Enlarged prostate (BPH) affects a large percentage of men over the age of 65. We offer an innovative, outpatient procedure to treat this condition by our world-class physicians.
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What Is The Prostate?
The prostate is an accessory organ of the male reproductive system. Its function is to produce fluid that helps preserve sperm after ejaculation. It is located below the bladder and is normally the size of a walnut. Urine travels from the bladder through the urethra before passing through the penis. Because the prostate surrounds the urethra, urination can be affected when the prostate is enlarged.
What Is Benign Prostate Hyperplasia (BPH)?
Benign Prostate Hyperplasia (BPH) is the most common disease of the prostate and can cause debilitating symptoms, impacting a patient’s quality of life. It affects 70% of men over 65 years of age, 80% of those aged between 70 and 80, and 90% of men over 80. BPH is a benign, non-cancerous, increase of prostate tissue growth, causing obstruction of the lower urinary tract. Some patients do not have any symptoms of BPH.
Common Symptoms Of BPH:
- Increased urinary frequency, particularly at night
- Weak and/or interrupted urine stream
- Incomplete emptying of bladder/difficulty starting
- Urgency/difficulty controlling urine
- Inability to urinate leading to catheterization
- Blood in the urine
- Erectile dysfunction (may overlap). There are other syndromes or diseases that can produce similar symptoms, so it is important to undergo a full examination to ensure symptoms are related to BPH.
How Is BPH Diagnosed?
- Medical history
- Detailed physical examination (including digital rectal exam)
- Rectal ultrasound of the prostate
- Mild: “watchful waiting”, follow-up
- Moderate/Severe: Medications, Surgery (TURP, Prostatectomy, Laser, Thermotherapy, Electrovaporization) or Prostatic Arterial Embolization (PAE)
What is Prostate Artery Embolization?
- A procedure in which a microcatheter is placed from the femoral artery (top of the leg) to the arteries of the prostate
- Small spheres are inserted into the prostate artery through the microcatheter to block it
- The abnormal tissue (BPH) will shrink, soften and reabsorb over time
What are the benefits of Prostate Artery Embolization?
Although it’s far from unusual, having benign prostatic hyperplasia is an unwelcome sign of aging. From having to urinate more than once at night to taking increasing time to fully urinate, BPH is a real pain.
That’s why our patients at our three Vascular Institute of Virginia locations love this procedure. Here are some of the benefits:
- It’s minimally invasive
- There is a lower risk of urinary incontinence moving forward
- Results can be experienced within a few days
- There aren’t any sexual side effects
- There isn’t any need for a bladder catheter
- Procedure involves less pain and discomfort both during and afterwards
Who is a good candidate for Prostate Artery Embolization?
- Suffer typical symptoms related to having an enlarged prostate
- Have tried drug therapy without improving their symptoms
- Have a prostate over 40 grams in size
- Cannot have general anesthesia
These diagnostic tests could confirm a patient’s viability for this procedure:
- PSA levels
- Prostate ultrasound
- A urodynamic pressure study
- A cystoscopy that examines the lining of the urethra and bladder
- Uroflowmetry to evaluate urine flow
"Dr. Lee, Rachel and Dave are all amazing. They are knowledgeable and make me feel safe and are always concerned with my comfort. They are fixing issues other doctors told me could not be fixed. The front office staff and Molly the nurse are also always helpful. I highly recommend this practice."
Is there anyone who is not a good candidate for PAE?
Patients cannot have prostate artery embolization if they have atherosclerosis, a malignant tumor, a twisted pelvic floor, or unusual anatomy in their prostate.
What are the risks involved with Prostate Artery Embolization?
Studies have shown prostate artery embolization to have lower side effects and risks than alternatives such as transurethral resection of the prostate. These procedures should only be performed by trained, experienced, certified radiologists, such as Dr. Lee and Dr. Nwosu of the Vascular Institute of Virginia.
Patients experience “post-PAE syndrome” for days following the procedure. These can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.
Other risks include hematoma at the incision site; blood in the urine, semen, or stool; bladder spasm; or infection of the puncture site or the prostate.
Other Things To Know About PAE:
- Outpatient procedure
- Performed under ‘twilight sleep’ without the need for anesthesia
- Painless procedure
- Approximately 1 hour
- No need for foley catheter
- Rare complication rate
- No reports of impotence or incontinence after PAE
- Symptom improvement occurs 2-3 weeks after the procedure
What should I expect during Prostate Artery Embolization?
Dr. Lee or Dr. Nwosu will start by inserting a catheter into an artery in your groin or wrist. The catheter is then fed into a blood vessel that carries blood to the prostate gland. Once they have the catheter in place, dye is injected into the blood vessels to provide a map of the blood vessels that lead to the prostate. This is known as an arteriogram.
Next, tiny particles are inserted into the catheter and introduced into the prostate gland’s blood vessels. The particles inhibit blood flow to the areas of the prostate most impacted by the enlargement. This decrease in blood shrinks the prostate reducing its size and reducing pressure on the urethra.
Now the catheter is moved so that Dr. Lee or Dr. Nwosu can repeat this process on the other side of your prostate.
Following this procedure, the prostate will begin to shrink, relieving and improving symptoms usually within days of the procedure.
How can I prepare for my Prostate Artery Embolization procedure?
Preparing for your PAE procedure can help your surgery go much more smoothly and quicker than average. Although these preparation recommendations may change depending on your medical history and your body’s needs, many patients do the following before the day of their PAE:
- Consult your doctor: If you are taking medication, ask your doctor if you can stop medication before your procedure and during recovery.
- Quit smoking. We recommend stopping smoking at least six months before your procedure to ensure your health is optimized before treatment.
- Do not eat solid foods at least six hours before your procedure. Drinking clear liquids is still recommended until four hours before your procedure.
- Arrange for a loved one to bring you to and from your appointment. Driving immediately 24 hours after your procedure is not recommended.
Does insurance cover PAE?
Yes, most insurance companies will cover PAE, especially if they provide coverage for prostate cancer. However, this may only sometimes be the case. We advise checking with your insurance provider to determine whether you can get full or partial coverage for your PAE procedure.
What is the recovery after having PAE?
Mild discomfort after the procedure is common. This can last for a few days. Some patients feel they are back to normal within three days of having prostate artery embolization. They can return to work and normal activities at that point. For others, discomfort when urinating can linger for up to two weeks.
Overall, this procedure does not create a difficult recovery.
Are there things I should avoid doing after PAE?
In order to encourage a complication-free recovery, it’s essential that PAE patients follow these aftercare guidelines and other recommendations from your doctor following your treatment:
- Avoid heavy lifting
- Avoid intense exercise or workouts
- Walk on a flat surface
- Avoid hiking
- Drink plenty of clear fluids after your PAE
- Avoid alcohol for the first 24 hours after your procedure
- Drink plenty of clear fluids after your PAE
- Avoid showering for at least 24 hours after your procedure
- Avoid the bathtub, hot tub, and swimming for one week or until you have completely healed
- Ensure your bandages are clean each time you replace them
How long will the results from my Prostate Artery Embolization last?
This is a newer option for treating benign prostatic hyperplasia, so there are not any long-term studies thus far. Initial research, however, found that patients were still experiencing good results one year after having this procedure. Based on those findings, the researchers estimated that the effects gained from prostate artery embolization can easily last at least five years.