What is Prostatic Artery Embolization (PAE)?
April 2, 2021
When medical management for Benign Prostatic Hyperplasia (BPH) fails, it’s time to discuss appropriate surgical treatment options. Traditionally, Transurethral Resection of the Prostate (TURP) and, more recently, the Urolift procedure, have been the most widely studied, effective and performed procedures to alleviate BPH symptoms.
Well, there’s a new kid on the block touting effective treatment of BPH: Prostatic Artery Embolization (PAE). While it’s considered an alternative treatment method for BPH, research and studies following the long term outcomes of the procedure are variable and conclude that effectiveness may not stack up as well against a TURP or Urolift. The general thought is, PAE is promising, but it may not be ready to be widely used as a treatment option just yet. The data on PAE post surgical outcomes is too widely varied and PAE, at this point, should be considered investigative at best. More research needs to be gathered to truly measure its effectiveness and safety against the current well established surgical treatment options.
What is BPH?
Most men, as they get older, begin to experience urinary problems. This is due to the benign growth of the prostate as men age, also called benign prostate hyperplasia (or BPH). This is a common, progressive urological condition, typically beginning around age 50 with 50% of men exhibiting some signs of BPH at age 60. By age 85, 90% of men will have signs of BPH.
BPH is normal prostate tissue growth which begins to obstruct the outlet of the bladder– squeezing down on the urethra. It is not a cancerous condition and does not predispose one to cancer. Typical symptoms of BPH are urinary frequency, urgency, incomplete emptying, weak or slow urinary stream, getting up a lot at night to urinate, straining to start a urinary stream and frequent prostate or urinary tract infections. BPH is a progressive disease and can lead to bladder damage, chronic infections, the inability to urinate, blood in the urine, and even kidney damage if left untreated.
Treatment of BPH
The simplest place to start with treating BPH is with lifestyle changes and prescription medications. However, this is often not very effective if the prostate has grown large enough . If medical therapy fails due to the severity of BPH or because BPH has progressed to the point that non-surgical treatments no longer work, then surgery is usually required to remove the obstructing prostate tissue. The prostate stays intact, just the tissue obstructing the bladder is removed.
What Surgical Procedures Treat BPH?
TURP (Transurethral Resection of the Prostate): A TURP is the most common surgery for BPH with approximately 150,000 performed each year in the U.S. It is a day surgery performed under general anesthesia and typically takes one hour. A resectoscope is inserted through the tip of the penis into the urethra. The resectoscope contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. The removed prostate tissue pieces are carried by the irrigating fluid into the bladder and then flushed out. There are no surgical incisions with this procedure. Typically, you go home the day of the surgery and a catheter temporarily stays in place for a few days before being removed in the office. The patient is usually able to resume most daily activities the next day, however, strenuous activities will be restricted for 2 weeks to prevent prostate bleeding. Dramatic changes in urination are seen about 2 weeks post surgery which continue to improve within the next 3 months.
Urolift: Urolift is a minimally invasive approach to treating BPH. The procedure uses a few small implants that lift the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. It is often done in the office without the need for general anesthesia, only light sedation. It takes less than 30 minutes and there is often no catheter to go home with. Men begin to see results quickly within 2 weeks and results are proven to last for many years post procedure. Eligibility for this procedure is dependent on prostate size.
Prostatic artery embolization (PAE): As we mentioned before, PAE is a very new addition for the treatment of BPH. PAE is a minimally invasive treatment and the procedure is performed by an interventional radiologist (IR), a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions. Initially, a Foley catheter may be inserted into the bladder to provide a reference point for the surrounding anatomy. PAE is then performed through a small catheter inserted by the IR into the artery in the wrist or groin. The interventional radiologist guides the catheter into the vessels that supply blood to the prostate. An X-ray with dye (arteriogram) is performed to map the blood vessels that “feed” the prostate. Tiny round microspheres (particles) are injected through the catheter and into the blood vessels that feed the prostate to reduce its blood supply. Ideally, following this procedure, the prostate begins to shrink, usually relieving and improving symptoms within days of the procedure. It received FDA approval relatively recently and is not widely used yet, as patient outcomes and complications vary greatly in research.
For more information about BPH and BPH treatment options, contact Austin Urology Institute at (512) 694-8888 or fill out our contact form to make an appointment with a provider.