Prostate Artery Embolization – frequently asked questions

The prostate gland is a usually walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. When enlarged, the prostate gland can reduce urinary flow and sometimes cause hard-to-detect pain in the lower part of the body or during urination. It produces part of the seminal fluid that is released into the urethra during ejaculation.

The most common cause of an enlarged prostate is the so-called benign prostatic hyperplasia (BPH), also called benign prostatic syndrome (BPS). It is a benign enlargement of the gland.

Benign prostatic syndrome (BPH) is one of the most common diseases in men; one in two men over the age of 60 suffer from it.

The constriction or increased pressure on the urethra can cause various symptoms. Many patients suffer from a frequent urge to urinate at night, but a strong urge to urinate may also occur suddenly and unexpectedly during the day. Often, the stream of urine is reduced so that urination is prolonged and delayed. In later stages of the disease, recurrent inflammation of the urinary tract may occur which may even lead to a deterioration in kidney function.

In addition, many patients also suffer from psychological problems due to the lack of sleep and the general reduction in quality of life.

The disease is initially treated with medication. If the therapy is unsuccessful or no longer sufficient, the prostate gland is usually removed reduced in size through the urethra (trans urethral resection prostate, TUR-P). Another option is open surgery of the prostate. A new, alternative procedure is prostate artery embolization (PAE).

The prostate, like any other organ, receives oxygen and nutrients through the arteries to perform and maintain its function. The PAE therapy aims to achieve a permanent and strong reduction in blood flow to the prostate. This causes a shrinkage of the organ.

In PAE, a small angio-catheter is inserted into the internal iliac artery after local anaesthesia via an access to the inguinal artery. Using a contrast medium and a state-of-the-art angiography system, a virtual 3D model of the pelvic vessels is created within a few seconds. Thus, the prostate artery can be probed with an extremely thin catheter. The catheter is used to deliver tiny beads (polyvinyl alcohol, diameter about 250 µm), which then block the small branches of this artery.

Since the procedure is performed under local anaesthesia, general anaesthesia and the associated risks are avoided. The procedure is painless for most patients. However, if a slight discomfort should occur, it is easily treatable. The risk of bleeding via the urinary tract is minimal.  

A consequence of conventional suergery is a substantial risk of backward ejaculation into the bladder; this occurs extremely rare after a PAE. Likewise, there is no increased risk of incontinence or erectile dysfunction after a PAE. The inpatient stay at the Helios Hospital Krefeld usually lasts two days.

Patients usually feel the first improvement of their symptoms after a few weeks.

Before a PAE, each patient is examined on an outpatient basis to determine any circumstances interfering with the procedure. Blood tests are performed and the prostate is measured by ultrasound. A bladder-catheter is usually not inserted.

After the procedure, an anti-inflammatory and pain-relieving medication (e.g. ibuprofen 400mg) and additional stomach protection (e.g. pantozol) is prescribed for ten days.

Malignant tumors of the prostate (prostate cancer) cannot be treated with PAE. A possible urinary tract infection should be treated before a PAE. In the case of severe arteriosclerosis, pelvic vessels might be severly narrowed or occluded, so that in individual cases the prostate arteries cannot be accessed with the catheter; in this case treatment is not possible.