What We Offer You For Prostatic Artery Embolization
- Extensive experience as one of the first in the US offering minimally invasive PAE as an alternative to surgery
- Expertise using PAE to treat benign prostatic hyperplasia safely and effectively
- Fast treatment usually on an outpatient basis, with relief within the first month for many patients
- Collaboration with Stanford Urologists and clinics to offer comprehensive urologic care
- Thought leadership by our doctors who train other interventional radiology specialists in the latest PAE advances
- Convenience and comfort for you with appointments available within days and treatment delivered in a private setting designed with your well-being in mind
- Active research programs to advance the use of this nonsurgical treatment for all appropriate BPH patients
What Is Benign Prostatic Hyperplasia
As men age, the prostate continues to grow. Benign prostatic hyperplasia is a condition that causes the prostate to be enlarged, but it is not cancer. More than 80 percent of men will develop BPH, with 50 percent of men developing the condition by the age of 50. In men with BPH, the enlarged prostate puts pressure on the urethra and bladder. This weakens and irritates the bladder, resulting in:
- Frequent urination
- Feeling of incomplete bladder emptying
- Excessive urination at night
If left untreated, BPH can lead to:
- Bladder damage and infection
Men with symptoms of BPH should seek treatment to prevent kidney damage and other serious conditions.
Understanding The Process Of Pae
The PAE treatment enables patients to get treated effectively. It is an excellent way to treat yourself if you witness symptoms such as urge incontinence and frequent urination. The PAE treatment limits the blood flow supplied to the prostrate and stops the growth.
If the vital nutrients offered by the blood vessels and the arteries which feed it get limited, the prostrate will start to shrink. After getting this treatment, the patients generally witness massive improvements in their health.
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Even though local anesthesia and sedation are used to complete this process, the treatment is non-surgical. Usually, expert radiologists conduct this process by starting with a tiny 3mm incision on the upper thigh or the groin.
They insert a small catheter via that incision that makes its way to the prostrate, guided by an x-ray. After that, they conduct the arteriogram, injecting blood vessels and the dye to highlight all the feeder arteries supporting the prostrate.
Once the prostatic arteries are highlighted with the catheter in the correct place, the radiologist will inject very small microsphere particles into the blood vessels for embolization. Or they will work in a way to block the blood flow.
The radiologist will remove the catheter and wrap the incision by placing a compression dressing when all the essential blood vessels get embolized.
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How Soon Can Prostate Artery Embolization Be Performed
PAE for BPH is not currently FDA approved for the treatment of a man with BPH and the United States. Most insurances do not cover the cost of prostate artery embolization for the treatment of enlarged prostate. PAE is available through some institutions as part of the studies. Commercially available PAE requires out-of-pocket payment for the procedure.
Prostate Artery Embolization Technique
The doctor may start by inserting a catheter into an artery in the patients groin, feeding the catheter into the blood vessels that carry blood to the prostate gland.
With the catheter in place, the doctor will inject a dye into the blood vessels to provide a map of the blood vessels that lead to the prostate.
Tiny microspheres are injected into the catheter to reach the necessary blood vessels, thereby reducing the supply of blood to the gland. Once one side of the gland has been treated, the doctor will treat the other side.
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What Are The Risks Of Pae
Just like with any medical procedure, PAE comes with a set of risks. It is considered a safe treatment option, but risks include:
- Haematoma a small bruise may form at the needles insertion site. This is quite normal and nothing to be concerned about. It can be treated by painkillers and will generally clear up on its own.
- Pain many patients experience some mild pain in the days following the procedure. This can usually be managed with over-the-counter painkillers and anti-inflammatory medication, but can occasionally become severe and warrant further intervention.
- Catheterisation in about 2-5% of cases, the treatment may cause the prostate to swell as a response to the treatment and block urinary flow. If this happens, it may be necessary to insert a urinary catheter.
- you may notice a small amount of blood in the days following your procedure. If your symptoms persist or bleeding becomes heavy, consult your doctor immediately.
- Bladder spasms the bladder can contract involuntarily, which may cause an intense urge to urinate, bladder leakage, and pain.
- Infection the prostate and needle insertion site may become infected if they are not adequately cared for in the following days.
- Post-PAE syndrome this affects about 9% of men who undergo PAE. It is characterised by nausea/vomiting, perineal pain, and dysuria
During your consultation youll be walked through all the risks and given advice on how to minimise post-treatment negative outcomes.
Preparing For Your Treatment
We’ve tried to make your experience with us as easy and relaxed as possible.
For more information on visiting hours, our food, what to pack if you’re staying with us, parking and all those other important practicalities, please visit our patient information pages.
Our dedicated team will also give you tailored advice to follow in the run up to your visit.
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Enlarged Prostate Learn About Pae A Non
Half of men 50 and older struggle with enlarged prostate, or BPH, and its uncomfortable symptoms. Prostate artery embolization is a minimally invasive procedure that can bring significant improvements for men with an enlarged prostate. Dr. Hsu, a radiologist with ARA Diagnostic Imaging, discusses this leading-edge approach with KEYE-TVs Trevor Scott on CBS Austins We Are Austin.
Trevor Scott: Welcome back to We are Austin.
Well, the month of June is mens health month. And one of the most important parts of mens well-being is prostate health. You hear that a lot. And as men get older, they may find that theyre having the uncomfortable symptoms of enlarged prostate.
Dr. Connie Hsu from ARA diagnostic imaging is joining us today to talk about prostate artery embolization, or PAE, which is a minimally invasive, leading-edge procedure that can bring significant improvements for men with enlarged prostate.
This is great. Good morning to you doctor. Thank you so much for joining us.
Dr. Hsu: Thanks for meeting with me.
Trevor: Well, I think this is a very important topic probably year-round, right? But since it is June and mens health month, lets dive in and talk a little bit about it. Maybe beginning kind of high level.
What is in an enlarged prostate?
Trevor: Interesting. Okay. So that would be my question. As gentlemen are aging, what kind of symptoms might they experience if they are dealing with an enlarged prostate?
Dr. Hsu: Yes. Happy to.
What Happens During Prostatic Artery Embolization
- PAE is performed by an interventional radiologist . An interventional radiologist is a doctor who uses X-rays and other imaging techniques to see inside the body and treat conditions without surgery.
- A Foley catheter may be inserted into your urethra and positioned in your bladder to provide a reference point for the surrounding anatomy.
- PAE is performed through a small catheter inserted by your interventional radiologist into the artery in your wrist or groin. The interventional radiologist will then guide the catheter into the vessels that supply blood to your prostate.
- An arteriogram is done to map the blood vessels feeding your prostate.
- Tiny round microspheres are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply.
- The interventional radiologist will move the catheter in order to treat the other side of your prostate, repeating the steps above.
- Following this procedure the prostate will begin to shrink, relieving and improving symptoms usually within days of the procedure.
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Why Have Prostatic Artery Embolization
As the prostate gets bigger, it may constrict or partly block the urethra, causing lower urinary tract symptoms such as:
- Urinary incontinence, which can range from some leaking to complete loss of bladder control
- Irritative voiding symptoms
- Increased urinary frequency, urgency, and pain upon urination
For some patients, these symptoms interfere with their quality of life.
What Is Enlarged Prostate Benign Prostatic Hyperplasia
Mr CM , a retired embassy officer & an American citizen settled in Thailand who is just 65, does not want his age or to be more specific his enlarged prostate limit his physical activities and desire to travel. Everyday he walks the streets of his darling city for about 5 km a day, however unfortunately he has to run to bathroom every one to three hours throught the day and night. The urgency to pass urine, when it hits, can be very creepy, according to Mr.CM.
Mr. CM, like up to 80 percent of men in their 60s, has benign prostatic hyperplasia, or B.P.H., a nonmalignant enlargement of the prostate gland. As the prostate enlarges with age, it squeezes the urethra that passes throughout it and can obstruct normal urinary flow.
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What Are The Different Ways To Embolize The Prostate Gland
The prostate gland gets blood supply from the right and left branches of internal iliac arteries. Prostate embolization can be achieved by embolizing both prostatic arteries on right and left side or by embolizing only one side. Typically, studies show that the embolization of both prostatic arteries results in higher clinical success rates of prostate artery embolization.
The PERFecTED technique for PAE: Two-step embolization technique where after initial administration of microspheres that are 100-500 micron made of hydrogel or polyvinyl alcohol , the catheter is pushed deeper in, and additional microbeads are administered.
Traditional embolization technique: is a one-step prostate artery embolization technique where the catheter is not advanced further into the prostatic artery for the second dose of microsphere administration. It appears that the traditional technique is less effective than the PERFecTED technique. For technical reasons, sometimes only traditional techniques can be accomplished.
Use of different embolization materials: embolization can be achieved using coils . Microbeads are the most commonly used material for prostate artery embolization, typically using a 2.7F catheter.
Benefits Of Prostate Artery Embolization
The benefits of the PAE procedure include:
- It is a non-invasive, outpatient procedure
- Patients can expect to see results within a few days
- Recovery time is significantly lower
- Less risk of urinary incontinence
- Less risk of sexual side effects
- Less pain/discomfort during and after the procedure
Patients who have BPH typically suffer from the following symptoms:
- Difficulty starting the urination process
- Frequent and urgent need to urinate
- Weak stream of urine or a stream of urine that stops and starts
- Increased nocturnal urination
- Inability to empty the bladder fully
- Post-urination dribbling
- Blood in the urine
Once a man undergoes this procedure, it typically takes a couple of weeks to get relief and feel like his body is functioning like it did when he was younger.
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How Does This Procedure Work Keyboard: Arrow: Down
- The procedure works by reducing or stopping blood flow to the vessels that supply the central part of the prostatic tissue to reduce the size of the gland and relieve symptoms.
- There are usually one or two vessels on each side that supply blood to the prostate. An interventional radiologist will insert a small catheter into a blood vessel in either your wrist, upper arm or your groin. The insertion point may vary due to your anatomy. The interventional radiologist will then position the catheter by feeding it into each prostate artery under imaging guidance. Microscopic particles are then injected into the prostatic arteries, blocking the blood flow to the central tissues of the prostate causing it to shrink.
Strengths And Weaknesses In Relation To Other Studies
Evidence regarding the efficacy and safety of PAE in the treatment of BPH-LUTS has mainly been based on proof-of-concept trials and cohort studies so far, and the three published trials providing comparative data have had substantial methodological limitations.11 While Russo and colleagues compared PAE with open prostatectomy in a matched pair non-randomised study,14 Carnevale and colleagues15 randomised only 30 patients to PAE or TURP. The trial15 was not registered, and did not report on a clearly defined primary outcome measure. The largest randomised controlled study published so far by Gao and colleagues13 has been questioned by the opinion leaders in the field of PAE because of major inconsistencies, including a limited adherence to fundamental standards of scientific practice, under-reporting of adverse events, and an over-reporting of the results of PAE.35
Although duration of hospital stay and catheterisation are practice dependent and were handled rather conservatively after TURP in this trial, PAE has been shown to be feasible even without catheterisation and in an outpatient setting.36 Radiation exposure of the patients receiving PAE was clearly below the thresholds recommended for such interventions by the Swiss Federal Office of Public Health37 and the mean total dose area product in this study was less than half than in other studies,38 indicating that the potential to improve radiation protection during PAE is currently clearly not yet fully exploited.
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Expertise Critical For Successful Treatment
In order to avoid possible risks, it is important for men to understand that PAE is a challenging procedure that should only be performed by experienced and properly trained interventional radiologists possessing a strong understanding of pelvic vascular anatomy. Dr. Dunleavy is a highly skilled interventional radiologist trained in the PAE procedure. He works collaboratively with the Primary Care Provider and Urologist to offer PAE when it provides the greatest benefit. PAE is not always the right choice and medical management and surgery may also be considered.
How Successful Is Pae For Enlarged Prostate
In a 2020 study, researchers found that PAE was as effective as TURP at relieving urinary symptoms. Researchers also pointed out two areas in which PAE was a better alternative to TURP:
- PAE patients had a greater improvement in quality of life scores compared with TURP patients.
- There were fewer adverse events reported in the PAE group than in the TURP group.
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Identifying The Right Candidate For Pae
Key to the effectiveness of PAE is identifying the right candidates by confirming the diagnosis, measuring prostate size and examining blood vessel anatomy.
It requires a urologic workup, Dr. Scheidt said. It needs to be proven that what the patients are experiencinglower urinary tract symptomsfits perfectly with BPH rather than other causes such as muscle or bladder dysfunction.
Other conditions to be ruled out are prostate cancer and prostatitis. To ensure patient compatibility, the workup should include a PSA test and an ultrasound or CT scan. The latter help establish prostate size, which is an important determinant of procedure effectiveness.
We know that we see the best results with a larger glandgreater than 100 grams measured off of imaging. Its not the same with smaller glands, Dr. Scheidt said.
The highway system of blood vessels in each patient is also a consideration and makes the procedure technically demanding.
Prostate artery anatomy is incredibly variable, no two are the same, he said. If the vessels are twisty and tortuous, we might not be able to get the catheter in there. The same with vascular disease and occlusions. We use MRI or CT angiography to make sure the anatomy in the vascular system is suitable for safe catheterization.
We know we could go back again and intervene if necessary, Dr. Scheidt said.
When Is This Procedure Conducted Keyboard: Arrow: Down
Prostate Artery Embolisation provides a non-surgical treatment alternative, which can usually be performed as a day procedure and does not require insertion of a urinary catheter. The treatment is performed by a highly trained interventional radiologist within a special screening room that is adapted for specialised interventional procedures.
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Cost Of Enlarged Prostate Treatment Without Insurance
At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.
At New York Urology Specialists, we offer a flat-fee all-cost-includedRezum procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment. Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.
At New York Urology Specialists, we offer a flat-fee all-cost-includedUrolift procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.
Where Does Prostate Artery Embolization Fit In With The Other Treatment Options For Bph
The standard approaches to address urinary bother associated with the enlarged prostate are procedures that remove the part of the prostate that blocks the urinary pathway, and include TURP, greenlight laser, and HOLEP. These procedures can provide excellent outcomes for patients but are associated with potential hazards which can include sexual dysfunction, bleeding , and incontinence.
Alternative minimally invasive surgical techniques now available include Urolift and Rezum. Of note, the minimally invasive procedures are restricted by the size of the prostate, and if the prostate is too large, then the minimally invasive techniques are less likely to provide benefit.
PAE is an increasingly used treatment option for the management of lower urinary tract symptoms associated with prostate enlargement . It provides an innovative and effective alternative to surgical procedures and offers the opportunity for fewer hazards related to treatment.
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