be discharged later the same day, with medication to help with post procedure discomfort,

 

What are the Advantages? 

There are many benefits of having a PAE compared to the surgical option

  • Minimally Invasive

  • Reduced hospitalisation, performed as a day case, under local anaesthetic

  • Reduced recovery time

  • Preservation of sexual function

  • Fewer complications

  • Reduced urinary catheterisation time, and sometimes this is avoided completely

  • Increased comfort

 

Risks Post PAE

  • Accidental release of the particles into an artery that feeds the bladder or rectum which could potentially cause complications. This is very uncommon though

  • Post PAE Syndrome – this may lead to nausea, vomiting, fever, pelvic pain, frequently or painful urination

  • A haematoma may occur at the puncture site

  • Blood may occur in urine, semen or stools and you may experience bladder spasm

  • An infection may occur at the puncture site or in the Prostate

 

More info about the procedure? 

 

Questions?