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What is prostate artery embolization?

Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common condition in older men that can cause symptoms such as poor urinary flow, frequent urination during the day and night (nocturia), incomplete bladder emptying, and sudden urge to urinate. This disease may be treated with oral medications, but not all patients have relief of their symptoms with medications alone. In patients with severe symptoms, a urologist may recommend a surgical procedure, such as transurethral resection of the prostate (TURP).

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Prostate artery embolization (PAE) is a minimally invasive alternative to surgical procedures like transurethral resection of the prostate (TURP). PAE shrinks the prostate by treating its blood vessels. It is performed by an interventional radiologist through a small incision in the upper thigh.

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Who is a candidate for prostate artery embolization?

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.

What are the benefits of PAE?

The PAE procedure is a minimally invasive procedure usually performed as an outpatient procedure.

PAE has a lower risk of sexual dysfunction than many other treatments for BPH. Approximately 80% of patients experience an improvement in overall urinary symptoms when both prostate arteries can be embolized. Patients experience noticeable improvement in urinary symptoms over a period of weeks to months.

What are the risks of the procedure?

PAE should only be performed by knowledgeable and trained interventional radiologists. Patients may experience “post-PAE syndrome” for days following the procedure, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.

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Other risks include hematoma at the incision site; blood in the urine, semen, or stool; bladder spasm; or infection of the puncture site or prostate.

The puncture site is sealed after the procedure. However, rare delayed bleeding at the puncture site is possible.
Rarely, temporary acute urinary retention (the inability to urinate) can occur for a couple of weeks requiring an indwelling catheter (Foley catheter).
A delayed urinary tract infection is possible, however, it rarely occurs. The procedure is performed in a sterile environment.

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There have been rare reports in the literature of non-target embolization, which occurs if beads enter vessels supplying adjacent structures. However, the use of Cone Beam CT during the procedure decreases this risk.

How is the procedure performed?

Your procedure will be done at El Camino Hospital where you will be set up with an IV to allow access for moderate, also known as “twilight” sedation. You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician and your interventional radiologist. You will be connected to heart, blood pressure and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation). Then your interventional radiologist will administer numbing medication (local anesthetic) to the procedure site. Using fluoroscopy guidance (X-ray) a catheter will be inserted through an artery that leads to the arteries supplying your prostate.

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An angiogram is performed where a small amount of contrast dye will “map” out the small arteries that supply the prostate. Tiny round microspheres (particles) are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply. This is the embolization process. A repeat angiogram is performed to confirm blockage of the targeted arteries then the catheter will be moved in order to treat the other side of your prostate, repeating the steps above. Once completed the catheter is removed and a seal is placed at the procedure site. The procedure takes approximately 30-60 minutes.

What should I expect after the procedure?

After your procedure you will recover for about 2 hours where your procedure site, heart rate, blood pressure, and oxygen will be monitored. Your family will be able to see you soon after the procedure in the post-operative area and you will be able to eat.

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Residual side effects from the procedure are typically due to the inflammatory response of the prostate that causes urinary symptoms which can last one to two weeks:

  • Urinary frequency (most common)

  • Nighttime urination (most common)

  • Urinary urgency

  • Mild pelvic discomfort

  • Occasional blood in your urine

Will I need a catheter to be placed?

In rare cases due to the inflammatory response of the prostate, temporary urinary retention may persist longer than your recovery time. We will have a discussion with you if you would like a Foley catheter placed so you can go home, or wait longer in recovery to see if the retention resolves.

Do I need any medications after the procedure?

You should continue to take your normal medications after the procedure. Although we may be able to taper off the prostate medications eventually, it is important not to stop them suddenly. We usually prescribe an antibiotic for 7 days after the procedure to prevent a urinary tract infection.

How do we measure success after the procedure?

The most important thing is your quality of life. Although only you can tell how satisfied you are, we use a questionnaire called IPSS (International Prostate Symptom Score) to measure the response to the treatment in a more objective way. We will ask you to answer 8 questions before the procedure and after the procedure (1 mo, 3mo and 6mo).

What is the IPSS?

It is an 8 item questionnaire to measure the impact of the prostate symptoms in the quality of life.

  1. Incomplete Emptying: How often have you had the sensation of not emptying your bladder?

  2. Frequency: How often have you had to urinate less than every two hours?

  3. Intermittency: How often have you found you stopped and started again several times when you urinated?

  4. Urgency: How often have you found it difficult to postpone urination?

  5. Weak Stream: How often have you had a weak urinary stream?

  6. Straininga: How often have you had to strain to start urination?

  7. Nocturia: How many times did you typically get up at night to urinate?

  8. If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?

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You can calculate your score using the following website.

https://www.uptodate.com/contents/calculator-international-prostatism-symptom-score-ipss

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The disease is classified based on the score:

Mild: 0-7

Moderate: 8-19

Severe: 20-35

Post-Procedure General Instructions:

Sedation

  • If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

Activity

  • You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.

  • No exercising, lifting heavy objects or strenuous activity for the next 24 hours.

  • You may shower 24 hours after the procedure.

Pain Management

  • You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.

  • If you feel that Tylenol or Advil are not enough to control your pain, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.

Diet

  • You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.

  • Make sure you drink enough fluids

Shower

  • You can take a shower tonight. You should not soak the procedure site in water (eg. bath and swimming pool) for 1 week.

When should you call your physician?

Chills or fever > 101 F
Worsening of redness or worsening of pain in the procedure site.
New lower extremity swelling.

You can reach your Interventional radiologist at 650-404-8446

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