PROSTATE ARTERY EMBOLISATION (PAE)
Prostate artery embolisation (PAE).
Prostate artery embolisation (PAE) is a new technique described in 2010 for the treatment of benign prostatic hypertrophy (BPH).
Traditional trans-urethral surgical resection (TURP) treatments treat the centre of the gland and risk urinary tract infection, retrograde ejaculation, and erectile dysfunction. PAE treats the whole gland by blocking the blood supply to the prostate causing a global reduction in size without risks of chronic infection and retrograde ejaculation. The national institute of health & clinical excellence (NICE) supports the use of PAE as a treatment for BPH.
What is Prostate Artery Embolisation (PAE)?
PAE is a non-surgical way of treating an enlarged and troublesome prostate by blocking off the arteries that feed the gland and making it shrink. It is performed by an interventional radiologist (image guided surgeon), rather than a urologist, and is an alternative to a TURP (transurethral resection of prostate) or other prostate operations including laser surgery.
PAE was first performed in 2009, and since then over 900 men have had the procedure performed predominantly in Portugal, Brazil and the USA.
When is Prostate Artery Embolisation (PAE) performed?
Other tests that you have had done will have shown that you are suffering from an enlarged prostate, and that this is causing you considerable symptoms. Your urologist and your GP should have told you all about the ways of dealing with this, usually starting with medication. Previously, most severe prostatic symptoms have been treated by a TURP operation. In your case, it has been decided that embolisation is an alternative treatment worth considering.
What happens during a Prostate Artery Embolisation (PAE)?
You will lie on the X-ray table, generally flat on your back. You need to have a needle put into a vein in your arm, so that you can have a sedative and painkillers if required. You may also have a monitoring device attached to your chest and finger and may be given oxygen through small tubes in your nose.
The interventional radiologist will keep everything as sterile and will wear a theatre gown and operating gloves. The skin near the point of insertion, groin or wrist, will be swabbed with antiseptic and covered with a theatre drape.
The skin and deeper tissues over the artery in the groin or wrist will be anaesthetised with local anaesthetic, and then a needle will be inserted into this artery. Once the interventional radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into this artery. Then the needle is withdrawn allowing a fine, plastic tube, called a catheter, to be placed over the wire and into this artery.
The interventional radiologist will use the X-ray equipment to make sure that the catheter and the wire are then moved into the correct position, into the other arteries which are feeding the prostate. These arteries are quite small and rather variable. A special X-ray dye, called contrast medium, is injected down the catheter into these prostate arteries, and this may give you a hot feeling in the pelvis.
The interventional radiologist may then perform a CT scan like technique where the Xray tube rotates around the table and the images are then processed by a powerful computer to make sure no abnormal arterial connections are present. Once the prostate blood supply has been identified, fluid containing thousands of tiny particles is injected through the
catheter into these small arteries which nourish the prostate. This silts up these small blood vessels and blocks them so that the prostate is starved of its blood supply. Both the right and the left prostatic arteries need to be blocked in this way. It can often all be done from a single artery puncture but occasionally two are required. At the end of the procedure, the catheter is withdrawn, and pressure is applied to prevent any bleeding.
The interventional radiologist will use the X-ray equipment to make sure that the catheter and the wire are then moved into the correct position, into the other arteries which are feeding the prostate. These arteries are quite small and rather variable. A special X-ray dye, called contrast medium, is injected down the catheter into these prostate arteries, and this may give you a hot feeling in the pelvis.
The interventional radiologist may then perform a CT scan like technique where the Xray tube rotates around the table and the images are then processed by a powerful computer to make sure no abnormal arterial connections are present. Once the prostate blood supply has been identified, fluid containing thousands of tiny particles is injected through the catheter into these small arteries which nourish the prostate. This silts up these small blood vessels and blocks them so that the prostate is starved of its blood supply. Both the right and the left prostatic arteries need to be blocked in this way. It can often all be done from a single artery puncture but occasionally two are required. At the end of the procedure, the catheter is withdrawn, and pressure is applied to prevent any bleeding.
How should I prepare?
PAE is performed as a day-case. We advise to starve so that sedation or painkillers can be administered.
Any anticoagulation medication should be stopped prior to the procedure.
