Prostate Artery Embolization - Types, Risks and Diagnosis

The choice of PAE technique depends on various factors, such as:

• The patient's anatomy
• The severity of the BPH
• Experience and preference of the interventionist performing the procedure. 

Your doctor can help determine the most suitable PAE technique based on your physical and medical condition.

The following are the types of PAE techniques:

• PAE: This technique involves accessing the prostate artery via a catheter inserted into the femoral artery in the groin or radial artery in your wrist. Your doctor will guide the catheter to the prostate arteries using X-ray or other imaging techniques. Once the catheter is in place, Calibrated particles, composed of polyvinyl alcohol (PVA) or its variant, are injected into these arteries to block blood flow to the prostate gland. It causes the prostate gland to shrink, relieving urinary symptoms.
• Transradial PAE: In this technique, the surgeon guides the catheter through the rather than the femoral artery in the groin. Transradial PAE may have some advantages over conventional PAE, such as a lower risk of bleeding and faster recovery. However, it may not be suitable for all patients, particularly those with smaller radial arteries or tall nin height.

The steps may depend on the type of technique for PAE. The exact procedure for each PAE technique may vary slightly depending on the interventional radiologist's choices and the specific equipment and materials used.

PAE:

• Pre-procedure preparation: Before the procedure, your doctor will perform a blood test and a physical exam. The doctor may ask you to stop taking certain medications, such as blood thinners.
• Anesthesia: The anesthetist will give you local anesthesia to numb the area where your doctor will insert the catheter. Sometimes you may also need some sedation to help you relax during the procedure.
• Catheter insertion: The interventional radiologist will insert a thin, flexible catheter into a blood vessel & guided to the arteries that supply blood to the prostate gland using X-ray or other imaging techniques.
• Embolization: Once the catheter is in place, small particles, usually created of polyvinyl alcohol, are injected into the arteries to block blood flow to the prostate gland. This chemical shrinks the prostate gland, relieving your urinary symptoms.

The eligibility criteria for PAE may vary slightly depending on the preferences of your treating doctor and the type of equipment and materials used. An OPD consultation is necessary to determine if you are a good candidate for the procedure. The specialists will evaluate your medical history, perform a physical exam, and may order tests or imaging studies to determine your eligibility. Some of the eligibility criteria for the same are:

• Age: There is no specific age limit for PAE, but older men may be at a higher risk of developing complications due to other medical conditions.
• Symptoms: The doctors may recommend PAE for men with moderate to severe lower urinary tract symptoms (LUTS) caused by an enlarged prostate that has not responded well to medication or who have experienced side effects after taking these medications to relieve symptoms. LUTS may include urinary frequency, urgency, weak stream, difficulty starting or stopping urination, and incomplete bladder emptying.
• Prostate volume: PAE is most effective in men with almost all prostate volumes 
• No evidence of prostate cancer: Before undergoing PAE, it is critical to rule out the presence of prostate cancer. It may involve a physical exam, PSA test, or prostate biopsy if your doctor feels it necessary.
• Overall health: Candidates for PAE should be physically fit and can tolerate anesthesia and the procedure itself. They should not have any underlying medical conditions that would increase the risk of complications.

Prostate artery embolization (PAE) is generally considered a safe procedure, but like any medical procedure, it does carry some risks. The overall complication rate for prostate artery embolization (PAE) is low. But the specific complications incidence can vary depending on the patient's health status and the techniques used during the procedure. Some of the potential risks and complications associated with PAE are:

• Pain or discomfort: Pain or discomfort at the site of catheter insertion is a common side effect of PAE. It is typically mild, and one can manage it with over-the-counter pain medication. One study found that up to 85% of patients experienced mild to moderate pain following PAE, but severe pain was rare. (Source: National Library of Medicine)
• Urinary tract symptoms: Following PAE, patients may experience changes in urinary function, including urinary retention, frequency, urgency, or difficulty urinating. One study found that up to 30% of patients experienced urinary retention following PAE. It was a transient symptom in most cases and resolved within a few days to weeks. (Source: National Library of Medicine)
• Infection: The infection rate following PAE is generally low. One study found that the overall infection rate following PAE was less than 1%. (Source: Radiology Journal)
• Bleeding: Bleeding during or after PAE is a rare potential complication. According to a study, the rate of heavy bleeding following PAE was less than 1%. (Source: Radiology Journal)
• Allergic reaction: Allergic reactions to the contrast dye or other materials used during PAE are rare but can occur. One study found that the overall rate of allergic reactions following PAE was less than 1%. (Source: Radiology Journal)
• Damage to surrounding organs: Damage to surrounding organs, such as the bladder or rectum, is a rare complication of PAE. PAE caused less than 1% damage to surrounding organs (according to one study published in Radiology Journal).

The long-term prognosis after prostate artery embolization (PAE) is generally good, with most patients experiencing significant improvement in their symptoms and quality of life. Studies have shown that most patients who undergo PAE experience a reduction in prostate volume and improvement in urinary symptoms, with little to no risk of sexual dysfunction or incontinence.

In a systematic review and meta-analysis of 21 studies involving 1,796 patients, researchers found that the technical success rate of PAE was 96%. The clinical success rate (a reduction in the International Prostate Symptom Score (IPSS) of at least 25% that may or may not include a reduction in the prostate volume of at least 25%) was 89%. The study also found that the rate of any major complications associated with PAE was low, at 2.8%.

Another study found that patients who underwent PAE experienced significant improvements in their quality of life and their urinary and sexual function, with few adverse events or complications. Specifically, the study found that patients experienced an average reduction in IPSS score of 49%, a reduction in the prostate volume of 30%, and an improvement in the International Index of Erectile Function (IIEF) score of 12.7 points.

Most available evidence suggests that PAE is a safe and effective treatment option for men with benign prostatic hyperplasia (BPH) looking to improve their urinary symptoms and quality of life. However, as with any medical procedure, specific outcomes and prognoses for each patient may vary depending on the health status, the techniques used during the prostate artery embolization, and other factors peculiar to each patient.

The recovery process after prostate artery embolization (PAE) is usually quick, and most patients can return to their day-to-day activities within a few days. However, the specific recovery process may vary depending on individual factors such as age, the health status of the individual, and the extent of the procedure.

• Immediately after the procedure: Patients are typically monitored in a recovery room for several hours after the PAE procedure. The medical team ensures that there should be no complications or adverse reactions to the anesthesia or the embolization material. Patients may experience mild discomfort or pain in the pelvic area and some urinary urgency or frequency. One can manage this pain and discomfort with medication or by drinking plenty of fluids.
• Discharge from the hospital: Most patients are discharged on the same day as the procedure, although some may need to stay overnight for observation. Before allowing for the discharge, the doctor gives detailed instructions on how to care for themselves at home. The hospital's discharge summary also includes information about managing pain or discomfort, when to resume normal activities, and when to follow up with the treating doctor.
• Recovery at home: After returning home, the person should rest and avoid strenuous activities for several days. Patients may also need pain medication or antibiotics to manage discomfort or prevent infection after the procedure. Patients need to drink plenty of fluids to help flush out any remaining embolization material from the body.
• Follow-up appointments: The doctor may ask patients to come for follow-up appointments at regular intervals after the prostate artery embolization to monitor their progress and ensure that patients have no complications or adverse effects. These appointments may include physical exams, imaging tests, and blood work to evaluate the patient's prostate function and overall health.
• Long-term recovery: Most patients experience a significant improvement in their urinary symptoms and quality of life within a few weeks to months after the prostate artery embolization. However, it may take several months for the full effects of the procedure to be evident as the prostate gradually shrinks in size. Patients may need to strictly adhere to the instructions given by their physician's instructions and attend all scheduled follow-up appointments to ensure a full recovery and minimize the risk of complications.

What is prostate artery embolization? How does it work to treat benign prostatic hyperplasia (BPH)?

Prostate artery embolization is a minimally-invasive procedure that involves blocking the blood supply to the prostate gland to shrink it and relieve urinary symptoms caused by BPH.

How is PAE performed? What should I expect during the procedure?

During PAE, a catheter is inserted through a small incision in the groin or wrist and guided to the prostate artery using X-ray imaging. The doctor then injects small particles or coils to block the blood flow to the prostate gland.

Who is a good candidate for prostate artery embolization? What criteria can determine eligibility?

Men with moderate to severe urinary symptoms caused by benign prostatic hyperplasia and who have not responded well to medications or do not want surgery may be good candidates for PAE. Eligibility is determined based on a thorough medical history, physical examination, and imaging studies.

How long does the PAE procedure typically take? What is the recovery time?

The PAE procedure typically takes 1-2 hours. Most patients can return home the same day. Recovery time varies, but most patients can resume normal activities within a few days to a week.

What is the success rate of PAE? How long do the effects last?

Studies have shown that PAE helps improve urinary symptoms in up to 80-90% of patients, with effects lasting for up to 2-3 years or longer.

Are there any risks or complications associated with PAE?

As with any other medical procedure, there are some risks and potential complications associated with PAE, including pain, bleeding, infection, and damage to surrounding tissue or organs.

Can PAE be performed under local anesthesia? Does it require general anesthesia?

Your doctor can perform PAE under local or Sedation, depending on your condition, consent, and the doctor's recommendation.

Will I need to use a catheter after PAE? How long do I need to wear it?

Most patients do not require a catheter after PAE, but in a few cases, one may need a temporary catheter for a few days to help drain the bladder.

Can PAE be repeated if necessary? Are there any limits to how many times a patient can undergo it?

The doctor may repeat PAE if necessary. But the number of times you can undergo this procedure may depend on your health status and anatomy.

How does PAE compare to other treatments for BPH, such as medication or surgery?

PAE is a newer, minimally-invasive alternative to surgery for BPH that may offer similar or better outcomes with fewer risks and complications. However, medication is often the first-line treatment for BPH and may be effective for some patients.

Does PAE have any impact on sexual function or cause impotence?

PAE has shown to have a low risk of causing erectile dysfunction or other sexual dysfunction in most patients, but individual results may vary.

Can PAE cause incontinence or worsen urinary symptoms?

Prostate artery embolization can cause temporary or permanent urinary incontinence in rare cases. But many studies have shown that it is generally safe and effective in improving urinary symptoms caused by BPH.

What are the possible side effects of PAE? How common are the side effects?

Possible side effects of PAE include pain, swelling, bruising, and fever. But most of these symptoms are usually temporary and resolve within a few days to a week.

Will I need to stay in the hospital after the procedure?

Most patients can go home the same day or the next day after the procedure. However, some patients may need to stay in the hospital for a slightly extended period if they experience complications.

How effective is prostate artery embolization?

PAE is effective in improving urinary symptoms caused by BPH in many patients. The success rate varies depending on the patient's case and the technique used, but overall, PAE has a success rate of around 75-90%.

Are there any alternative treatments for BPH?

Yes, there are several alternative treatments for BPH, including medications, minimally invasive procedures, and surgery. The best treatment option depends on the patient's case. It is always better to discuss these options with a healthcare professional.

Will PAE affect my sexual function?

Most clinicians have accepted PAE as a procedure with minimal impact on sexual function. In some cases, it may even improve sexual function. However, some patients may experience a temporary decrease in sexual function after the procedure.

How often do I need to follow up after PAE?

Patients typically need to follow up with their healthcare provider 1-3 months after the procedure to evaluate its effectiveness and monitor for any complications.

Will I need to have PAE again in the future?

PAE is considered a long-term solution for BPH. Most patients do not need to have the procedure again. However, some patients may require additional treatment if their symptoms return.

Can PAE be done on patients with prostate cancer?

PAE is not recommended for patients with prostate cancer, as it may interfere with cancer treatment and lead to complications.

Can PAE be done on patients with other medical conditions?

PAE may be safe and effective for patients with other medical conditions. But to minimize the risk of complications, the doctor will evaluate the patient's case to determine if they are a suitable candidate for the procedure.

What are the chances of complications from PAE?

The risk of complications from PAE is low. The exact risk depends on the patient's health status. One can discuss these risks with a healthcare professional.

Is my insurance covers PAE?

Your insurance may cover PAE. But the coverage and reimbursement policies vary depending on your insurance provider and policy. Patients should check with their insurance provider to determine their coverage options.

Why choose Medanta for prostate artery embolization?

Medanta Hospitals is a multi-specialty hospital chain located in India. The group offers a range of medical and surgical treatments, including PAE for BPH. Some factors that you may consider when choosing Medanta Hospitals for PAE include

• Expertise and experience: Medanta Hospitals is known for its highly qualified and experienced team of physicians and healthcare professionals. The hospital has specialists in all the medical and surgical & interventional disciplines. Our physicians are trained in the latest techniques and technologies for performing PAE, ensuring each patient should receive the highest level of care.
• Comprehensive care: Medanta Hospitals offer state-of-the-art facilities with advanced medical equipment and a dedicated team of support staff to all their patients to ensure holistic and personalized care to patients. In addition, the hospital offers a range of support services and amenities, such as on-site laboratories, diagnostic imaging, and rehabilitation services, to provide patients with a seamless and integrated care experience.
• Patient-centered approach: At Medanta Hospitals, patient satisfaction and comfort are the core drivers. The hospital takes a patient-centered approach to care, which means curation of care plans around the unique needs and preferences of each patient. This approach ensures that patients are fully involved in their care.
• Cost-effective care: Medanta Hospitals offers the best possible payment and insurance options to its prospective patients. We always try to provide cost-effective care that is accessible and affordable for all patients. In addition, the hospital works closely with insurance providers to ensure that patients receive maximum coverage for their treatment.