Prostate Artery Embolization BPH Treatment in Men: Office Procedure in New York and New Jersey
by Dr. Alex Shteynshlyuger, a board-certified urologist and specialist in the treatment of enlarged prostate, BPH and urinary retention. He is one of the first urologists in the US and NYC to offer Urolift and prostate enucleation, an alternative to traditional TURP as a treatment for enlarged prostate.
What is Prostate Artery Embolization?
Prostate artery embolization is a procedure designed to block the arteries that supply blood to the prostate. By cutting go of blood supply to the prostate, the prostate tissue dies off (or undergoes necrosis and resorption). The end result is that the prostate shrinks in size. Prostate artery embolization can be performed his initiation of prostate bleeding but more commonly performed for treatment of BPH symptoms in men with an enlarged prostate.
How Effective is Prostate Artery Embolization for Treatment of BPH in Men?
It appears that prostate artery embolization has good efficacy in published studies for the treatment of men with enlarged prostate. However, it is important to understand that studies that have been published have numerous limitations including the fact that many have a high dropout rate after treatment. High dropout rate means that patients do not follow-up after the procedure; as a result, it is impossible to verify whether these patients have improved or had severe complications. Often, men who do not see clinical improvement or those who experience severe complications do not follow up with the same physician and go for a second opinion elsewhere.
What are the Different Ways to Embolize the Prostate Gland?
The prostate gland gets blood supply from the right and left branches of internal iliac arteries. Prostate embolization can be achieved by embolizing both prostatic arteries on right and left side or by embolizing only one side. Typically, studies show that embolization of both prostatic arteries results in higher clinical success rates of prostate artery embolization.
PERFecTED technique for PAE: Two-step embolization technique where after initial administration of microspheres (beads) that are 100-500 micron (1/1000 of a meter) made of hydrogel or polyvinyl alcohol (PVA), the catheter is pushed deeper in and additional microbeads are administered.
Traditional embolization technique: is a one-step prostate artery embolization technique where the catheter is not advanced further into the prostatic artery for the second dose of microsphere administration. It appears that traditional technique is less effective than PERFecTED technique. For technical reasons, sometimes only traditional technique can be accomplished.
Use of different embolization materials: embolization can be achieved using coils (not commonly used for prostate artery embolization). Microbeads are the most commonly used material for prostate artery embolization, typically using a 2.7F (very tiny and narrow) catheter.
How does Prostate Artery Embolization Compare to Urolift?
No study has directly compared prostate artery embolization to the Urolift procedure. Based on the indirect comparison, the Urolift procedure is associated with fewer risks and complications than prostate artery enucleation.
How Does Prostate Artery Embolization Compare to Bipolar TURP?
In the study comparing TURP and prostate artery embolization, a TURP procedure resulted in somewhat better urine flow then PERFecTED technique for PAE. Original embolization technique is less effective than the PERFecTED technique for PAE. (Carnevale et al 2016) . Patients after TURP had more short-term complications but the clinical success of TURP surgery was somewhat better than of prostate enucleation with 4% in the TURP group and 9% in PAE group not improving after treatment. Clinically TURP and prostate artery embolization, and particularly when performed using bilateral PERFectTED technique results in similar improvement in symptoms as measured by AUA symptom score.
Risks and Side Effects of Prostate Artery Embolization.
The prostate is a part of the urinary tract and is often a harbinger of infection. After prostate artery embolization, necrosis of prostatic tissue which is the desired effect of prostatic artery embolization predisposes to increased risk of infection within the prostate and formation of a prostatic abscess. Because of the risk of infection, antibiotic prophylaxis is often prescribed after the procedure.
- Dysuria: 9%-15%
- Urinary infection: 7%
- Blood in urine: 5% (but likely higher as many patients may not ejaculate after the procedure for a while)
- Blood in semen: 0.5%
- Urinary retention: 10-20%
- Rectal bleeding: 3%
Embolization of prostate tissue can also cause flu-like symptoms
Prostate artery embolization is associated with small risks of hematomas, pseudoaneurysms and nonselective embolization of adjacent organs as well as other organs.
Men may experience pain, urethral burning, and urinary frequency after prosthetic artery embolization possibly related to non-targeted embolization.
Patients may experience pelvic pain and discomfort, perineal, suprapubic, rectal, urethral and testicular pain. Men can also experience frequent urination, a sensation of incomplete bladder emptying and ejaculatory pain. Some men experience nausea and vomiting as well as febrile symptoms due to post embolic inflammatory syndrome (PES). This occurs in about 10% of patients.
Superior rectal artery connects to the branches of the prostatic artery in as many as 30% of patients. This can cause ischemic damage to the rectum, rectal pain, blood per rectum and other rectal side effects such as erosions, fistula or abscess.
Radiation Exposure During Prostate Artery Embolization
Fluoroscopy, a type of radiation to visualize the arterial supply to the prostate, is used during prostate artery embolization. Studies report procedure time from 1 hour to 2 hours and the radiation exposure rate as measured by fluoroscopy time anywhere from 30 minutes to 1 hour. This is a significant amount of radiation. Long-term repercussions are not known but at higher doses, radiation to the pelvis can increase the risk of bladder cancer and rectal cancer.
How Successful is PAE for BPH Treatment?
It is important to understand the difference between technically successful prostate artery embolization which simply means that embolization was performed as planned, and clinically successful embolization. Clinically successful embolization means that embolization actually helped patient with his symptoms. A technically successful embolization may not be clinically successful if patient symptoms are not improved after PAE.
Technically successful prostate artery embolization can be performed in around 90% of patients with bilateral embolization. Unilateral embolization appears to result in the lower clinical efficacy of prostatic artery embolization.
Based on published studies, it appears that the benefit of prostatic artery embolization is durable for more than a year. Few long-term studies have been published with patients who underwent prosthetic artery embolization.
Clinically studies suggest that 75-80% of patients benefit from prostate artery embolization with the benefit persisting to 3-6 years. With unilateral embolization, success is lower, around 50% in terms of symptomatic benefit.
Studies Demonstrate That Prostate Artery Embolization Is An Effective Treatment Option For Men With Enlarged Prostate.
PAE shows good efficacy in reducing urinary frequency in men with IPPS score going from 24 to 8 (-16) in a large study of patients who underwent PAE. Similarly, the urinary stream can be expected to improve significantly with peak urinary flow (Qmax) improving from 8.5 to 17 (+9) ml/second.
Bladder Ischemia after Prostate Artery Embolization
Bladder wall ischemia after prostate artery embolization is a reported complication of PAE. Management of bladder wall ischemia is complicated and individualized but may require surgical treatment or conservative management under close monitoring in select patients.
It appears that there is no significant detrimental effect of prostate artery embolization on sexual function however studies have not been performed with a specific intent of evaluating sexual and ejaculatory function.
Who are Not Good Candidates for PAE?
Patients with severe atherosclerosis or vascular disease have a higher risk of failure of PAE
Some extremely rare complications have been described, such as septicemia and thrombophlebitis of the pelvic veins, sometimes associated with a pulmonary embolism that can even result in death.
How Soon can Prostate Artery Embolization Be Performed?
PAE for BPH is not currently FDA approved for treatment of a man with BPH and the United States. Most insurances do not cover the cost of prostate artery embolization for treatment of enlarged prostate. PAE is available through some institutions as part of studies. Commercially available PAE requires out-of-pocket payment for the procedure.
What Are My Options Right Now For Treatment Of Enlarged Prostate?
For patients suffering from symptoms of the enlarged prostate such as slow urine stream, urinary urge, frequent urination and waking up at night to urinate, procedures such as Urolift procedure and Rezum procedure are currently available in the United States and have similar efficacy and safety profile as iTind. These procedures are performed in our offices at New York Urology Specialists.
For men with very large prostates, laser enucleation of the prostate is a good and effective treatment option. Our surgeons are experienced in performing laser enucleation of the prostate in NYC.
Why Choose New York Urology Specialists for Treatment of Urinary Retention Caused by Enlarged Prostate?
- All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of BPH using medical therapy, minimally invasive therapies, lasers and open surgery.
- We are one of the few practices in the region to offer a full range of options for treatment of BPH.
- We offer BPH treatment options under local anesthesia which avoids the risks, costs, and recovery from general anesthesia. Most men are able to return to office work and other normal activities the next day.
- Extensive Experience: Hundreds of men treated successfully using medical therapy, Urolift, lasers for BPH (Holmium, Thulium, Evolve, Greenlight lasers), Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
- We treat men with BPH who have heart problems (hypertension, CAD, CHF), renal failure (ESRD) on hemodialysis, men on blood thinners such as aspirin, Lovenox, Coumadin (Warfarin), apixaban, rivaroxaban (Xarelto).
When it comes to experience and innovation – New York Urology Specialists are a step ahead. Better Science Means Better Care. We specialize in minimally invasive highly effective treatment for symptoms of enlarged prostate and BPH. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.
Medicare and major insurances accepted. We offer affordable rates and financing options.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems in men. He uses modern effective and proven treatment methods including prostate enucleation and Urolift for BPH. He is highly recommended by top primary care physicians in the New York area.
He has successfully performed hundreds of prostate procedures in adults. Urolift procedures are performed in the office under local anesthesia, in a surgical center and affiliated hospitals under anesthesia.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.