Prostatic Artery Embolization (PAE) is a simple procedure that reduces the size of the enlarged prostate gland without resorting to surgery to improve urinary symptoms in patients with benign prostatic hyperplasia (BPH). PAE is considered among minimally invasive interventional radiation therapy, which is different from Cyberknife and traditional radiation therapy.
We perform this procedure for patients with benign prostatic hyperplasia (BPH) who suffer from moderate to severe urinary symptoms and do not wish to undergo surgical treatment to avoid its bothersome side effects.
Continue with us in this article to learn in detail about Prostatic Artery Embolization, when it is performed, its benefits, side effects, and whether it is preferred over traditional surgery.
What is Prostatic Artery Embolization?
Prostatic Artery Embolization is a minimally invasive procedure, meaning it is not surgery itself and does not require general anesthesia or surgical incision during the procedure. This procedure aims to block some of the arteries that supply blood to the enlarged prostate gland, leading to decreased blood supply to the prostatic tissue, causing it to necrose and shrink. This reduces pressure on the urethra (the passage of urine surrounded by the prostate gland, which becomes obstructed when the gland enlarges).
To achieve this, a catheter is inserted into the imaging devices in one of the peripheral arteries (such as the femoral artery or the radial artery in the wrist). Its path is guided using radiographic imaging, hence the name “interventional radiology”. Afterward, we pass the catheter through the arteries until we reach those that supply blood to the prostate gland. At that point, we inject certain materials aimed at blocking these arteries and preventing blood flow through them.
As a result, a portion of the prostate gland dies (not the entire gland due to multiple sources of blood supply), and the body’s immune system then removes the damaged cells and forms scar tissue. The prostate then shrinks, and urinary symptoms in patients with benign prostatic hyperplasia (BPH) improve over several months.
Advantages of Prostatic Artery Embolization
This procedure is characterized by its high success rates, with 80% of patients who undergo prostatic artery embolization experiencing significant improvement and relief of urinary symptoms, in addition to fewer side effects after the procedure. This success rate is higher when performed by highly experienced interventional radiologists at Bimaristan Medical Center. Among its important advantages are:
- Minimal sexual side effects.
- Reduced risk of urinary incontinence.
- Same-day discharge from the hospital.
- Fast recovery and minimal downtime.
When is prostatic artery embolization performed?
Embolization is performed to treat benign prostatic hyperplasia (BPH) when the patient experiences severe bothersome urinary symptoms and does not achieve the desired benefit from medication. Urinary symptoms treated by interventional radiology prostatic artery embolization include:
- Difficulty starting urination.
- Weak urine stream.
- Frequent and urgent need to urinate.
- Dribbling urine at the end of urination.
- Incomplete bladder emptying after urination.
Failure to treat benign prostatic hyperplasia can lead to various complications, including recurrent urinary tract infections and urinary retention in advanced stages. Many patients prefer to avoid surgical treatment for BPH to avoid side effects, especially those affecting sexual function (such as erectile dysfunction and retrograde ejaculation) and urinary symptoms (such as urinary incontinence and bleeding).
Instead, they opt for non-surgical treatment of benign prostatic hyperplasia through interventional radiology prostatic artery embolization because it does not require general anesthesia and has fewer complications and side effects after the procedure compared to other treatment options. There are other non-surgical options in Turkey, such as treating prostatic enlargement with steam.
Who Benefits the most from prostatic artery embolization?
Studies are still ongoing to determine the patients who benefit the most from undergoing prostatic artery embolization (PAE) for the treatment of prostate enlargement. However, generally, the conditions for performing PAE in cases of prostate enlargement include the following:
- Severe or moderately severe urinary symptoms due to prostate enlargement.
- Prostate size larger than 40 milliliters.
So far, a specific size has not been determined for performing this procedure. However, if the enlargement is severe, meaning the prostate size is larger than 100 milliliters, surgical treatment should be considered instead of embolization. The patient may need prostate gland removal, and one of the preferred options available in Turkey for such cases is robot-assisted prostatectomy for better results.
It’s worth noting that PAE cannot always be performed for all patients. Evaluation of the condition by a urological surgeon is necessary to determine the optimal and best treatment option for the patient. Cases where PAE should not be performed include:
- Patients with malignant tumors.
- Patients with kidney failure.
- Presence of large diverticula or bladder stones.
- Neurogenic bladder.
- Weak detrusor muscles.
- Urethral stricture.
- Urinary tract infection or prostatitis.
- Arterial sclerosis (in some cases).
In these cases, other more effective treatments are sought to improve the patient’s urinary symptoms.
Before prostatic artery embolization
Before undergoing PAE for prostate embolization, the patient undergoes a series of laboratory and radiographic investigations to ensure there are no contraindications for embolization. Additionally, radiographic imaging of the pelvic area using magnetic resonance imaging, CT scans, or X-rays is performed to determine the arteries supplying blood to the prostate gland.
Based on the radiographic imaging results, the appropriate arteries to be closed to achieve the best benefit with minimal side effects from PAE are identified.
Prostatic artery embolization for artery occlusion does not require general anesthesia. During the procedure, only sedative and pain-relieving medications are administered, and the patient remains awake. The procedure is painless and does not involve surgery.
During prostatic artery embolization
As mentioned earlier, the procedure is simple and does not involve general anesthesia. It involves inserting a small needle into the wrist or thigh, passing a sterile wire called a catheter through the artery, and administering a set of medications to keep the patient calm if anxious.
Additionally, prophylactic antibiotics and anti-inflammatory drugs are given to prevent complications. The catheter is then passed until it reaches the arteries of the pelvic area. At this point, the interventional radiologist injects a contrast agent under X-ray guidance to visualize the artery’s path beyond the injection site.
A urinary catheter may be used to aid in visualizing the organs more clearly on X-ray. Using radiographic imaging, we can differentiate between the arteries supplying blood to the prostate and those supplying blood to other organs. The catheter is then advanced until it reaches an artery that supplies blood to the prostate gland alone.
Occluding one of these arteries will only reduce the size of the prostate gland. Therefore, the artery’s passage is closed by injecting specific materials that block its passage and prevent blood flow through it. The same procedure is repeated on the arteries of the opposite side of the gland. There are various embolic materials available for this purpose, including:
- Polyvinyl alcohol particles
- Microscopic gelatin spheres
- Microscopic hydrogel beads
The choice of embolic material depends on its size and type, and it is left to the discretion of the specialist to select the most suitable type for the patient. Bimaristan Medical Center will guide you to the best interventional radiologists in Turkey for the treatment of benign prostatic hyperplasia.
After Prostatic Artery Embolization
Since prostatic artery embolization is a simple procedure, the patient can return home on the same day of the procedure. This helps improve urinary symptoms faster because the patient can still move and walk freely immediately after the procedure.
Improvement in the patient’s condition is expected several weeks after the procedure (as it is not surgical, improvement is not immediate), and the patient gradually improves over 6 months after the procedure. The patient may experience some pelvic pain for a short period after the procedure, but it quickly subsides. The patient is monitored during and after this period by a specialist.
Complications of Prostatic Artery Embolization
Prostatic artery embolization using interventional radiology is considered a very safe procedure, and the resulting complications are rare and not serious. The main complications of prostatic artery embolization include:
- Necrosis of adjacent prostate tissues (this is avoided by accurately identifying the artery to be occluded so that it only supplies the prostate gland).
- Blood in semen, urine, or stool.
- Leakage of blood from the catheter insertion site in the wrist or thigh.
- Nausea, vomiting, and fever.
- Pelvic pain.
- Painful and frequent urination.
Most of these symptoms disappear after a few days of undergoing PAE and do not persist for long. The patient can quickly return to normal life, especially when the procedure is performed by highly experienced doctors in the field of prostatic artery embolization.
Prostatic artery embolization (PAE) can be considered a very promising procedure in Turkey for treating prostate enlargement using interventional radiology. It offers significant advantages over transurethral resection of the prostate (TURP) in terms of downtime, side effects, and degree of symptom improvement after the procedure. Prices for prostatic artery embolization in Turkey start from $3800. Contact Bimaristan Medical Center for a free consultation and initial treatment plan to guide you to the best interventional radiologists in Turkey.
References:
