What is Prostate Artery Embolization (PAE)?
A minimally invasive, image-guided procedure for patients with benign prostatic hyperplasia (BPH), also known as enlarged prostate. The procedure involves placing a small catheter inside the arteries supplying the prostate gland and injecting tiny microscopic beads to cut off its blood supply. Over time the prostate gland shrinks and allows for easier passage of urine from the bladder out the urethra.
Indications for this procedure include uncontrollable hematuria (blood in urine) from the prostate, lower urinary tract symptoms (LUTS) secondary to BPH that are not controlled with medications. Lower urinary tract symptoms include frequent urination, pain with urination (dysuria), going to urinate at night often (nocturia). Patients with permanent indwelling bladder catheters due to enlarged prostates are also candidates.
For patients without indwelling catheters, most common side effects are urethral burning when urinating and frequent urination. These are effectively treated with over the counter medications. There is also a very small risk of “non-target embolization”, meaning unintentionally cutting off blood supply to nearby organs during the procedure. With PAE, organs of concern with non target embolization include the bladder, rectum, and penis. This risk is minimized with careful planning, intraprocedural mapping of blood vessels, and using the appropriate embolic material. There is a theoretical risk of sexual dysfunction after the procedure, but studies have shown there to be no risk. In fact, a minority of patients have reported an improvement in erectile function after the procedure for reasons yet unknown.
This is the least invasive outpatient procedure currently available for the treatment on BPH. All other surgical treatments require advancing an instrument through the urethra which comes with risk. Since it takes time for the prostate to shrink, the majority of PAE patients will see improvement from the procedure at earliest around 3-4 weeks after the procedure, with maximum improvement 3-6 months post procedure. Current medical data notes show very good and durable results at least 5 years out from the procedure.
PAE offers a minimally invasive procedure to patients that does not require tissue removal or manipulation through the urethra, decreases the risk of impotence and incontinence associated with surgical treatment, provides shorter recovery time, and can be done on an outpatient basis.
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