Section of Vascular and Interventional Radiology

Section of Vascular and Interventional Radiology

 

Prostate Artery Embolization (PAE):

A new treatment to relieve the obstructions from enlarged prostate glands.

The prostate gland is part of the male reproductive system. It is situated at the base of the urinary bladder surrounding the bladder empting conduit for urination, the urethra.  As a man age, the prostate gland enlarges. It may press on the urethra and obstruct the urine flow.
PAE - Prostate Artery Embolization


Benign Prostate Hypertrophy (BPH) refers to the enlarged prostate gland and is the most common cause of Lower Urinary Track Symptoms (LUTS) in older males. The most common symptoms are:
1.Frequent urination, especially problematic at night
2.A hesitant, interrupted, or weak stream of urine
3.Leaking or dribbling of urine, as the bladder remains overfilled attempting to empty
4.Feeling as though the bladder is not empty even after urination
5.Repeated or non-resolving urinary tract infections, as contaminated urine remains retained in the bladder
Mild symptoms from BPH might require just some lifestyle changes like
1. avoid drinking fluids after certain hour
2. avoid ingesting products with diuretic effect like caffeine or alcohol
3. double void, as wait a moment after urination and try  for a second time

 

Moderate to Severe symptoms from BPH frequently require medical treatments.
The medicines used to relieve LUTS from BPH are drugs that relax muscles that are normally responsible for urine continence at the base of the bladder outlet (Flomax, Hytrin, Cardura, Uroxatral, Rapaflo) to compensate for the obstruction effects. Other used drugs reduce the size of the prostate by blocking the male hormones that stimulate the gland growth (Finasteride, Dutasteride).

 
Therapeutic interventions are considered when drugs fail to resolve the BPH problems. Trans-Urethral Resection of the Prostate (TURP) is a procedure commonly performed by Urologists where prostate portions are resected using special instruments inserted through the penis urethral meatus.

 

Procedure Details
Prostate Artery Embolization (PAE) is a procedure performed by Interventional Radiologists (IR) where the prostate size is reduced by blocking its arterial blood supply (embolization).


vascular access
PAE is performed through a single needle puncture at the upper thigh/hip, or at the forearm wrist area.

 

prostate artery selectionmicro catheter
Through this puncture, a minuscule duct (micro-catheter) is used to release microscopic particles at the arterial branches that supply the prostate gland with blood (embolization).

 

embolized prostate
The oxygen and nutrition restriction from the embolization results in shrinkage of the prostate tissue relieving obstruction of urine flow.


What to Expect ?
PAE is an ambulatory procedure which means that most patients go home and do not have to spend a night at hospital. The procedure recovery is fast and most patients resume their routine lifestyle by next day.


Results

Immediately after PAE, the tissues respond with inflammation.  The inflammation typically produces transient symptoms of urinary track irritation like moderate pelvic pressure sensation, burning pain with urination, frequent urge to urinate with small volume discharges and sensation of incomplete bladder empting after urination. These symptoms improve gradually over the next 1-2 weeks after PAE, as the inflammation resolves. Then, the tissue heals and the prostate gland shrinks over the course of 1-2 months producing the benefits of the PAE procedure by reliving the urinary obstruction of BPH.   
PAE is successful for treatment of BPH symptoms in over 80% of patients with persistence lasting for years. However, on about 10-15% of patients, the PAE is incomplete or not possible due to inaccessible vascular branches from tortuous anatomy or small caliber vessels.  Additionally, PAE fails to improve BPH symptoms in 5-10% of the cases despite a technically successful procedure.

 

Why UT Health ?

At UT Health, patients will find a group of experienced specialized interventional radiologists with the best technical skills perfected by working at an academic center were 100% of their clinical duties are dedicated to endovascular and percutaneous imaged guided interventions.  The group also counts with experienced ancillary staff and an outpatient clinic that supports the patient care, preparing patients before the procedure, coordinating hospital care the day of procedure and guiding the patients after their hospital discharge. The hospital where the procedures are performed is a large referral center fully equipped for endovascular procedures with the best technology available and counting with onsite support from multiple medical specialties and experienced hospital services.


Contact and Appointments -

To schedule an appointment please call:
Perla Williams 210 358-2373

Otilia Merjil 210 358-0420

 


 

Frequently Asked Questions

 

How much will this procedure cost me?
Most health insurance companies pay for this procedure if appropriate need can be demonstrated.

 

What can I expect during the evaluation process?
Patients are evaluated by one of our Interventional Radiologists (IR) at the IR outpatient clinic were prostate anatomy and volumes are evaluated by imaging (CT, MRI or US) and urodynamic studies (if available by the Urology Service) are evaluated . Proper screening for Prostate Cancer is also considered and addressed.  Once the diagnosis is confirmed, possible PAE treatment is considered. The procedural benefits are weighted against each patient physical condition and health risks (co-morbidities).  If PAE is agreed and recommended during the clinic visit evaluation, the procedure is scheduled as per patient requests and availability.   

 

What tests are needed?
Imaging studies that evaluates the prostate anatomy and if available the pelvic blood vessels like CT or MRI of the pelvis.  Ultrasound of the bladder and prostate sometimes is sufficient if there are no major concerns of severe arterial disease. History of prostate cancer screening results and most recent PSA test.  Urodynamic studies by Urologist if available.   Routine blood test like Basic Metabolic Panel (BMP), Complete Blood Count (CBC) and coagulation test (INR) would be required.

 

Will I need to have a catheter?
A urethral catheter (Foley catheter) will be used and removed during the PAE procedure.  Patients that were not previously dependent on urethral catheters will have the catheters removed right after the PAE procedure is finished. But, patients presenting already dependent to urethral catheters due to severe BPH will continue with the urethral catheter for about 2 weeks after procedure,  prior to removal attempt.  

 

Will I be sedated?
This procedure is normally performed under moderate sedation. This level of sedation means that the patient is drowsy and relaxed, but alert enough to respond to verbal commands. However, general anesthesia is available and can be offered to patient with special needs.

 

Will I be sedated?
The benefits from PAE normally persists for years, however, if the symptoms recurred after several years, a second procedure can be performed searching for new or re-canalized vessels supplying the prostate gland for further embolization treatment. On the other hand, if PAE failed, the transurethral/surgical treaments can still be performed by urology to treat the BPH obstructive symptoms.


 

Uterine Artery Embolization (UAE) or Uterine Fibroid Embolization (UFE):
Uterine fibroids are the most common tumor found in women. Approximately 25% of premenopausal women suffer from fibroids. Medical treatment of the uterine fibroids using Gonadotropin Releasing Hormone Analogue such as Lupron, has been employed in some cases; however, its effect to reduce the fibroid size is reversible (Fibroid increase in size again after stopping the medication). Surgery is another treatment option and the presence of symptomatic fibroids is the most common indication for hysterectomy (Uterine removal).  Myomectomy is another surgical treatment option that leaves the uterus in place and may therefore preserve the fertility. Currently, uterine fibroid embolization (UFE) is a well-established minimal invasive treatment for symptomatic uterine fibroids.

 


Schematic of the various locations of fibroids within the uterus:
Submucosal fibroids indent into the uterine cavity.
Intramural fibroids are located within the wall of the uterus.
Subserosal fibroids extend from the surface of the uterus.

  • Prolonged and intensive cyclical menstrual bleeding (Heavy monthly period) is the most frequent clinical presentation of submucosal fibroids.
  • Bulk symptoms are usually caused by subserosal fibroids that compress the nearby pelvic structures, resulting in the associated symptoms of pain, urinary frequency and constipation.
  • Uterine fibroids may impact fertility usually due to a submucosal fibroid distorting the endometrial cavity. 

 
Uterine Artery Embolization (UAE) is a procedure performed by Interventional Radiologists (IR) where the fibroid size is reduced by blocking its arterial blood supply (embolization).
UAE is performed by a single needle stick at the wrist or the groin. Through this puncture, a minuscule duct (micro-catheter) is used to release microscopic particles at the arterial branches that supply the fibroid with blood, blocking the blood supply to the fibroid and consequently shrinking the fibroid.

Uterine artery embolization is a minimal invasive procedure to treat uterine fibroids with comparable results to surgery and faster recovery time.

 

Contact and Appointments -

To schedule an appointment please call:
Perla Williams 210 358-2373

Otilia Merjil 210 358-0420