Prostate artery embolization

Prostate artery embolization (PAE) is a minimally invasive treatment for an enlarged prostate, also called benign prostatic hyperplasia (BPH). The procedure blocks blood flow to parts of the prostate, causing it to shrink.

PAE can help relieve symptoms such as frequent urination or a weak urine stream and improve your overall quality of life. As the first in the region to offer PAE, Penn Medicine has a depth and breadth of expertise with this innovative technique that’s hard to find elsewhere.

During PAE, an interventional radiologist makes a small puncture in your groin or wrist. They insert a catheter (thin, flexible tube) into blood vessels that feed your prostate.

With imaging guidance, they use special tools to deliver microscopic beads (called the embolic agent) to the blood vessels. The beads fill up the blood vessel and block blood flow to the gland. Over time, reduced blood flow to your prostate shrinks the gland and improves symptoms.

PAE is a minimally invasive alternative to the standard treatment for BPH, called transurethral urethral resection of the prostate (TURP). During TURP, a surgeon inserts a special scope and surgical tools through your urethra and removes part of your prostate. Possible side effects of TURP include erectile dysfunction and urinary incontinence (accidental urine leakage).

PAE offers a variety of benefits over TURP, including:

• Faster, less painful recovery
• Outpatient procedure (no hospitalization)
• Lower risk of sexual and urinary complications

An enlarged prostate is a common condition in men over the age of 40. As the gland gets bigger, it can press against the urethra and cause problems with your bladder and urination.

Lifestyle changes and medication can help relieve symptoms for some men. But if the following symptoms persist despite other treatments and affect your quality of life, it may be time to ask your health-care provider about PAE:

• Frequent urination, especially at night
• Pain with urination or ejaculation
• Urinary incontinence
• Urinary retention
• Urinary urgency
• Weak urine stream

You may need imaging exams such as an ultrasound, MRI, or MRA before prostate artery embolization. These tests help us locate the blood vessels that need treatment.

Your care team will give you detailed instructions about how to prepare for your procedure. You may need to stop taking certain medications, such as blood thinners, before PAE. Don’t eat or drink anything for at least six hours before PAE.

PAE is an outpatient procedure, so you don’t have to stay in the hospital overnight. An interventional radiologist performs the procedure, which takes anywhere from one to three hours.

During PAE, here’s what you can expect:

1. You receive a local anesthetic and intravenous ‘twilight’ anesthesia, so you stay comfortable without the need for general anesthesia.
2. The interventional radiologist makes a small needle puncture in your groin or wrist.
3. They insert a catheter into a blood vessel and use X-ray guidance, called fluoroscopy, to advance the catheter to one of your prostatic arteries.
4. The interventional radiologist injects a special contrast dye into the artery to see it more clearly.
5. They use the catheter to deliver the embolic agent to the blood vessel and wait for the beads to fill the artery and block blood flow.
6. The interventional radiologist repeats the procedure on the other side of your prostate gland.
7. We remove the catheter and place a bandage over the puncture site.

After PAE, you should take it easy for a few days and avoid heavy lifting, aerobic exercise, and other strenuous activities. Your care team will give you a full list of restrictions. But you should be able to return to light, daily activities the day after the procedure. We give you medicine to manage any discomfort and lower the risk of infection or urinary problems.

You’ll have a follow-up appointment with your care team about a week after your procedure to make sure you’re not experiencing any problems. We also do imaging exams to check the size of your prostate. It can take a few months for symptoms to improve.

Most people only have minor side effects the first few days after PAE such as:

• Blood in the urine
• Burning with urination
• Fatigue
• Mild fever
• Pelvic cramps
• Temporary urinary frequency

Complications from PAE aren’t common, but they can include:

• Bleeding
• Blockage of other blood vessels outside of the prostate gland
• Infection
• Temporary inability to urinate

At Penn Medicine, our expertise in interventional radiology and urology means you can get the treatments you need without a lengthy recovery. When you turn to us for care, you’ll find:

• Collaborative approach: Interventional radiologists and urologists work together to plan your treatment. They oversee a team of skilled radiation technologists, nurses, and other providers. You receive seamlessly coordinated care before, during, and after your procedure.
• Experience: We were the first medical center in the region to perform PAE and do a high volume of procedures each year. This depth of experience translates to better outcomes for our patients.
• Advanced technology: We use the latest imaging technology to guide PAE and other interventional procedures. This sophisticated equipment allows us to deliver treatment with exceptional precision, accuracy, and speed.