PAE is a minimally-invasive method of treating a symptomatic enlarged prostate gland. It is performed by an interventional radiologist, after prior full assessment by a Urologist. The blood supply to the prostate gland is targeted in a specific way using special, technical, vascular (blood vessel) access. This ultimately leads to a reduction in prostate size up to 30%
Symptoms that may improve after the PAE procedure include:
Getting rid of a long-term catheter with restoration of normal spontaneous voiding
Problems starting to urinate (hesitancy)
Weak urine flow or stopping and starting
having to strain to pass urine
A frequent need to urinate
Waking up frequently during the night to urinate (nocturia)
A sudden urge to urinate (urgency)
Being unable to empty your bladder fully
The PAE procedure is recommended when prostate enlargement (benign prostatic hyperplasia)
Key Benefits of the PAE procedure :
Giving a patient an opportunity to get rid of a long-term in-dwelling urethral catheter inserted to relive urinary retention
Clinically proven, safe and effective
Particularly beneficial for men with very large prostates
Can help preserve sexual function
Who will be doing the prostate artery embolisation?
The procedure is performed by an interventional radiologist.
Where will the procedure take place?
Generally performed in the X-ray department, in a special screening room, which is adapted for specialist interventional procedures.
How do I prepare for prostate artery embolisation?
You need to be admitted to the hospital. This can be done as a day case procedure or with an overnight stay if you are travelling or are on your own at home. You will probably be asked not to eat for four hours beforehand, though you may be told that it is alright to drink some water. You may receive a sedative to relieve anxiety. You will be asked to put on a hospital gown. The procedure is carried out via the artery in the groin or the wrist ( If this is from the groin, you may be required to shave the area). You will also require a course of antibiotics start 2-3 days before the procedure and finish the course for 7 days.
Prior to the procedure, you will also have to undergo a special scan of the arteries supplying the prostate gland (called a CT angiogram). The scan is to ensure that the arteries supplying the prostate gland are not diseased and that you suitable for the procedure.
What happens during prostate artery embolisation?
You will lie on the X-ray table, generally flat on your back. You need to have an intravenous cannula inserted into your arm so that a sedative and/or painkillers can be administered if required. You will also have a finger to monitor blood oxygen levels. Oxygen can also be sometimes administered using a face mask or small nasal tubes in your nose.
The site of vascular (blood vessel) access, typically either the wrist or groin access will be carefully cleaned with antiseptic and the interventional radiologist will wear a theatre gown and operating gloves.
The skin and deeper tissues over the artery in the groin/wrist will be anaesthetised with local anaesthetic, and then a special needle will be carefully inserted into this artery. A guide wire is placed through the needle, and into this artery. Then the needle is withdrawn allowing a fine, plastic tube, called a catheter, to be placed over the wire and into this artery.
The interventional radiologist will use the X-ray equipment to make sure that the catheter and the wire are then moved into the correct position, into arteries which are feeding into the prostate. These arteries are quite small and rather variable. A special X-ray dye, called contrast medium, is injected down the catheter into these prostate arteries, and this may give you a warm/hot feeling in the pelvis. Once the prostate blood supply has been identified, fluid containing thousands of tiny particles is injected through the catheter into these small arteries which nourish the prostate. This silts up these small blood vessels and blocks them so that the prostate is starved of its blood supply.
Both the right and the left prostatic arteries need to be blocked in this way. . At the end of the procedure, the catheter is withdrawn, and the interventional radiologist then presses firmly on the skin entry point for several minutes, to prevent any bleeding. A special device can also be used to close the entry point. If the procedure is undertaken from the wrist a temporary compression band id used.
How long will it take?
This is variable but typically does not last longer than 60-90 minutes. After the procedure, we will normally monitor and observe you in hospital at least for 2-4 hours before discharge. Patient may be required to stay in overnight if the procedure is undertaken later in the day or they are travelling a significant distance.
Are there any risks or complications?
Prostate artery embolisation is a relatively new procedure. From the published data and our experience, It appears to be safe, but there are some risks and complications that can arise, as with any medical treatment.
There may occasionally be a small bruise, called a haematoma, around the site where the needle has been inserted, and this is quite normal. If this becomes a large bruise, then there is the risk of it getting infected, and this would then require treatment with antibiotics.
Pain – Some pain afterwards is to be expected – usually easily manageable with oral painkillers
Need for a new urethral catheter – This is extremely uncommon but maybe necessary if you are unable to pass water after the procedure. The catheter time is very
variable – from 2 weeks to 6 weeks duration
The risk of embolisation ( blockage) of non target organs is an extremely small risk. The quality of the X ray equipment, the planning CT angiogram and the experience of the Interventional radiologist make this an extremely unlikely event.
What else may happen after this procedure?
Some patients may feel very tired for up to a week following the procedure, though some people feel fit enough to return to work three days later. However, patients are advised to take at least one week off work following PAE.
What are the results of prostate artery embolisation?
There are just two medium term studies of the results of prostate artery embolisation. Over 70% of men will gain symptomatic improvement after PAE with reduction in prostate volumes and an increase in urinary flow rates. Also about 60-70% of catheter dependent patients can expect to become catheter free. In case of failure, additional TURP surgery may be offered.
Some of your questions should have been answered by this information but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.
PAE is a safe procedure, designed to improve your medical condition and save you having a larger operation. There are some risks and complications involved, and you do need to make certain that you have discussed all the options available with your doctors.