Prostate artery embolization for benign prostatic hyperplasia

Prostate artery embolization (PAE) is a minimally invasive procedure used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland that can cause urinary symptoms. PAE involves blocking the blood flow to the prostate gland by injecting embolic agents into the arteries that supply it, leading to a reduction in prostate size and improvement in urinary symptoms. 

Indications

PAE is indicated for patients with:

1. Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland causing lower urinary tract symptoms (LUTS) such as frequent urination, urgency, weak stream, and difficulty emptying the bladder (Click here to read more on Benign Prostatic Hyperplasia)
2. Persistent or Severe Symptoms: Patients who have not responded well to medications (such as alpha-blockers or 5-alpha-reductase inhibitors) or who are not suitable candidates for surgery due to health concerns.
3. Desire to Avoid Surgery: Patients seeking a minimally invasive alternative to surgical treatments like transurethral resection of the prostate (TURP) or laser prostate surgery.

Procedure

1. Pre-procedure Evaluation:
   • Imaging Studies: MRI or CT scans are used to evaluate the size, shape, and blood supply of the prostate gland.
   • Medical History and Assessment: Evaluation of urinary symptoms, overall health, and suitability for the procedure.
2. Preparation:
   • Informed Consent: Explanation of the procedure, its risks, benefits, and alternatives, followed by obtaining informed consent from the patient.
   • Patient Preparation: Fasting before the procedure and instructions regarding medications.
3. Anaesthesia:
   • PAE is typically performed under local anaesthesia and conscious sedation to ensure patient comfort.
4. Catheterization and Arterial Access:
   • A catheter is inserted into the bladder to drain urine during the procedure.
   • A small incision is made in the groin or wrist, and a catheter is inserted into the femoral or radial artery, respectively, for access to the arterial system.
5. Angiography and Embolization:
   • Under fluoroscopic guidance, a catheter is advanced into the prostatic arteries that supply blood to the prostate gland.
   • Contrast dye is injected to visualise the arterial anatomy and identify the branches supplying the prostate.
   • Embolic agents, such as microspheres or coils, are then injected through the catheter into these arteries to block blood flow and reduce the size of the prostate.
6. Post-embolization Assessment:
   • The position of the embolic agents and the extent of arterial occlusion are confirmed using angiography.
   • The catheter and sheath are removed, and pressure is applied to the insertion site to prevent bleeding.
7. Post-procedure Care:
   • Patients are monitored for a few hours post-procedure for any immediate complications.
   • Post-procedure instructions, including pain management, activity restrictions, and follow-up appointments, are provided.

Benefits

• Reduction in Prostate Size: PAE leads to a reduction in prostate volume, relieving pressure on the urethra and improving urinary flow.
• Symptom Improvement: Decrease in lower urinary tract symptoms (LUTS) such as frequency, urgency, nocturia, and incomplete emptying.
• Minimally Invasive: PAE is a minimally invasive procedure with shorter recovery times compared to traditional surgical options.
• Preservation of Sexual Function: PAE has been shown to preserve sexual function, including erectile function, in many patients.

Risks and Considerations

• Post-embolization Syndrome: Patients may experience temporary symptoms such as pain, urinary frequency, and urgency, which typically resolve within a few days.
• Urinary Retention: Some patients may experience temporary urinary retention after the procedure, which can be managed with catheterization if needed.
• Infection: Risk of infection at the arterial access site or within the urinary tract, requiring monitoring and appropriate antibiotic therapy.
• Complications of Anesthesia: Risks associated with local anaesthesia or conscious sedation, such as allergic reactions or respiratory issues.

Conclusion

Prostate artery embolization (PAE) is a valuable minimally invasive option for treating benign prostatic hyperplasia (BPH) and relieving associated lower urinary tract symptoms (LUTS). By reducing blood flow to the prostate gland, PAE leads to a reduction in prostate size and improvement in urinary flow, offering significant benefits to patients who may not be suitable candidates for traditional surgical interventions. Close monitoring and follow-up care are essential to assess treatment outcomes and manage any potential complications.