Prostatic Artery Embolisation
Novel Technique for Prostate Treatment
Symptomatic benign prostatic hyperplasia (BPH) is a common condition in the aging population that results in troubling symptoms in the lower urinary tract impacting quality of life. Patients are often treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments are also offered.
Prostatic artery embolisation (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalisation. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolisation are critical to optimise results.
Some indications for PAE may include:
• Moderate-to-severe urinary symptoms: Men with BPH may experience symptoms such as
frequent urination, difficulty starting urination, weak urine flow, and incomplete emptying of
the bladder. PAE may be recommended for those who have not responded well to
medication or wish to avoid traditional surgical treatments.
• Prostate size: PAE is typically recommended for men with prostates that are larger than 30 to 40
grams. This is because larger prostates are more difficult to treat with medication and may require
surgery.
• Age and overall health: PAE may be recommended for older men who may not be good candidates for
traditional surgical treatments due to their age or overall health.
• Desire to avoid surgery: Some men may prefer to avoid surgery due to the potential risks and
complications associated with traditional surgical treatments.
• Medication intolerance: Some men may not be able to tolerate the side effects of medication used to
treat BPH. PAE may be a good alternative for such patients.
It is important to note that PAE is not appropriate for all men with BPH. Men who have prostate cancer, active prostate infection, or severe urinary blockage may not be good candidates for PAE. It is important to discuss all treatment options to determine the best course of treatment for individual cases.
Case Study
A 65-year-old male with a history of benign prostatic hyperplasia (BPH), presented at Medanta – Gurugram with lower urinary tract symptoms (LUTS) that had not responded to medication. His International Prostate Symptom Score (IPSS) was 28, indicating severe symptoms. Hence, he was advised for prostatic artery embolisation (PAE).
The patient underwent the procedure under local anaesthesia. A catheter was inserted into the femoral artery and navigated to the prostatic artery using X-ray guidance. Embolic agents were then injected to block blood flow to the prostate gland. The procedure went well with good clinical outcomes and the patient reported significant improvement in his LUTS within a few weeks after the procedure. His IPSS decreased to 10, indicating mild symptoms. He was able to urinate more easily, and had less urinary frequency and urgency.
Patient had no major complications from the procedure and was discharged on the same day. He returned for follow-up appointments after 3, 6, and 12 months post procedure, and continued to report improvement in his symptoms. His IPSS remained stable at 10, and he did not require additional treatment for BPH.
PAE is emerging as an effective minimally invasive treatment for lower urinary tract symptoms caused by BPH. It is safe, effective and has several benefits compared to traditional surgical treatments for BPH, including:
• Minimally invasive: PAE is performed through a small incision in the groin, and does not require
general anaesthesia or major surgery. This means that patients typically experience less pain,
bleeding, and scarring compared to traditional surgical treatments.
• Short recovery time: Most patients are able to return home on the same day or the day after the
procedure, and can resume normal activities within a few days. Traditional surgical treatments, on
the other hand, may require several weeks of recovery time.
• Lower risk of complications: PAE has a lower risk of complications compared to traditional surgical
treatments, such as bleeding, infection, and sexual dysfunction. The risk of urinary incontinence, a
common side effect of surgery, is also lower with PAE.
• Effective: Studies have shown that PAE is effective in reducing the symptoms of BPH,
such as urinary frequency, urgency, and difficulty in urination. Many patients
experience significant improvement in their symptoms within a few weeks after the procedure.
• Repeatable: PAE can be repeated if necessary, unlike surgical treatments that remove part of the
prostate gland. This means that if the symptoms of BPH return, another PAE can be performed to
provide additional relief.
In conclusion, PAE provides an effective treatment option to relieve symptoms caused by prostate enlargement and bladder outlet obstruction. This offers an additional option in the spectrum of treatments for BPH that may be appropriate for select groups of men, including those with large prostates, or surgical comorbidities, those who cannot stop taking anticoagulation therapy for surgery, those with a strong desire to preserve sexual function, and those looking to treat concurrent lower urinary tract symptoms and haematuria with a single procedure.
