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Minimally invasive breakthrough treatment For (BPH) Benign Prostatic Hyperplasia By Prostatic Artery Embolization
Enlarged Prostate - Prostatic Artery Embolization (PAE) |
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Introduction |
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As a man ages, there is a good chance that he will develop an enlarged prostate or benign prostatic hyperplasia (BPH). In fact, it is estimated that close to 80% of men will develop BPH. Most men will be able to treat this condition with alpha-blockers or 5-alpha reductase inhibitors, but close to 10% of men who develop an enlarged prostate will need surgery to correct complications from this disorder. The complications include frequent urinary tract infections, bladder stones, inability to urinate and urinary incontinence.
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Fig 1 : Normal Prostate |
Fig 2 : Enlarged Prostate |
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| Prostate gland enlargement: Symptoms |
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These signs and symptoms may include:
- Weak urine stream, Difficulty starting urination
- Stopping and starting while urinating, Dribbling at the end of urination
- Straining while urinating, Frequent need to urinate
- Increased frequency of urination at night (nocturia)
- Urgent need to urinate and not being able to completely empty the bladder
- Blood in the urine (hematuria)
- Urinary tract infection
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- Digital Rectal Examination
- Transabdominal / transrectal ultrasound
- Prostatic Specific Antigen (PSA)
- Urine Analysis
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Up until now, there were several different types of surgeries that a man could elect to have. Most of the results from these surgeries were temporary and the surgery would have to be repeated. Only one was found to be effective, transurethral resection of the prostate (or TURP).
TURP required the doctor to insert a device up the urinary tube and remove the prostate, as pieces at a time. This procedure was found to be effective at stopping the symptoms. But there were complications from this type of procedure. Such as erectile dysfunction, blood in the urine, blood loss even few days after surgery, water intoxication and urinary incontinence. Also TURP could only be performed on prostates that are 60 cubic centimeters in size or less.
Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction).
Now a new procedure has been developed that is comparable to TURP in recovery of the symptoms. It is called Prostatic Artery Embolization or PAE. Prostatic Artery Embolization
The patients stops all prostatic medication 1 week before embolization, and after successful PAE, all prostatic medication is abandoned and some specific medication is given.
The patients are admitted to the hospital on the day of the procedure. Embolization is performed under local anesthesia by unilateral approach, usually the right femoral artery. Initially, pelvic angiography is performed to evaluate the various arteries. Then, an angiography catheter is introduced in right femoral artery advanced in the ostium of the prostatic artery before embolization. For embolization, PVA particles are injected causing slow flow or near-stasis in the prostatic vessels with interruption of the arterial flow and prostatic gland opacification.
When embolization of the both prostatic arteries is finished, the catheter is removed. After 6- 8 hrs patients can start walking around in room.
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Angiographic findings in a 74-year-old patient with urinary retention with a bladder catheter. Right prostatic arteries before (arrow, a) and after (b) embolization (arrow). (c) After embolization of the right prostatic arteries, in the parenchymal phase of angiography, the prostate is slightly opacified (arrow). The bladder catheter is marked with an arrowhead. Left prostatic arteries before (arrow, d) and after (e) embolization (arrow). Left internal pudendal artery remains patent (arrowhead). (f) After embolization of the left prostatic arteries, in the parenchymal phase of angiography, the prostate is shown with good opacification (arrow). The bladder catheter is marked with an arrowhead. |
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The men undergoing this procedure experience little or no pain and can leave the hospital within hours after the procedure is performed. Plus, they experience none of the complications that frequent men after the TURP surgery.
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Pelvic MR images in a 78-year-old patient with BPH. (a) Sagittal pelvic MR before PAE shows a prostate cephalocaudal diameter of 59.2 mm and a prostate volume of 95.5 mL. (b) Axial image before PAE shows prostate sagittal and transverse diameters of 49.9 _ 61.8 mm and prostate volume of 95.5 mL. (c) Sagittal image 6 months after PAE shows a prostate cephalocaudal diameter of 40.2 mm and prostate volume of 36.6 mL, a decrease of 61.7%. (d) Axial image 6 months after PAE shows prostate sagittal and transverse diameters of 39.0 _ 44.7 mm and prostate volume of 36.6 mL, a decrease of 61.7%. |
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Advantages of Prostatic Artery Embolization ( PAE) |
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- PAE unlike TURP, can be performed on any size prostate,
- It does not produce the side effects that TURP does.
- Whole procedure done through a small nick around the skin in the groin region.
- Most men experience no pain to light pain and leave the hospital in a day after intervention.
- No sexual dysfunction following prostatic artery embolization and a quarter of patients report that sexual function improved after the procedure.
- Unlike traditional surgical treatment, this procedure need no general anesthesia it need just mild to moderate sedation,
- No blood loss or risk of blood transfusion.
- No surgical ugly scars and makes for faster recovery.
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PAE appears that it may replace TURP as the gold standard for prostate surgery and without the complications associated with this type of surgery.
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For more in-depth information contact :
Dr. Pradeep Muley M.D.
Head & Senior Consultant Interventional Radiologist
Fellow, Neurointerventional Radiology, John’s Hopkins Medical
Institutions, USA
Visiting Associate, Neurointerventional Radiology, Iowa University,
USA
Fellow Interventional Radiology, Singapore General Hospital, Singapore
Lecturer Vascular & Interventional Radiology, KEM Hospital,
Mumbai.
Neuroradiology, AIIMS, New Delhi.
Mobile 098104 92778 or E-mail at muleypradeep@hotmail.com
Website http://www.indianinterventionalradiology.in
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Minimally invasive breakthrough treatment For (BPH) Benign Prostatic Hyperplasia