“Neend poori nahi hoti bar bar peshab ki vaja se ankh khul jaati hai”, is a common complaint of men in late age. This is one of the classical symptoms of benign prostatic hyperplasia (BPH). Interestingly, many individuals seek treatment for disrupted sleep only to discover that BPH is the underlying cause. As the name suggests, BPH is the excessive growth of the prostate.
In men, prostate cells consistently respond to testosterone, causing the prostate gland to expand throughout life. As a result, with age, the gland becomes enlarged to the point where it compresses the urethra that passes through it. Consequently, individuals may experience an increased urge to urinate, difficulty in passing urine, and a sense of fullness in the lower abdomen.
Medicine is the first choice of treatment for mild symptoms, but when the condition becomes troublesome and does not respond to medical therapy, surgery becomes the preferred solution. The conventional surgery for benign prostatic hyperplasia is transurethral resection of the prostate (TURP). During TURP, a resectoscope is inserted through the urethra, allowing the surgeon to remove excess prostate tissue with an electrically heated wire loop. However, this procedure carries several risks, including bleeding, urinary incontinence, urinary tract infection, erectile dysfunction, stricture formation, and retrograde ejaculation.
In contrast to TURP, prostate artery embolization is an advanced, safe and a non-surgical technique. It is designed to alleviate the symptoms of BPH by reducing the blood supply to the prostate, leading to its shrinkage.
What is prostate artery embolization?
Prostate artery embolization (PAE) is a minimally invasive, non-surgical procedure used to treat benign prostatic hyperplasia. The duration of PAE can vary depending on factors such as the complexity of the case, the experience of the interventional radiologist, and the specific techniques employed during the procedure.
Preparation: Before the actual procedure, there will be some time for patient preparation, which includes obtaining medical history, performing any necessary imaging studies, and explaining the procedure to the patient. This phase can vary in duration but is usually relatively brief.
Anesthesia and Catheterization: The patient is then given local anesthesia and conscious sedation. Following this, a catheter is inserted, often through the femoral artery in the groin, and guided to the arteries supplying blood to the prostate. This step usually takes about 30 minutes to an hour.
Angiography: Contrast dye is injected, and X-ray imaging is used to visualize the blood vessels leading to the prostate. The angiography helps identify the specific arteries that need to be targeted for embolization. This step can take approximately 30 minutes to an hour.
Embolization: Once the arteries are identified, tiny particles (embolic agents) are injected through the catheter to block or reduce blood flow to the prostate, leading to its shrinkage. The embolization phase typically takes about 30 minutes to an hour, but the time can vary depending on the complexity of the case.
Monitoring and Recovery: After the embolization is complete, the interventional radiologist monitors the patient for a period of time to ensure stability. The patient may spend some additional time in a recovery area. The total monitoring and prostate artery embolization recovery time can range from 1 to 2 hours.
Post-Procedure Care: After monitoring, the patient is typically observed for any immediate post-procedure complications. If everything is stable, the patient may be discharged on the same day or, in some cases, the following day.
Benefits:
Prostate Artery Embolization has shown several benefits as a minimally invasive alternative for the treatment of benign prostatic hyperplasia. Here are some of the key benefits associated with PAE:
Minimally Invasive: PAE is a less invasive procedure compared to traditional surgical treatments for BPH, such as TURP. It is performed through a small incision in the groin or wrist, reducing the need for major surgery and associated risks.
Shorter Recovery Time: Patients undergoing PAE typically experience a shorter recovery period compared to those undergoing traditional surgical interventions. Many patients can go home on the same day or the day after the procedure.
Preservation of Sexual Function: Unlike some surgical procedures for BPH, PAE has been associated with a lower risk of sexual side effects. This can be an important consideration for patients concerned about the impact of treatment on their sexual function.
Outpatient Procedure: PAE is often performed on an outpatient basis, meaning that patients do not need to stay overnight in the hospital. This contributes to a more convenient and less disruptive treatment experience.
Avoidance of General Anesthesia: PAE is typically performed under local anesthesia and conscious sedation, eliminating the need for general anesthesia in many cases. This can be advantageous, especially for patients who may not be suitable candidates for general anesthesia due to underlying health conditions.
Improvement in Urinary Symptoms: PAE has been shown to effectively reduce the symptoms associated with BPH, such as urinary frequency, urgency, weak stream, and difficulty initiating urination. It can lead to improved urinary flow and overall quality of life for patients.
Lower Risk of Bleeding and Infection: Since PAE is a minimally invasive procedure, the risk of bleeding and infection is generally lower compared to open surgical procedures. This can be particularly beneficial for patients with certain medical conditions or those at higher risk for complications.
Customized Treatment: PAE is a targeted procedure that allows for a more individualized approach. The interventional radiologist can tailor the treatment to the specific anatomy and characteristics of each patient’s prostate, potentially improving the precision and effectiveness of the intervention.
How long does prostate artery embolization last?
The benefits of the PAE procedure typically remain for a minimum of 3-4 years. According to a study PAE results in long-lasting relief from symptoms of BPH, with re-intervention rates of 20% within the initial 5 years and increasing to 30%-60% beyond 5 years following the procedure.
What are the side effects of prostate artery embolization?
Prostate artery embolization side effects are limited. As with any medical procedure, there are risks of complications, including bleeding, infection, and damage to surrounding structures. Some patients may experience transient symptoms such as pain, urinary retention, or difficulty urinating after the procedure.
With expert hands, these risks are further minimized. Dr. Imtiaz Ahmed is an interventional radiologist and endovascular surgeon with extensive experience in treating BPH using prostate artery embolization. His areas of expertise lie in minimally invasive procedures.
For further information email now at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.
