ENLARGED PROSTATE Treatment
New England Endovascular Center offers Prostate Artery Embolization (PAE). PAE is a leading-edge and highly effective treatment option for many patients with lower urinary tract symptoms caused by an enlarged prostate. However, if you are not a candidate for PAE, there may be excellent medical and surgical options available to you by your urologist. Occasionally, this procedure is performed in conjunction with other urologic procedures to reduce their bleeding risk.
PROSTATE ARTERY EMBOLIZATION
Prostate Artery Embolization is a minimally invasive treatment for enlarged prostates that safely and effectively shrinks the prostate by reducing the blood flow to the prostate gland. A small tube (called a catheter) is inserted into the artery at the top of the leg or wrist. The catheter is maneuvered under x-ray guidance to the arteries that supply the prostate gland. Once in place, small beads (called microspheres) are slowly injected. By reducing blood flow to the prostate gland, the prostate shrinks, thereby alleviating the urinary symptoms. As the microspheres are carefully sized, the blood flow is reduced without completely cutting off blood supply.
WHAT ARE THE BENEFITS OF PROSTATE ARTERY EMBOLIZATION?
Prostate artery embolization (PAE) is a minimally-invasive procedure that works directly on the blood vessels. It will decrease the blood supply to the prostate which then causes it to decrease in size. The procedure can be performed on a prostate of any shape and there are no upper limits as to the size of the prostate.
PAE is performed through a tiny pinhole in the skin at the top of your leg or wrist. This is different from the alternative surgical procedures which are performed through the penis.
The majority of patients experience symptom relief:
- Decrease in urinary frequency, intermittency and urgency
- Decrease in nighttime urination
- Decrease in hematuria (blood in the urine)
Less risk than surgery
Other surgical options have a risk of causing impotence/sexual dysfunction as well as urinary incontinence. With PAE, these risks are minimal. In fact, following this procedure some people may actually experience improved sexual function.
General anesthesia is not required as the procedure is safely performed with moderate sedation and local anesthesia. In addition, the procedure is performed in an outpatient setting, so you can go home that day. The tiny pinhole incision does not require stitches, and there are excellent outcomes, with marked reduction in symptoms and lower risks. There is less risk of infection and blood loss.
Quick recovery– Majority of patients are back to most regular activities within 1-2 days of having PAE. PAE offers a quicker return to work and regular activity compared to surgery.
“Within a couple of weeks after a PAE procedure, most men experience a significant improvement in urinary tract function.”
ARE YOU A CANDIDATE FOR PROSTATE EMBOLIZATION?
You are a candidate for PAE if you:
- Have been diagnosed with an enlarged prostate (BPH)
- Are experiencing lower urinary tract symptoms, such as weak urinary stream, urinary frequency, urgency or excessive nighttime urination.
- Prefer a minimally invasive non-surgical approach and want an option with a markedly decreased risk of impotence/sexual dysfunction and urinary incontinence.
Be sure to discuss all of the treatment options with your doctor before deciding.
WHAT SHOULD I EXPECT BEFORE MY PROCEDURE?
You will first meet with our physician for a consultation to discuss your symptoms and medical history. Pending any further diagnostic tests, our physician will provide treatment recommendations. If PAE is warranted, our friendly staff will help you schedule the procedure. Our physician will follow-up with your doctors to inform him/her/them of the treatment plan.
Our physician will need to know which medications you are taking — you will be informed which medications to take and which ones to hold on the day(s) leading up to the procedure. We will need to know about any allergies. A simple blood test will be ordered to ensure your kidney function is acceptable for the contrast dye used during the procedure.
You will be asked to not eat nor drink anything after midnight on the day prior to your procedure.
WHAT SHOULD I EXPECT ON MY PAE PROCEDURE DAY?
Preparation
After arriving and checking in with our front staff, our nurse will take you back to the prep/recovery area to get you ready for the procedure. A bedside locked cabinet and key are provided for your personal items.
An IV will be secured into your hand or forearm, allowing easy medication access for moderate sedation and pain control. You may have a catheter placed into your bladder to keep it empty during the procedure. Later, our staff will safely transport you into the surgical room and prep you for the procedure. You’ll notice surgical drapes placed over much of the surrounding area. This keeps the surface area sterile and clean.
The Procedure
Once in the room, you will be placed on a comfortable, soft table. The skin at your upper leg or wrist will be sterilized. Moderate sedation is administered at the beginning of the procedure to provide enough sedation to make the procedure as comfortable as possible. You will be relaxed, but awake the entire time! Since there is a ceiling-mounted TV in the procedure room, you catch up on your favorite TV series or listen to your favorite music.
A numbing medication will be injected into your skin at the access site. Our physician will make a small, painless pinhole nick in your skin to create an opening for the catheter to go through. Next, a catheter will be inserted into the artery. Although the procedure is commonly performed through the femoral artery at the top of the leg, the procedure can be safely performed through the radial artery at the wrist.
The catheter placed inside the femoral or radial artery is a long, thin tube. Live x-ray guidance is used to steer the catheter to each of the prostatic arteries in the pelvis. Contrast dye is injected through the catheter to determine catheter location and which blood vessels are supplying blood to the prostate. Tiny particles (microbeads) measuring less than 1mm are injected through the catheter, which decreases the blood flow to the prostate. The beads are sterile, inert beads designed solely to obstruct blood flow without eliciting any type of adverse reaction. After the prostatic arteries are treated, a final injection of contrast is occasionally made in the aorta to ensure there are no other vessels supplying the prostate. The procedure typically takes 2-3 hours.
WHAT IS THE RECOVERY FROM PROSTATE EMBOLIZATION?
Following the procedure, the artery catheter will be removed and a small dressing will be placed at the access site. You will be transported back to the recovery area. To prevent any bleeding from the access site, you will be asked to lie flat for a while. Additional medication will be provided to control any pain. If a bladder catheter was placed, this usually will be removed once you are cleared to sit up and move around.
You can expect to stay at NEEC for approximately 4-6 hours following the procedure. Snacks and drinks will be provided at this time. IPads are available to use while you wait to catchup on your favorite Netflix or Hulu series. You’ll need to plan to have someone drive you home once you have been discharged because sedative drugs were given. Be sure to follow the discharge instructions about taking your medications.
Once home, please be sure to rest and drink plenty of fluids. We suggest that you avoid heavy lifting and strenuous exercising for at least 24-48 hours. Prostate artery embolization is generally a well tolerated procedure. Most people will only experience minor symptoms which may include fatigue and mild pelvic cramping. Some people may also experience a brief increase in urinary frequency, burning with urination and blood in the urine which will go away after a short period in most cases. You will be prescribed medications to minimize these symptoms.
We Can Help!
New England Endovascular Center offers expertise, state-of-the-art imaging, and resources for the diagnosis, treatment, and management of PAE. We customize each patient’s treatment plan to maximize the best possible outcome. We are committed to providing excellent, personal patient care.
Call our office today to schedule a consultation at 413-693-2852.
Our doctors are nationally recognized experts in minimally invasive therapies for treating PAE.
We provide treatment for PAE for patients throughout Western, MA and Northern, CT.
To learn more about treatments available at New England Endovascular Center call 413-693-2852 to make an appointment.