Prostatic Artery Embolization

1. What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia, simply called “Prostate enlargement”, is an abnormal increase in the size of the prostate gland. Normally, the prostate gland is a walnut sized gland located just below the urinary bladder in males.

Enlargement is very common in older males (50% of men by the age of 60 years and up to 80% of men older than 70 years)

Source : National Cancer Institute

2. What are the symptoms of BPH?

The enlarged prostate obstructs the flow of urine from the urinary bladder. The affected patients develop symptoms due to  difficulties in passing urine freely. 

Symptoms include – 

  • Frequent passing of urine (especially during the nights)
  • Urgent need to urinate
  • Difficulty in starting urination
  • Thin or interrupted urine stream 
  • Dribbling at the end of urination
  • A sense of incomplete emptying of urinary bladder

3. How is BPH diagnosed?

The diagnosis and work-up for BPH requires a consultation with the Urologist. Diagnosis of BPH is made by 

  • Detailed Medical History
  • Physical examination (including Digital Rectal Examination). 

The following tests may also be a part of the diagnostic work-up.

  • Blood tests including “Prostate Specific Antigen”
  • Urine Analysis
  • Uroflowmetry
  • Ultrasound scan including Post-void residual urine. 

4. What are the treatment options for BPH?

Medications

Minimally invasive transurethral procedures 

Prostatic artery embolization

Transurethral resection of Prostate

Open Prostatectomy

5. What is Prostatic artery embolization (PAE)? How is it performed?

PAE is a non-surgical treatment option done through a pin-hole in the groin (or the wrist). The interventional procedure blocks the blood supply of the prostate and thereby causing it to shrink in size. 

This angiography-based procedure is done by advancing a small catheter into the Prostatic artery (Artery supplying the Prostate) and injecting small particles under the guidance of specialized x-rays (fluoroscopy)

6. What are the advantages of Prostatic artery Embolization?

  • Lower risk of sexual side effects
  • Low risk of urinary incontinence
  • Can be done as an outpatient procedure and some patients can be discharged the same day
  • Quick recovery 

7. Which patients are likely to benefit the most from Prostatic artery Embolization?

  • If medications are not adequately controlling  the symptoms
  • If a patient is not a candidate for surgery
  • Patients with very large sized prostate glands.
  • No symptom relief after BPH surgery