Prostatic Artery Embolization

The Division of Interventional Radiology is proud to provide prostatic artery embolization services for treatment of symptoms related to BPH for the Southcoast Hospital System.

Introduction to BPH

BPH (Benign Prostatic Hyperplasia) is noncancerous enlargement of the prostate gland that is very common in older men.
The exact cause of BPH is unknown, but it is thought to be related to hormonal changes that occur with aging.
As the prostate enlarges, it can narrow the urethra and cause symptoms including difficulty urinating, incomplete bladder emptying, frequent urination, nocturia (waking up at night to urinate), urgency (needing to urinate immediately), incontinence (loss of bladder control), urinary retention requiring catheterization, recurrent urinary tract infections (UTIs), and hematuria (blood in the urine)

BPH Treatment Options

BPH can be treated with medications that relax the prostate and improve urine flow, lifestyle changes (reduce fluid intake before bed, avoid caffeine and alcohol, exercise, etc.), surgery to remove part of the prostate (i.e. transurethral resection of the prostate - TURP), or prostatic artery embolization (PAE), which is a minimally-invasive procedure that is performed by an interventional radiologist.

What is an Interventional Radiologist? (learn more)

Interventional Radiologists (IR doctors) are physicians who perform minimally-invasive procedures in nearly every organ system of the body using ultrasound, x-ray, CT, or MRI guidance.
By performing procedures in the least invasive way possible, interventional radiologists can diagnose, treat, and even cure disease while minimizing the risk to the patient and improving health outcomes with less pain and shorter recovery times in comparison to open surgery.
Most procedures can be performed without the need for general anesthesia or admission to the hospital.

What is Prostatic Artery Embolization?

Prostatic artery embolization (PAE) is a low-risk procedure that has the potential to significantly improve lower urinary tract symptoms due to BPH.
It involves blocking the blood supply to the prostate, which deprives it of oxygen and nutrients, causes it to shrink, and improves urine flow.

How is the procedure performed?

The procedure itself is not significantly painful and is performed with sedation medicine rather than general anesthesia (no breathing tube).
The procedure is performed by inserting a small catheter/tube into the artery in either the groin or the wrist and advancing it to the blood vessel that supplies the prostate.
Once the catheter is in position, the blood vessel is blocked (embolized) by injecting small particles/beads through the catheter.
The procedure can take anywhere from 1-4 hours, depending on the size and location of the prostatic arteries.

Is PAE safe and what are the risks?

Prostatic artery embolization is a relatively safe procedure with a lower complication rate than surgery (TURP).
The main risks of the procedure include bleeding at the access site, infection at the access site or in the prostate, injury to blood vessels, and non-target embolization (blocking the blood flow to the wrong blood vessel).

What is the benefit of PAE over surgery?

No incision and no need for general anesthesia.
Lower complication rate and shorter recovery time.
Patients have the procedure and go home the same day.
Surgery is still an option if symptoms persist after PAE.

What is required before I can have a PAE?

Prior to the procedure, patients will need a CTA for pre-procedure planning to define their anatomy and identify the location of the prostatic arteries.
Patients also take International Prostate Symptom Score (IPSS) and Quality of Life (QoL) surveys before and after the procedure to establish a baseline and to be able to evaluate the outcome.
Blood thinning medications will need to be held.

How effective is PAE?

Technical success for prostatic artery embolization has been reported to be 75% to 94%.
Clinical success can be measured by IPSS and QoL score improvements and successful Foley catheter removal.
At 12 months, studies have shown an average improvement of 15 points for IPSS and of 2.2 points for QoL.
For patients with chronic urinary retention, successful Foley catheter removal rates have been reported to be 80-90%.
Most patients experience durable results; however, there is a potential for recurrence with some studies reporting a 20% recurrence rate within 5 years and 30–60% within 10 years, which may be due to glandular regrowth over time.
If symptoms persist or recur after PAE, repeat embolization or surgery can be considered.