Non-Surgical Prostate Artery Embolization for BPH Q&A
Benign prostatic hypertrophy (BPH) - an enlarged prostate - is evident in up to 90% of men by age 85 years. As many as 14 million men in the United States have symptoms of BPH. About 150,000 men per year get a transurethral resection of the prostate (TURP) although more and more men turning to nonsurgical options like prostate artery embolization. Although transurethral resection of the prostate (TURP) has been considered to be the gold-standard prostate surgery for this condition, it is associated with significant morbidity including erectile dysfunction, incontinence, and urinary retention.
The prostate is often described as walnut-sized. Once it becomes enlarged it can be palpated by a digital rectal exam (DRE) from a ping-pong ball size up to a tennis ball. Importantly the digital rectal exam can underestimate the gland size by up to 55%. The prostate is part of the male reproductive system. It is located below the urinary bladder and in front of the rectum, at the bladder neck. The prostate surrounds the urethra so when prostate cells grow and the prostate enlarges it presses on the urethra. It secretes fluid that helps to nourish and transport sperm during ejaculation.
As men age, the prostate gland commonly enlarges. This condition is called benign prostatic hyperplasia (BPH). BPH is not cancerous, but it can cause lower urinary tract symptoms (LUTS) such as hesitancy (difficulty starting urination), frequent urination (needing to urinate more often), weak stream, and urinary urgency (a strong need to urinate). These urinary symptoms can be disruptive.
Risk factors for BPH include advancing age, family history, and ethnicity. African American men have a higher risk of developing BPH than Caucasian men. Other medical conditions such as diabetes and heart disease do not appear to increase the risk of developing BPH.
Prostate growth leads to excess prostate tissue and pressure on the prostatic urethra leading to obstruction. This benign prostatic obstruction (BPO) is a condition in which the enlarged prostate gland presses on the urethra, the tube that carries urine from the bladder out of the body. The urethra runs through the middle of the prostate gland. When the prostate gland enlarges due to enlarged tissue from prostate cell growth, the excess tissue can squeeze or partially block the urethra. BPO can cause urinary tract symptoms such as hesitancy (difficulty starting urination), urinary frequency (needing to urinate more often), weak stream, urinary incontinence, and urgency (a strong need to urinate). These symptoms can interfere with a man's quality of life.
Severe BPH symptoms can progress to urinary retention where enlarged prostate tissue closes off the urethra, blocks off urine flow, and causes urine to "backup" into the bladder called urinary retention. In this situation, prostate enlargement can cause urine to sit in the bladder. This residual urine can lead to urinary tract infections, bladder stones, chronic inflammation, and even bladder cancer. In this situation to relieve symptoms and restore urinary flow a catheter may be acutely needed until an intervention can be performed. The bladder wall may become thickened due to enlarged bladder muscles further adding to difficulties voiding and fully emptying the bladder. This decrease in bladder function can lead to recurrent urinary tract infections.
Transurethral resection of the prostate (TURP) is a type of surgery that involves removing part of the prostate through the urethra. The urethra is the tube that carries urine from the bladder out of the body. This surgery is done through an endoscope, a thin, lighted tube. It is inserted into your body through the penis. Then it is moved up to your prostate gland where the enlarged issue is removed by this surgical treatment to improve urine flow and decrease painful or frequent urination.
TURP has been considered to be gold-standard therapy for symptomatic BPH but although it is a leading benign prostatic hyperplasia treatment it can lead to significant morbidity and sexual side effects.
The most common complications of a TURP are:
- Transient urinary incontinence
- Urinary retention (needing a catheter
- Erectile dysfunction
- Ejaculatory dysfunction
- Retrograde ejaculation
More and more men are now choosing prostate artery embolization (PAE) a new, minimally invasive treatment for symptomatic benign prostatic obstruction (BPO) due to benign prostatic hyperplasia (BPH) - an enlarged prostate. PAE works by cutting off the blood supply to the prostate, which shrinks the gland and relieves symptoms.
During prostate artery embolization, the interventional radiologist inserts a thin catheter into an artery in the groin and guides it to the arteries that supply blood to the prostate. The radiologist then uses x-ray guidance to place tiny beads (embolic material) in those arteries. The embolic material blocks the flow of blood to the prostate, which shrinks the gland and relieves symptoms.
PAE is performed by an interventional radiologist, a specialist physician who has advanced training in this minimally invasive procedure. What are the benefits of PAE? PAE can treat even severe symptoms from large prostate glands. The advantages of PAE over TURP and other traditional surgery for BPH are:
- Minimally invasive (done through a small needle stick in the groin or wrist)
- Reduced risk of urinary incontinence and sexual side effects
- Alternative to surgery
- Fast recovery time
- Effective at relieving urinary symptoms due to BPH
- No general anesthesia or hospital stay is required.
- How do you prepare for a prostate artery embolization (PAE)?
No special preparation is required for this minimally invasive outpatient procedure. You will be asked to sign a consent form that gives your permission for the procedure.
You will be monitored during the procedure and for a short time afterward to make sure you are comfortable and have no problems.
Our experienced board-certified specialists successfully will perform a history and physical exam as well as order blood tests (including prostate specific antigen) and imaging tests to determine your prostatic volume and exclude prostate cancer. Imaging may include:
Doppler ultrasound which is a non-invasive test using sound waves to visualize blood flow
CT angiogram (CTA) is a non-invasive test that uses x-rays and special computer software to create pictures of blood vessels
Magnetic Resonance Imaging (MRI) scan which is a non-invasive test that uses a magnetic field and radio waves to create detailed pictures of organs and structures inside your body
Magnetic Resonance Angiogram (MRA) which is a non-invasive test that uses a magnetic field and radio waves to create pictures of blood vessels.
Why Imaging & Interventional Specialists? Imaging & Interventional Specialists are leaders in interventional radiology and experts in the minimally invasive procedures that will address your enlarged prostate/benign prostatic hypertrophy.
Our physicians perform “pinhole” procedures every day offering this region's leading, world class, state-of-the-art solutions for enlarged prostate/benign prostatic hypertrophy. Our minimally invasive image-guided procedures are cutting-edge technology without the cutting, without the scalpel. You leave with a Band-Aid!
At Imaging & Interventional Specialists board-certified physicians offer in-house testing for diagnosis and to develop an individualized treatment program for your enlarged prostate/benign prostatic hypertrophy.