Is Prostate Artery Embolization Right For Me
PAE is for men who either don´t want to go down the traditional surgical route or are ineligible for it. A consultation with the team at MINT will determine if you are a candidate for the procedure. During this discussion, we will ask you if you have any urinary symptoms, their severity and how they impact your quality of life.
How Is Pae Done
PAE is an outpatient surgical procedure that involves injecting very small beads into small prostate blood vessels. The beads are placed using a flexible hollow tube called a catheter that is threaded to their target through an artery in the upper thigh. When done correctly, PAE has a good safety record. However, side effects can occur due to inflammation or misplaced beads.
Are There Any Risks Associated With Prostate Artery Embolization
PAE is deemed a safe procedure, but there can be some risks and complications, as with any medical treatment. According to the World Journal of Urology, some people may experience some side effects such as rectal bleeding, acute urinary retention and transient blood in the urine. Some men may experience a slight burning sensation in the pelvis for a few days following the procedure.
PAE is safer and more effective when performed by experienced professionals such as the team at MINT.
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Prostatic Artery Embolization : Costs And Coverage By Health Insurance Companies
The cost of prostatic artery embolization is usually covered by health insurance. However, international patients should inquire about costs with specialized clinics.
- Teichgräber U, Aschenbach R, Diamantis I et al.: Prostate Artery Embolization: Indication, Technique and Clinical Results. Fortschr Röntgenstr 2018 190: 847855
- Leitlinie zur Therapie des benignen Prostatasyndroms der Qualität S2e, 2014
Who Made This Decision
The decision was made by your urologist and an interventional radiologist who is going to perform the procedure. Interventional radiologists are doctors specially trained to perform minimally invasive treatments of various diseases with guidance of an x-ray machine, avoiding the need for open surgery. This includes inserting and navigating special catheters inside blood vessels.
In addition to the standard tests for prostate enlargement, you will need to have a special CT scan to help us visualise the arteries in your pelvis. This will help the radiologist to decide if the anatomy of your arteries is suitable for the treatment. If tests have shown that you are suffering from an enlarged prostate gland you probably have already been told about the more traditional treatment options, including a TURP operation and medication by your urologist or GP.
In your case, a decision was made that you are likely to benefit from an alternative non-surgical treatment option: prostate artery embolisation.
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Who Is A Candidate For Pae
All men whove been diagnosed with BPH, who experience symptoms that are not controlled well by medications and who are not able to or do not want to undergo invasive surgical treatments, are candidates for PAE. Patients must have reasonable kidney function and not be allergic to the contrast dye used during the procedure.
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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Are You A Candidate
This nonsurgical treatment is for men with enlarged prostates who have tried other therapies and want or need to avoid more invasive surgery.
- If you have urinary tract symptoms such as frequent urination or an inability to empty the bladder.
- If you have tried medication for six months or more without relief of symptoms, or if medication caused significant side effects.
- If you have been screened for prostate cancer risk.
If you are considering this procedure, our interventional radiologist will meet with you to review your medical history and imaging studies. Together, we will determine whether PAE is right for you.
For more information or to schedule a consultation with one of our doctors, please call:
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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How Long Does Prostate Artery Embolization Last
One of the main concerns men have about various BPH treatment options is how long they will last. Their concern is valid for multiple reasons:
- They want to save money
- They do not want to undergo any more treatments than they absolutely must
- If it is possible, they do not want to deal with the symptoms of BPH ever again
Since PAE is a newer form of treatment, there are not any long-term studies. However, a study by João Martins Pisco of St. Louis Hospital in Lisbon, Portugal found that patients were still experiencing good results 12 months after the procedures. Based on their findings, some estimate that the effects of the PAE procedure can last at least five years.
Who Performs This Type Of Procedure
The doctors who perform PAE are called interventional radiologists. They are medical doctors with up to seven years of additional training post-medical school.
Interventional radiologists use specialized radiology or imaging to perform minimally invasive procedures, like prostate artery embolization. They commonly use:
- Fluoroscopy (a technique that utilizes x-rays to create a real-time movie of the insides of a particular body part
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What Is Prostate Artery Embolization
Understanding Benign Prostatic Hyperplasia
The prostate is a walnut-sized gland located beneath the bladder and surrounding the urethra.
This naturally occurring prostate enlargement is called benign prostatic hyperplasia . Technically, this condition refers to the increase in the number of non-cancerous cells in the prostate.
Benign prostatic hyperplasia virtually affects all men above 50. According to the Mayo Clinic, about one-third of men experience symptoms of prostate gland enlargement by age 60. By age 80, this number can reach up to 50%. A family history of prostate problems, an unhealthy lifestyle, or comorbidities can also increase the risk of BPH.
Treatment Options for BPH
The impact of benign prostatic hyperplasia is variable among each individual. Some may experience stable, mild symptoms for many years. In contrast, others may suffer from several possible complications such as irritable bladder or even infection.
On this account, treatment for benign prostatic hyperplasia, usually surgical intervention, should be considered carefully by weighing the potential side effects and the degree of symptom improvement after the treatment.
Some traditional treatment options for BPH include:
- Transurethral resection of the prostate
- Prostatic urethral lift
PAE as a Minimally Invasive Treatment for BPH
Definition: What Is Prostatic Artery Embolization
Prostatic artery embolization is a newer procedure for treating benign prostatic syndrome .
Over 70% of men over the age of 60 have problems urinating, which is often due to an enlarged prostate gland. The disease of the benign prostate syndrome is caused by a benign proliferation of inconspicuous prostate cells. Due to the increased growth of the prostate gland, the urethra, which runs through the prostate, is squeezed, and the urinary stream is weakened. Because of the narrowed urethra, men suffer from nocturnal urination, urinary retention, or weak urinary stream with high bladder pressure.
The BPH will steadily worsen without treatment due to further growth of the prostate. In the early stages of the disease, therapy consists primarily of drug approaches. In later stages or the presence of complications such as blood in the urine, kidney damage, or deposits in the bladder , invasive therapy is recommended. There are various options for either directly removing the prostate tissue or damaging the tissue in various ways to reduce the volume of the prostate gland . Prostatic artery embolization is one of the newer procedures in treating benign prostatic hyperplasia. PAE falls under the specialty of interventional radiology .
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What Happens Before The Procedure
- You will need to have a blood test a few days before the procedure to check your kidney function, that you are not at increased risk of bleeding and that it will be safe to proceed. This may be arranged to take place at your GP surgery.
- You can continue taking your normal medication. If you are on any medication which thins the blood we ask you to call the imaging department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.
Acute Urinary Retention: Less Common
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What do you tend to see more frequently?I would say the most common thing you’re going to see, is what I would consider post-PAE syndrome, which would include urinary urgency, frequency, some degree of dysuria, some patients will have some degree of pressure or pain in the pelvis. Those are probably the most frequent things. The other things that you will see sometimes, rarely, or not as frequently as those others, is hematuria, hematochezia, hematospermia, and that’s pretty much it. That’s the great thing about this procedure, is that the side effects are pretty mild, and rare.
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What Happens During Prostatic Artery Embolisation
The outpatient procedure typically ranges from 30120 min and patients are discharged the same day after a few hours of recovery. Typically, it takes patients a few days at home to fully recover before they can return to work and other routine activities. It is common for patients to experience mild pelvic pain during and after the procedure, which usually subsides after 13 days post-procedure. After PAE, the prostate will begin to shrink over the course of the first 3 months. Symptoms usually improve within a few weeks to a few months after the procedure. The procedure is performed in the interventional radiology suite under local anaesthesia and sometimes under conscious sedation. Overnight hospitalisation is rarely required.22,31-36,42,48
Bph Treatment At Columbia Interventional Radiology
Prostate artery embolization is a minimally invasive, safe, and highly effective treatment for BPH that shrinks the prostate by blocking its blood supply. Prostate artery embolization is performed by interventional radiologists, who use tiny tools and imaging to perform procedures that would otherwise require open surgery. Most of the time, this means that patients go home on the day of their procedure with a Band-Aid instead of an incision.
During this procedure an interventional radiologist uses X-ray imaging to navigate a catheter to the vessels that supply the prostate with blood. Tiny round beadseach measuring the size of a grain of sandare injected into the catheter and into the prostate-feeding vessels. The tiny beads block the blood flow to the prostate, causing it to shrink.
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Who Can Undergo Pae
PAE offers a suitable alternative to the more traditional transurethral resection of the prostate , making it a viable solution for prostate reduction for:
- Men who take antiplatelets or blood thinners/anticoagulants, as the risk of bleeding is much less than in more invasive treatments. The procedure can also be performed without interrupting the anticoagulants
- Men who, by virtue of other medical problems, are considered too high risk for general anaesthetic can undergo PAE as it is performed under a local anaesthetic instead
- Men with very large prostates, for whom surgical options may be less safe or effective. In fact, with PAE, the larger the gland, the more effective the treatment.
- Men with permanent urinary catheters who have been told that they dont have another option it is very common for men to be able to successfully remove their catheters following PAE
- Men who dont want to undergo surgery and whose symptoms are poorly controlled on medication PAE is a much less drastic procedure than traditional surgery, and many men who dont feel comfortable going under the knife are more at ease with PAE compared to an alternative such as TURP.
Interventional Radiology Treatments For Prostate Enlargement
Benign prostatic hyperplasia is a common condition in men. The prostate becomes enlarged causing symptoms such as frequent urination, incomplete emptying of the bladder, difficulty urinating, and incontinence. More than half of men over the age of 60 have some urinary symptoms due to BPH and up to 90 percent of men over the age of 70 experience symptoms.
For some people, the symptoms interfere with daily activity and sleep. BPH is a noncancerous condition and does not require treatment unless the symptoms interfere with quality of life.
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What Can I Expect After Prostate Artery Embolization Treatment
Once the treatment is completed, the doctor removes the catheter and applies pressure to the tiny incision in your groin to allow it to heal. You will then lie flat on your back for several hours. Usually, you will be able to go home the same day, but there is a small chance you will be observed overnight and discharged in the morning. During a period of regular follow-up appointments, which can include imaging tests, your doctor will monitor your progress after the therapy.
Bottom Line: Pae Offers A Superior Treatment Option For Bph
PAE is a new and more effective approach to BPH than other traditional methods. In addition, this procedure minimizes the disadvantages of more invasive surgery like post-operative pain, longer recovery time, or qualifications for surgery.
The procedure only takes anywhere from 1-4 hours, depending on the complexity of the condition. The possibility of detecting the prostatic arteries location is one factor affecting the complexity of BPH. Overnight hospitalization after surgery is often unnecessary, and patients can be discharged on the same day.
The effects of PAE will likely appear within the first six months from the procedure, as the prostate is expected to shrink , leading to significant improvement in urinary symptoms while maintaining normal sexual functions.
However, the PAE procedure can be challenging due to the microscopic size of the prostatic arteries, which causes difficulties in navigating the catheter. Thus, by all means, PAE must always be performed by interventional radiologists under the guidance of angiography.
In conclusion, creating a successful PAE practice requires a multidisciplinary strategy incorporating urologists and interventional radiologists. The goal is not to replace current surgical treatments for BPH but rather to provide an extra option that would be appropriate for some men, including those with larger prostates, those with surgical comorbidities, or those with a strong desire to maintain sexual function.
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Details Of Prostatic Artery Embolization Procedure
This procedure is performed by placing a catheter inside the femoral artery which is then directed towards the pair of prostate arteries. Then a beaded microscopic biological substance is inserted into the arteries which blocks the blood flow.
In order to check the effectiveness of this method, a research study was conducted on 68 men, out of which 46 males reported after one month of the procedure that they all had felt noticeable relief in the intensity and severity of symptoms.
At 3-month follow-up, 38 men received PAE out of which 28 reported a marked reduction in the frequency of urination episodes per night. Researchers also believe that more than the size reduction, it is the softening of the gland which helps in relieving the symptoms. Another logical reason can be less active prostate which reduces the stimulation towards sympathetic nervous system that triggers the message for urination.
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Prostate Artery Embolization Relieves Urinary Symptoms Of Bph Without Causing Major Side Effects
- Society of Interventional Radiology
- A minimally invasive treatment that reduces urinary tract symptoms for men with enlarged prostates maintains its effectiveness for at least three years after patients undergo the therapy, according to new research. This study of 1,000 men is the largest of its kind to evaluate the long-term effectiveness of prostate artery embolization .
A minimally invasive treatment that reduces urinary tract symptoms for men with enlarged prostates maintains its effectiveness for at least three years after patients undergo the therapy, according to research being presented at the Society of Interventional Radiologyâs 2017 Annual Scientific Meeting today. This study of 1,000 men is the largest of its kind to evaluate the long-term effectiveness of prostate artery embolization .
Enlarged prostate, also known as benign prostatic hyperplasia , is one of the most common prostate problems occurring in men older than 50. According to the National Institutes of Health, as many as 14 million men in the U.S. had symptoms suggestive of BPH, which can affect 50 percent of men between 51 and 60 years of age and up to 90 percent of men older than 80.
Researchers also found that PAE, developed and performed by interventional radiologists, is especially effective in men with BPH who also have acute urinary retention or the inability to voluntarily urinate and in patients with very large prostates who are normally treated with open surgery.
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