Lower urinary tract symptoms due to an enlarged prostate is a frequently encountered problem amongst older men. Benign prostate hypertrophy (BPH) affects 80% of men by the age of 70 years old.
Symptoms can be classified as:
Storage symptoms – Frequency, urgency, nocturia (3 or more times), incontinence
Voiding symptoms – micturition pain, hesitancy, prolongation of voiding, weak stream, incomplete emptying, dysuria, interruptions of voiding and terminal dribbling
Patients should be tried on medical therapy alpha 1 adrenergic antagonist and/or 5-alpha-reductase inhibitors for 3-6 months
What is the current gold standard?
Transurethral resection of the prostate (TURP) is considered the gold standard for treatment. Patients looking for a minimally invasive option or not a candidate for TURP (significantly enlarged prostate or high surgical risk)
When is prostate artery embolization an option?
If the prostate gland is too large for surgery
If you are a high risk surgical candidate
What are the advantages of PAE over surgery?
Performed with moderate sedation
Quicker recovery period
Avoidance of potential risks associated with surgery
Decreased risk of sexual side effects such as erectile dysfunction and retrograde ejaculation
Lower rate of major complication
What studies are needed to determine candidacy?
Urology consultation to exclude other causes of lower urinary tract symptoms
Urodynamics – to determine that detrusor contractility is adequate and assess urine flow rate
Imaging – a CT may be requested to visualize the prostate anatomy and procedural planning purposes
Blood work: CBC, creatinine, PSA
How is the procedure performed?
Access is obtained from either an artery in the groin or wrist. Contrast is injected via a catheter under fluoroscopy to identify the vessels feeding the prostate. After the prostate arteries are identified microscopic particles are injected into the arteries effectively cutting off the majority of the blood supply to the prostate.
How long does the procedure take?
Usually, 2-3 hours
Do I need to stay in the hospital after the procedure?
Procedure is performed on an outpatient basis.
90% technical success rate
What are the risks associated with PAE?
Urinary tract infection – antibiotics pre and post procedure are given to reduce risk
Non target embolization: bladder, seminal vesicles, rectum, penis
Urinary retention – which may require foley catheter placement for management
Patients are contacted via phone at specific time intervals to assess progress