From the Guidelines
Prostate artery embolization (PAE) should be offered to men with moderate-to-severe lower urinary tract symptoms (LUTS) who wish to consider minimally invasive treatment options and accept less optimal outcomes than transurethral resection of the prostate (TURP) 1.
Procedure Overview
PAE is a minimally invasive procedure used to treat benign prostatic hyperplasia (BPH) by blocking blood flow to the prostate, causing it to shrink. During PAE, an interventional radiologist inserts a catheter through a small incision in the wrist or groin and guides it to the arteries supplying the prostate. Tiny particles are then injected to block these vessels, reducing blood flow to the prostate gland.
Benefits and Considerations
The procedure typically takes 1-4 hours under local anesthesia with moderate sedation. Patients usually go home the same day and can return to normal activities within a few days, much faster than traditional surgical approaches. Common side effects include pelvic pain, urinary burning, blood in urine, and temporary worsening of urinary symptoms, which generally resolve within a week. PAE is particularly beneficial for men with very large prostates, those who cannot tolerate general anesthesia, or those wishing to preserve sexual function.
- Key benefits of PAE include:
- Minimally invasive
- Faster recovery compared to traditional surgery
- Lower risk of complications such as retrograde ejaculation and erectile dysfunction
- However, it's essential to note that PAE is inferior to TURP in terms of improving symptoms and urodynamic parameters 1.
Recommendations
PAE should only be performed in units where the work-up and follow-up are performed by urologists working collaboratively with trained interventional radiologists for the identification of PAE-suitable patients 1. Patients should be informed about the risk of bleeding and the lack of long-term follow-up data. PAE offers a valuable alternative to traditional surgical options like TURP, but its long-term effectiveness compared to surgery is still being studied.
From the Research
Prostate Artery Embolization Surgery
- Prostate artery embolization (PAE) is a minimally invasive treatment option for benign prostatic hyperplasia (BPH) with moderate to severe lower urinary tract symptoms (LUTS) 2, 3, 4.
- The procedure involves embolizing the prostatic arteries to reduce blood flow to the prostate, resulting in a decrease in prostate volume and improvement in LUTS 3, 5.
- PAE has been shown to be effective in reducing prostate volume, improving urinary flow, and decreasing post-void residual volume 2, 6.
- The procedure is considered a safe and effective alternative to traditional surgery, with few reported adverse effects and minimal blood loss 3, 5.
- Proper patient selection and meticulous embolization are critical to optimize results, and interventional radiologists must have a detailed understanding of the pelvic arterial anatomy 3, 4.
Indications and Preparation
- PAE is indicated for patients with BPH and moderate to severe LUTS who have not responded to medical therapy or are not suitable for conventional surgery 2, 3.
- Pre-procedural evaluations, including clinical examinations, laboratory tests, and urodynamic and imaging examinations, are essential to achieve successful treatment 4.
- Patients with large prostates (≥80 cc) may also benefit from PAE, which can reduce prostate volume and improve LUTS 6.
Techniques and Outcomes
- PAE can be performed using various techniques, including superselective embolization, and has been shown to be effective in reducing prostate volume and improving LUTS 3, 6.
- Clinical outcomes, including International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, and post-void residual volume, have been improved with PAE 2, 5, 6.
- Long-term outcomes and durability of PAE are still being studied, but initial data show promising results 5.