Overview Of Applicable Medical Devices For Pae
Types of Embolic Material
Materials, characteristics, and approaches for use. Currently used embolic agents for PAE include polyvinyl alcohol particles and spherical embolic agents such as spherical PVA , trisacryl gelatin microspheres , polyzene-coated hydrogel microspheres , and polyethylene glycol microspheres .1-24,33-35 There are limited comparative studies between the different commonly used embolic agents for PAE and no clear benefit of one over another.34,36,37 Basic knowledge of how to use and prepare these embolic agents for PAE is required because prostatic arteries are small, and premature stasis may be obtained after only 1 or 2 mL of the embolic solution have been injected, leading to suboptimal results.
To avoid premature stasis during PAE, the operator has four options: place the microcatheter distally inside the prostatic arteries to avoid clumping of the embolic material proximally inside the main prostatic artery trunk use very diluted embolic solutions flush the microcatheter with saline with every 1 to 3 mL of embolic solution injected and downsize the embolic materials.
Catheters and Wires
How Do I Know If Prostatic Artery Embolization Is Right For Me
The PAE procedure is for candidates who are either ineligible or not interested in traditional surgery. An exam with an interventional radiologist can determine if you are a candidate for PAE. At this appointment, you may be asked how often you have urinary symptoms of BPH, how severe they are, and how much they affect your quality of life.
Pre-procedure workup may include:
- Digital rectal exam to help assess the size of your prostate.
- In some cases, a prostate-specific antigen test is done to help rule out prostate cancer.
- An MRI or ultrasound of the prostate gland.
What Is The Success Rate Of Pae
Prostate artery embolization has a high rate of success, with over 90% of men experiencing relief in the first year. Unlike other treatments that may have unwanted sexual side effects, PAE does not affect sexual performance.
Whats more? Additional research indicates that PAE also has long-term success in treating an enlarged prostate. A recent review of men treated with PAE found 82% were still enjoying a successful PAE three years after their procedure, and about 78% had success following the 3-year mark.
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How Is Prostate Artery Embolization Performed
Prostatic artery embolization is performed through a small puncture in the wrist or the groin. A catheter is inserted through the artery and advanced towards the prostate. Once the catheter is positioned in the artery supplying blood to the prostate, tiny particles are injected that are lodged in the tiny branches within the prostate, blocking blood flow. The blockage of these branches is called embolization. The procedure is then repeated on the other side of the prostate. The procedure can take anywhere from 1-2.5 hours, depending on the location and size of the prostatic arteries. Most men will not feel any pain during the procedure except minor pinch at the access point in wrist or groin. Mild sedatives are used to alleviate anxiety, however patients are awake during the procedure.
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.
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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.
What Are Other Benign Prostatic Hyperplasia Surgery Options
If your symptoms are severe or minimally invasive surgical treatments dont help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Other prostate procedures include:
Transurethral resection of the prostate : This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra. This is why it is called transurethral. Inserting the scope this way means no cutting into the prostate. They will then use the charged resectoscope to remove the excess tissue that is blocking the urine from leaving the bladder.
You may be put to sleep with general anesthesia. Local anesthesia for the lower part of the body may be used for this procedure. The average in hospital stay for TURP is 1 to 2 days.
Transurethral incision of the prostate : This is a similar procedure to TURP. Instead of prostate tissue being removed the bladder neck and prostate are cut to relax the bladder opening, allowing urine to flow more freely. TUIP is most successful on men with smaller prostates.
Simple prostatectomy: This method is a surgical procedure in which an incision is made through the abdomen or performed laporoscopically. The inner portion of the prostate gland is removed, leaving the outer segment intact.
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Prostate Artery Embolization For The Treatment Of Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia
Prostate Artery Embolization is performed by Dr. J. Dana Dunleavy in the Windsong Interventional and Vascular Suite for Benign Prostatic Hyperplasia . This procedure is a minimally invasive treatment performed as an outpatient with zero hospital days and results include rapid symptomatic improvement, reduced recovery, and diminished risk of side effects, including erectile dysfunction.
What Does It Mean To Have An Enlarged Prostate
Having an enlarged prostate, a common part of aging, is also known as Benign Prostatic Hyperplasia or benign prostatic hypertrophy.
This occurs when the prostate gland becomes very large, it and may cause problems passing urine. BPH is not cancer.
As the prostate grows, it presses against the urethra, the tube that carries urine out of the body. This interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract, even when it contains only small amounts of urine. This can cause more frequent urination. These changes cause the bladder muscle to weaken. It may not empty fully and can leave some urine behind. This leads to symptoms.
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The Use Of Pae In Clinical Practice
In 2000, DeMeritt et al. performed the embolization of the right lower cystic artery in a76-year-old man with incurable macrohematuria caused by BPH. Transcatheter arterialembolization of the right lower cystic artery was performed using polyvinyl alcohol until the prostate was completely devascularized. Based on the results of a12-month follow-up, it was noted that the International Prostate Symptom Score improved from 24 to 13 points and prostate volume decreased by 40% from 305to 190 ml.
In Russia, the first results of the clinical use of PAE for BPH treatment werepresented by Yakovets et al. in 2010. From 2004 to 2010, 38 patients with BPH and severeconcomitant pathology, which did not allow traditional surgical treatment, underwentPAE. Embolization was successfully performed for all 38 patients the quality ofurination improved in all patients, prostate volume decreased, and 4 patients hadcystostomy drainage removed.
Carnevale et al. performed PAE in two patients using 300500 µm microspheres. Six months later inboth cases, a decrease of infravesical obstruction, prostate volume, and volume ofresidual urine was noted. Later in 2011, the same authors presented the medium-termresults of treatment of the same patients: The volume of the prostate did notincrease and the quality of urination after 30 months of observation was similar tothe value at the 6-month point .
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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First What Is An Enlarged Prostate
The urethra runs through the prostate.
Prostate enlargement is a normal occurrence among older men. The prostate can enlarge as men experience age-related changes in their cell structure and hormone levels, especially after 50.
An enlarged prostate, also called benign prostatic hyperplasia , puts excess pressure on the urethra and can block urine flow, causing frequent urinary tract issues.
The direct cause of an enlarged prostate is still widely unknown, but there are key factors to consider when discussing this condition, including
- The likelihood of developing an enlarged prostate increases with age beginning at 40.
- More than 90% of men over 80 have an enlarged prostate.
It is important to note that an enlarged prostate is not cancerous and does not increase your chances of developing prostate cancer.
Over 50 Years Of Serving Fayetteville
Considering prostate artery embolization as an alternative treatment for your BPH? Our caring, knowledgeable interventional radiologists at Valley Radiology are here to provide you with the information you need to make an informed decision and start your journey to relief from BPH symptoms. Through every step of the process, well be ready to answer your questions, address any concerns you may have, and walk you through the process of your procedure. We take pride in the skills and experience of our doctors, but giving patients the most comfortable experience possible is our top priority. To schedule an appointment, call our office at or fill out our quick contact form today!
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What You Need To Know
- PAE symptoms related to Benign Prostatic Hyperplasia are present in about one in four men by age 55, and in half of 75-year-old men.
- Treatment is only necessary if symptoms become bothersome.
- The PAE procedure has a lower risk of urinary incontinence and sexual side effects , when compared with more invasive surgical procedures such as a TransUrethral Resection of the Prostate .
What Is An Enlarged Prostate
The prostate gland, located under the bladder and surrounding the urethra, is responsible for the production of seminal fluid. Many older men experience growth in their prostate as they age, leading to benign prostatic hypertrophy or an enlarged prostate gland.
As the gland enlarges, it constricts the urethra and puts pressure on the bladder leading to uncomfortable symptoms, including:
- Inability to urinate
- Delayed start when urinating
- Weak or slow urine stream
BPH can cause sudden and strong urges to urinate and, in severe cases, urinary tract infections , damage to the kidney and bladder, and bladder stones.
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Bph Treatment At Columbia Interventional Radiology
BPH is a noncancerous, common condition in which the prostate becomes enlarged and constricts or blocks the urethra, causing urinary symptoms. More than half of men over the age of 60 have some urinary symptoms due to BPH and up to 90 percent of men aged 70 to 89 experience symptoms.
Symptoms of BPH include frequent urination, incomplete emptying of the bladder, difficulty urinating, and incontinence. For some patients, symptoms interfere with daily activity and sleep. BPH does not require treatment unless the symptoms interfere with quality of life.
Prostate artery embolization is a minimally invasive, safe, and highly effective treatment for BPH. 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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Why Would You Have Surgery For A Benign Prostate Condition
The prostate is the walnut-sized gland that surrounds the urethra in a male. The urethra is the tube that carries urine from the bladder to outside the body. One of the non-cancerous conditions that can affect the prostate is called benign prostatic hyperplasia , which is also known as enlarged prostate.
BPH is the most common prostate problem in men over age 50. About half of men in their 50s and as many as 90% of men in their 70s and 80s have enlarged prostates.
Enlarged prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:
- An inability to urinate.
- Excessive blood in the urine.
- Bladder stones.
Prostate cancer and infertility arent symptoms or causes of BPH. Benign prostatic hyperplasia doesnt cause erectile problems.
Prostate procedures for BPH range from minimally invasive treatments to more extensive surgeries. Your healthcare provider will help you decide which type of prostate surgery is best for you.
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Am I A Candidate For Prostate Artery Embolization
A consultation with an interventional radiologist can help determine whether prostate artery embolization is the right treatment for you. Patients who are ideal candidates for prostate artery embolization include men who:
- have symptomatic BPH
- want to preserve sexual function
- have had an adverse reaction to or side effects from medications
- dont want or might not be good candidates for surgery
Studies have shown that close to 90 percent of patients experience improvement after prostate artery embolization, with many patients showing up to ten years of good results.
Your interventional radiologist will schedule an exam to determine if you are a candidate for prostate artery embolization. The exam may include a health history, urine test, rectal exam, and MRI or ultrasound imaging to determine the size of the prostate. As with any medical intervention, discuss the most current clinical data with your interventional radiologist before deciding on the treatment that is best for you.
Prostate Artery Embolization At Uva
The skilled interventional radiologists at the University of Virginia are proud to offer prostate artery embolization as a minimally invasive treatment for BPH.
If you notice any of the symptoms of BPH, talk to your care provider. Or call 924-9401 to schedule a consultation with Dr. Ziv Haskal or one of our other interventional radiologists. They can help determine if PAE is the right option for you.
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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.
Prostate Artery Embolization: A Minimally Invasive Option To Treat Benign Prostatic Hyperplasia
A common condition among most aging men is benign prostatic hyperplasia , a noncancerous condition where the prostate becomes enlarged and urinary issues start to take hold.
In fact, approximately 50 percent of men who are 50 and older and 80 percent of men who are 80 and older struggle with BPH, symptoms of which include urinary urgency, frequent urination, straining to urinate, urinating multiple times in the night, incomplete emptying of the bladder, and sexual side effects. BPH can have a deeply negative impact on a mans quality of life and leaves most searching for relief.
Why Does Urination Become a Problem for Some Men?
Traditional Complex & Invasive Treatment Options for BPH
Treatment of BPH involves medication as well as several procedural options, some of which require invasive surgery, an inpatient hospital stay, and the potential for unpleasant side effects. Additionally, a patient must meet certain requirements to qualify. Treatment options include:
Benefits of Minimally Invasive Prostate Artery Embolization
Performed in the hospital by an interventional radiologist like Dr. Dalal, PAE is a technical procedure that requires precision and expertise. Dr. Dalal has had extensive training for PAE during his interventional radiology fellowship.
Positive Results & Improved Symptoms
Helping High-Risk Patients Face BPH
Interventional radiologists and urologists are very selective when choosing patients for PAE.