What is Prostate Artery Embolization (PAE)?

Prostate artery embolization (PAE) is a relatively novel procedure which is minimally invasive and can be carried out in an outpatient department setting.

It is used to relieve urinary symptoms caused by an enlargement of the prostate gland.

PAE works by cutting off blood flow to the excess prostate tissue, leading to its necrosis and re-absorption of the dead tissue by the body, resulting in a smaller prostate gland and reduced urinary symptoms.

Benefits of Prostate Artery Embolization

This procedure has certain advantages over the TURP (trans-urethral resection of the prostate) which is currently the golden standard for treating cases of mild to moderate benign prostatic hyperplasia and other methods. The benefits include:

  • A lower risk of bleeding, making it more suitable for patients with a bleeding disorder or those on blood thinning medications.
  • PAE can be completed as a day procedure, which means no hospital stay.
  • PAE is also considered to have a lower associated risk of resulting in dry orgasms, which may cause difficulties in starting a family.

The physician will decide which method is most suitable for a patient, after an examination.

Preparation Before Prostate Artery Embolization

In order to prepare for the surgery, the patient should be adequately counselled to ensure that the informed consent obtained is fully understood.

The doctor then runs a number of tests to ensure that the patient is fit and in good health for the surgery. These will include:

  • Pathology tests
  • Urine analysis
  • PSA test
  • CT scans if needed, and
  • a thorough physical examination

Steps in Prostate Artery Embolization

In preparation for the surgery, the patient is instructed to empty his bladder and an IV line is inserted in his arm. The anesthesia administered will either be intravenous or local in nature, which is decided by the interventional radiologist on a case by case basis.

The procedure includes the following steps:

  • The patient is positioned on his back and administered anesthesia as required.
  • The legs of the patient are placed in stirrups and elevated and spread apart.
  • The surgeon inserts a Foley catheter in the urethra to help with urination.
  • Another tiny catheter is placed in a groin artery through a pinhole. It is navigated to the prostate arteries, where small beads are injected into them to cause the blockage.
  • The catheter is left in the urethra to help with urination for a few days.

The entire procedure can take anywhere from an hour to four hours.

Immediate Post Prostate Artery Embolization

The patient is kept in the recovery room for observation and their vitals are monitored. Once they have recovered, they are discharged with pain medication.

The catheter is usually removed after the patient has passed clear urine or up to 3 days after the procedure.

Recovery After Prostate Artery Embolization

Pain medication can also be taken on a per needed basis. Normal work activities can be resumed within a few days of the procedure.

The doctor may instruct further caution with regards to strenuous activities as well for a few days.

Care Plan for Prostate Artery Embolization

The doctor will devise a care plan for the patient for the next few months, to aid in recovery and to help improve bladder control. He will also advise a follow-up visit chart to check the patient’s progress in the clinic as well and to check for any post-surgical complications.

Improvements in urinary symptoms are often noticeable within a few weeks of the procedure and improvement is continuously seen until 5-6 months after the procedure.

  • Royal Australasian College of Surgeons
  • Australian and New Zealand Urogenital and Prostate
  • da Vinci Surgery