Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that is the most common benign tumor found in men. While this condition is not life-threatening, it can seriously impact quality of life for men affected. If left untreated for a prolonged period of time, it can also affect the function of the bladder and/or kidneys. Thus, many men seek surgical treatment to address the effects of BPH, even when those treatments carry the risk of urinary incontinence or sexual side effects.
However, surgery is not the only possible solution for BPH. Prostatic artery embolization (PAE) is a minimally invasive alternative to surgical procedures used to treat BPH, such as Transurethral Resection of the Prostate (TURP). Performed by an interventional radiologist, PAE works by blocking the blood supply to the prostate, shrinking the enlarged tissue and reducing the uncomfortable, bothersome urinary symptoms of BPH. General anesthesia is not necessary, and patients are able to go home the day of their procedure rather than undergoing a hospital stay.
Who Is a Candidate for PAE?
In general, treatment is only necessary for BPH if symptoms become troublesome. When the prostate grows too large, it can constrict or partially block the urethra, resulting in increased urinary frequency and/or urgency, urinary incontinence (ranging from mild leaking to complete loss of bladder control), and pain during urination. Some patients may be ineligible for traditional surgery due to other health concerns, or they may be uninterested in surgery due to the potential for serious side effects such as retrograde ejaculation, erectile dysfunction, or incontinence. For such patients, prostatic artery embolization can be effective in reducing the symptoms of BPH without the risks of surgery.
The procedure is performed through a small puncture in the groin, which is used to thread a catheter through the artery toward the prostate. Imaging is used to guide the catheter to the correct position, and tiny particles are injected to block blood flow through the artery. The procedure is repeated on both side of the prostate, typically using the same incision for both sides.
While the procedure is short, typically taking 1 to 4 hours, the results develop gradually over the months following treatment. First the treated tissue dies, becoming softer and relieving pressure on the urethra. As the dead tissue is reabsorbed by the body, it is replaced by scar tissue that contracts, shrinking the prostate. Change is most commonly experienced one to two months after treatment, with continued improvement up to six months post-procedure.
Possible Risks of PAE
Every medical procedure carries risks, but with PAE, these risks are mild. Potentially, it is possible for the microparticles injected during the procedure to accidentally be inserted into arteries that supply structures adjacent to the prostrate like the rectum or bladder. Therefore, PAE should only be performed by a knowledgeable, trained, experienced interventional radiologist, to ensure that embolization affects only the intended tissues.
Minor complications that can arise after PAE include blood in the urine, semen, or stool; leakage of blood at the puncture site; bladder spasm; and/or infection of the puncture site or prostate. Patients may also experience “post-PAE syndrome”—nausea, vomiting, fever, pelvic pain, or painful or frequent urination—in the days following the procedure. In most cases, these complications will either resolve on their own or can be treated with a short course of medication.
While PAE is relatively new, data that has already been published indicates that 75 to 80% of men who undergo the procedure achieve satisfactory improvement of their symptoms, and results are maintained for at least three to four years. For patients unable or unwilling to undergo surgery to treat BPH, prostatic artery embolization offers an effective alternative with less risk, less pain, and reduced recovery time.
Expert Noninvasive Care
At AVA Vascular, we specialize in interventional radiological techniques that improve patient health and quality of life with minimal side effects, such as prostatic artery embolization. If you have been diagnosed with benign prostatic hyperplasia and you’re struggling with difficult lower urinary tract symptoms, PAE may be the solution. To determine if you’re a candidate for PAE, schedule an exam with AVA Vascular by contacting us here.