Prostatic Artery Embolization

Prostatic Artery Embolization

What is prostatic embolization?

Prostatic Artery Embolization (PAE) in Benign Prostatic Hyperplasia (BPH) treatment is a new application of a long-known technology used in Medicine. 

Effectively, embolization is successfully performed for over half a century. The innovation was using this treatment technique in patients with benign prostatic hyperplasia (BPH). 

It is a micro-invasive technique that allows the relief of the urinary tract symptoms in patients with BPH, with good results in the short, medium, and long term.

Its goal is to partially interrupt the blood circulation that irrigates the prostate, allowing the relief of the lower urinary tract symptomatology associated with BPH, as well as the reduction of the prostate size. 

It is a minimally invasive technique, performed under local anesthesia, painless, and it is an outpatient treatment, with no blood loss. A small hole of 1.5 mm-diameter is made on the groin or wrist, and a small plastic tube, the catheter, is inserted. 

Upon monitoring by a sophisticated digital X-ray device, the catheter is headed to the prostatic arteries. 

Small-sized embolic particles, like sand grains, are then injected into the prostatic arteries, clogging parts of the branches that irrigate the prostate, sparing, however, the penis arteries, for the patient to maintain the erectile function.

The technique usually takes 1 to 2 hours to be done. The patient is conscious during the procedure and can even see it on the monitor. 

When the embolization is done, the catheter is removed. We performed manual compression for 10 minutes and place a small compressive patch, which must be kept until the next morning. 

The patient can stand and walk to urinate two hours after the embolization. The hospital stay lasts only a few hours and the patient is usually discharged on the same day.

How is the recovery after the prostatic embolization?

Prostatic Artery Embolization

Most patients don’t feel any pain after embolization treatment. The recovery room is in a room next to the angiography room, where the embolization was performed.

Prostatic Artery Embolization

If the vascular access is on the groin, a patch is placed, and you must remain in bed for 4 hours until you can start walking again. 

The patient recovers in a room for 4 hours. Usually, patients don’t feel pain and can be discharged from the hospital.

Prostatic Artery Embolization

If the vascular access to place the catheter is on the left wrist, at the end of the embolization you get a bracelet and you can walk freely in the room while you recover from the intervention.

The recovery is prompt. Patients can eat right after the treatment and have no pain or bleeding. Practically all patients are discharged on the same day of the procedure and can go home on their own. 

The recovery is prompt and painless. You may feel burning while urinating and need to urinate several times in the first 2 days after the prostatic embolization. There can rarely be some blood on urine, sperm, or feces, but it will pass after 1 to 2 weeks. 

Anti-inflammatory medication is prescribed to reduce the inflammation caused by the embolization, and an antibiotic to prevent urinary tract infection. 

This medication is initiated 2 days before the embolization and must be taken for a week. Since there is usually no pain, pain medication is only used if necessary.

What happens to the prostate after the embolization?

As a result, it is possible to verify a progressive reduction of the prostate size, that differs between 10% and 60%. 

However, around 10% of patients improve without changing the prostate size. The absent reduction of the prostate volume occurs mainly in patients that take pills that reduce the volume before the embolization. 

As patients stop taking them after the embolization, the prostate tends to grow back, which is compensated by the embolization, since it cuts part of the prostate blood flow. The embolization is done to improve the BPH symptoms, not to reduce its size, which, however, occurs in most patients.

What is the follow-up after the prostatic embolization?

Patients are followed after 1 week, 1 month, 6 months, and 12 months after the procedure. After this period, patients are followed annually. 

In these evaluations after the embolization, several surveys are filled in, and the prostatic volume is evaluated with an ultrasound or MRI. The PSA is evaluated through blood tests, and the urethral jet strength is evaluated by flowmetry. 

Finally, the post-void residual (amount of urine that remains in the bladder after urinating) is evaluated through bladder ultrasound. We follow up on every patient that we have treated with embolization, including the first patients, treated since 2009!

FAQ

Prostatic embolization allows relieving urinary complaints, preserving ejaculation without affecting the erection. Thus, it is the only effective and safe treatment that allows preserving the sexual function of men with benign prostatic hyperplasia. 

We initiated this pioneering technique to treat urinary symptoms of patients with benign prostatic hyperplasia 10 years ago. At this moment, we have already treated over 1600 patients, demonstrating that it is an effective and safe technique, with excellent results in the short, medium, and long term

It is a painless and minimally invasive treatment without scalpel cuts, urethral manipulation, or catheterization. We approach the prostate through arteries. 

This way, recovery is prompt, and many patients mention the immediate improvement of urinary symptoms. It is a complex procedure where experience and anatomical knowledge are essential to get good results.

The urology and radiology multidisciplinary assessment is essential to a correct patient evaluation and to exclude the possibility of clinically significant cancer. 

By using rectal examination and PSA (Prostate-Specific Antigen) it is possible to exclude most prostate cancers. In doubtful cases, prostatic MRI and/or prostate biopsy can help to evaluate the presence of prostate cancer.

We are pioneers in performing prostatic embolization in Benign Prostatic Hyperplasia (BPH). In our country, we perform prostatic embolization in patients with Benign Prostatic Hyperplasia (BPH) since March 2009, and over 1600 patients were treated until December 2018. 

We are an international reference center; we have already treated over 400 foreign patients of over 90 nationalities. It is proven that prostatic embolization in Benign Prostatic Hyperplasia (BPH) treatment has comparable effects with surgery in terms of urinary complaints improvement, but with fewer complications

That is to say, it is almost as effective as surgery, more effective than medication, and it has not the adverse effects like impotence, incontinence, or ejaculation loss, which can occur with medication or surgery. 

It is a painless procedure, and the recovery is prompt. The patient comes in in the morning and leaves in the afternoon on his own. There is no need for catheterization, and patients can eat immediately after the embolization. They can return to their normal daily activities the next day, with no need for hospitalization.

Of 1800 patients already treated, an initial significant improvement is visible in 85% to 90%, and 75% to 80% at a long term.

In successfully treated patients, an almost immediate improvement of the symptoms is visible, and the medication they have been taking for years to Benign Prostatic Hyperplasia (BPH) can be stopped. 

A small number of patients may not improve; however, their medical situation does not suffer any worsening and there are no serious complications. Of the 200 patients with a catheter, 190 took it off 1 to 2 weeks after the embolization, urinating without difficulties and medication.

To improve results, patients whose arteries are very involved by atherosclerosis, revealed on CT angiography, are excluded. 240 of the patients treated had their prostates with a volume over 100cc.

Embolization can be performed even on very large prostates, with over 400cc volume. If your prostate is below 30cc volume, you probably will not be referred. The same happens if have any symptoms.

Thanks to the good results and few complications, the procedure is being made in worldwide centers, being our hospital the reference center with more experience, where over 100 foreign medical teams visited to learn the technique. Most patients don’t feel any pain during the embolization.

Complications are those of any catheterism, being the most frequent the bruise on the catheter area and ecchymosis, that is to say, the color purple on the thigh or the forearm, and even on the abdomen.

Hardly ever, patients can have some difficulty in urinating, after the embolization. Blood in the urine can happen in some patients and it can last for a few days, but it goes away without treatment. 

The temporary existence of blood in feces or sperm is very rare (2%). Some patients might feel some burning when urinating or in the anus, but it last only for a few hours.

Constipation is frequent for 1 to 2 days. On the night following the treatment, the patient might urinate several times, but on the next day, he will be normal. However, these side effects disappear after a few days, with no need for any kind of intervention. It is rare to have patients that feel some pain.

Usually 2 weeks after the prostatic embolization. It is not possible to take the catheter after 2 weeks in less than 20% of the cases. In those cases, we try again after 2 weeks, that is to say, 4 weeks after the prostatic embolization. 

It is possible to remove the catheter and start to spontaneously urinate in over 90% of patients treated with prostatic embolization because they were under urinary retention with the catheter and couldn’t urinate.

Of over 1600 treated patients since March 2009, sexual function was not affected in any, and around 400 patients reported improvements. 

However, it is a very rare risk that might happen right after the embolization, but recoverable. Ten of the treated patients had children after the embolization. There are 13 healthy newborns.

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