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PAE (Prostate Artery Embolization)

An enlarged prostate affects approximately 50% of men age 51 to 60 and as many as 90% of men older than 80. Our Prostate Artery Embolization (PAE) is a non-surgical procedure used to treat Benign Prostatic Hyperplasia (BPH; aka enlarged prostate). The procedure does not require the use of general anesthesia, is relatively painless, and the patient is usually free to return home the same day.

Prostate Artery Embolization (PAE) is a minimally-invasive Interventional Radiology (IR) procedure used to treat Benign Prostatic Hyperplasia, or BPH. Men who have BPH have an enlarged prostate that is putting pressure on the urethra (the tube that carries urine and semen to a man’s penis), causing difficulties with urination and sometimes other symptoms such as erectile dysfunction.

PAE is a painless outpatient procedure and does not require the use of general anesthesia. Instead, it is performed under “twilight sleep.” The patient is usually free to return home the same day.

Prostate Artery Embolization


About the Treatment and Evaluation procedures

The prostate is an organ of the male reproductive system. Its primary purpose is to produce the seminal fluid that helps to preserve sperm after ejaculation. Located under the bladder, the prostate is normally about the size of a walnut, and surrounds the urethra. In older men, the prostate can become enlarged, which exerts pressure on the urethra and hinders the proper flow of urine and semen through the urethra to the penis.

BPH affects over 50-60% of men in their sixties, 70-80% of men in their seventies, and 90% of men age 80 or older.

Although the increased prostate tissue growth is benign (non-cancerous), it can cause obstruction of the lower urinary tract and a number of symptoms:

Symptoms of Benign Prostatic Hyperplasia

Naturally, these symptoms can negatively impact one’s quality of life, so many men with BPH seek treatment. Moderate to severe cases of BPH have traditionally been treated with invasive surgeries such as TURP (transurethral resection of the prostate), Prostatectomy, Laser, Thermotherapy, or Electrovaporization. These procedures require general anesthesia and can result in complications such as incontinence, sexual dysfunction, impotence, and retrograde ejaculation (in which semen “backs up” into the bladder).

PAE provides a safer, non-surgical alternative to treating BPH.

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What To Expect?

PAE is performed under light sedation, without the need for general anesthesia. Interventional radiologists perform the procedure by introducing a microcatheter into a tiny incision in the femoral artery in your groin or the radial artery in your wrist.. X-ray guidance is used to allow the small catheter to be pass into the artery supplying the prostate. Small spheres are then inserted into the artery to block it, causing the abnormal tissue (BPH) to shrink, soften, and become reabsorbed.


Results

Procedure times vary, but average 60 to 120 minutes, plus a couple of hours in the recovery area. There is no appreciable at-home “recovery time” after PAE, with the exception of being advised to avoid strenuous activities such as heavy lifting or climbing long flights of stairs for 24 hours after the procedure. The procedure also has a very low complication rate, with zero reports of impotence or incontinence, and with no effect on sexual function. Patients typically report improvement of their symptoms within 2 to 3 weeks. No Foley catheter is required for the procedure

Getting the best interventional radiology care possible.

MTVIR is a team of experienced interventional radiologists who consult with other doctors or hospitals to bring state-of-the-art radiology treatment to their patients. We provide the most comprehensive BPH treatment options in Dallas, because we stay at the cutting edge of new techniques and technologies.

A Few Of Our Cases

Image A
This is an arteriogram that demonstrates the common origin of the artery to the prostate and the artery to the bladder or the prostaticovesicular artery. The patient was having symptoms of chronic lower urinary tract obstruction with increased frequency of urination. There is an artery on the right and left that both supply the prostate gland. In this case, the catheter was inserted into the femoral artery on the right and advanced into the small artery to the prostate gland. Sometimes the artery in the wrist is used as the access point and the catheter can be advanced all the way to the prostate artery.
Image B
This image demonstrates the "blush" seen in the prostate gland when the catheter is further advanced into the prostate and small particles are injected. These small particles are used to block flow to just the prostate gland causing it to shrink. The shrinkage of the prostate gland then allows the LUTS (lower urinary tract sytmptoms) to improve. At the end of the procedure, the catheter is removed but the small particles stay, keeping the artery to the prostate blocked.
Image
This case was performed from the wrist, also known as the radial approach. The catheter was inserted at the left wrist and advanced all the way in to the pelvis on the left side. The contrast is seen inside the arteries to the left side of the pelvis. The prostate artery usually comes off a branch of the internal iliac artery. In this image of the internal iliac artery, there is no prostate artery. This represents a normal variant called "empty pelvis sign." This means the prostate artery on this side is arising off a different parent vessel.
Image B
This image shows the catheter was then removed from the internal iliac artery and the advanced into the left external iliac artery. The inferior epigastic artery was noted to be larger than normal. Further advancement of the microcatheter identifies this as the parent vessel to the left prostate artery.
Image C
The microcatheter has been advanced all the way into the left prostatic artery. There is an enhancement of the prostate artery on the left and right demonstrating the rich collateral network in the prostate gland. From this location, the prostate can be embolized safely causing it to shrink.