At a glance
- Anaesthetic
- Local anaesthetic with mild sedation
- Where
- St George’s Hospital, Strowan
Your consultant will explain the anaesthetic, how long it takes and the recovery for your treatment.
On this page
What is prostate artery embolisation (PAE)?
Prostate artery embolisation is a minimally invasive treatment for urinary symptoms caused by an enlarged prostate (benign prostatic hyperplasia, or BPH). It has a lower risk of the sexual side effects that can follow surgery, such as retrograde ejaculation or erectile dysfunction.
PAE is performed by an interventional radiologist (IR), a doctor who uses X-rays and other imaging to see inside the body and treat conditions without open surgery.
Before the procedure
Depending on your IR’s approach, a urinary catheter (a thin tube held in place by a small balloon) may be placed through your urethra into your bladder, to act as a reference point for the surrounding anatomy.
During the procedure
- You are given a local anaesthetic and mild sedation, and stay awake.
- A tiny incision is made at the top of your thigh or in your wrist, and a catheter is passed through the arteries to near your prostate.
- An arteriogram (X-ray pictures taken while dye is injected into the blood vessels) maps the vessels supplying the prostate.
- Tiny round particles (microspheres), each about the size of a grain of sand, are injected through the catheter into those vessels, reducing the prostate’s blood supply.
- The catheter is then moved to treat the other side of the prostate in the same way.
After the procedure
As the prostate shrinks, pressure on the urethra eases. Many men notice their symptoms start to improve within days to weeks.
Benefits compared with surgery
- A shorter hospital stay and recovery
- A low risk of sexual side effects
- A low risk of urinary incontinence
- A shorter time with a urinary catheter, which may be avoided altogether
- Less discomfort
Transurethral resection of the prostate (TURP) and open prostatectomy are invasive operations with higher rates of retrograde ejaculation (semen going back into the bladder), impotence and urinary incontinence. There have been few reports of these side effects after PAE.
Possible risks
The most serious risk is non-target embolisation, when particles reach arteries that do not supply the prostate, which can cause serious complications. PAE is a demanding procedure that should be performed only by interventional radiologists with the right training and experience of the pelvic blood vessels.
Some men have “post-PAE syndrome” for a few days afterwards, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.
Other risks include a bruise (haematoma) where the catheter went in; blood in the urine, semen or stool; bladder spasm; and infection of the puncture site or prostate.