Prostatic Artery Embolization: A Minimally Invasive Treatment for Benign Prostatic Hyperplasia

 

Prostatic Artery Embolization 

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH), also known as enlarged prostate, is a common condition that affects most men as they age. The prostate is a walnut-sized gland that sits below the bladder. As men get older, the prostate often enlarges and squeezes the urethra, the tube that carries urine from the bladder. This causes several bothersome lower urinary tract symptoms including frequent urination, difficulty starting or stopping the urine stream, feeling of incomplete bladder emptying, urgency, and dribbling. BPH requires treatment if it interferes with daily activities and causes urinary issues.

Conventional Treatment Options for BPH

Traditional treatment options for BPH include medication, surgery or a combination of both. Medications such as alpha blockers and 5-alpha reductase inhibitors work to relieve BPH symptoms by relaxing the prostate muscles and shrinking the enlarged gland. However, medications may have side effects and the symptoms may return once the medication is stopped. The gold standard surgical treatment for BPH is transurethral resection of the prostate (TURP). In TURP, the prostate tissue is shaved off through the urethra using an instrument called a resectoscope. TURP provides lasting relief of symptoms yet it requires general anesthesia and there is a risk of side effects like impotence and urinary incontinence.

Introduction to Prostatic Artery Embolization

Prostatic artery embolization Prostatic Artery Embolization is a minimally invasive treatment alternative for BPH that was introduced in 2010. In this procedure, interventional radiologists use imaging to access the prostatic arteries through the groin area and blocks the blood flow to the prostate gland by injecting small acrylic polymer beads known as embolic agents. By depriving the prostate of its blood supply, the gland shrinks, relieving pressure on the urethra and reducing BPH symptoms. Compared to other treatment options, PAE provides rapid and effective symptom relief with few risks and complications and without affecting sexual function. It only requires local anesthesia and patients can go home the same day.

How is Prostatic Artery Embolization Performed?

During PAE, the patient is positioned on the angiography table in a special computed tomography scanner called a fluoroscopy room. The skin in the groin area is cleaned and numbed with local anesthesia. Then a thin catheter is inserted into the femoral artery through a small nick in the skin. Using live x-ray guidance, the catheter is guided up through the artery into the branches leading specifically to the prostate. Once the catheter is in place, the embolic agents are injected slowly into the prostatic arteries until they no longer fill. This blocks off the blood flow to the prostate tissue causing it to shrink over the next 3 months. The catheter is removed at the end of the procedure and a small bandage placed over the nick. Most patients experience only mild symptoms like frequent urination or discomfort for a short period as the prostate heals.

Immediate and Long Term Results of PAE

Many studies evaluating PAE have reported satisfactory outcomes in terms of symptom reduction and flow rates. Patients often notice positive results as early as a few days after PAE with improvements in urinary symptoms, quality of life and sexual function. At 6 months to a year post-procedure, up to 90% of men noted significant relief of BPH symptoms on international prostate symptom scores along with reduction in prostate volume by 25-30%. The effects were found to be lasting, with long term studies up to 5 years demonstrating sustained symptom relief and no need for retreatment in the majority. PAE does not impact erectile or ejaculatory functions as no tissue is removed during the procedure. Potential adverse effects are limited to minor complications like temporary pain, hematoma and urinary tract infection in less than 5% cases.

Candidates for Prostatic Artery Embolization

Men who experience moderate to severe lower urinary tract symptoms due to BPH that are not adequately managed by medications are potential candidates for PAE. It is most suitable for medically unsuitable or high surgical risk patients due to advanced age or underlying conditions. Patients with prostate size greater than 80cc to 100cc may not get full benefit from PAE. Those with existing urinary retention requiring a catheter would first need a stent placement or surgical procedure before considering embolization. Active urinary tract infection or pelvic malignancy are contraindications to PAE currently. Interventional radiologists thoroughly evaluate each case to ascertain if the benefits of the procedure outweigh any risks.

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