Prostatic artery embolisation
Prostate artery embolisation is a non-surgical procedure to treat lower urinary tract
symptoms caused by benign prostatic hyperplasia.
Causes & symptoms of BPH
Benign prostate hyperplasia or BPH for short, is a non-cancerous enlargement of the prostate gland which causes a blockage in the urine duct from the bladder.
Disturbed urination symptoms can be different in men:
- Needing to pee more than normal. Increase frequency can be during day time or night time (nocturnal frequency)
- A sudden need to pass urine that is hard to put off
- Trouble starting a urine stream
- A weak urine stream or slower than normal stream
- Dribbling at the end of urination
- Feeling like you have not emptied your bladder.
What are the treatment options for
prostate gland enlargement?
Mild to moderate symptoms are usually managed with medication. When drugs fail and the urinary symptoms do not get better, that is when surgical options are considered. The surgical options include trans-urethral resection of the prostate (TURP) or green light laser. Majority of patients in Australia with prostate enlargement will be offered green light laser.
Some men find the side effects of medication difficult to live with or simply do not want to have surgery. A modern less invasive method that does not involve surgical cutting is now available. It is performed by interventional radiologists using xray guidance and the procedure is called prostate artery embolisation. This procedure is very effective in shrinking the prostate gland which improves urinary symptoms.
The prostate artery embolisation procedure is performed with light sedation anaesthetics in the angiography suite. Access to the prostate vessels is achieved by going through the femoral artery in the groin or the radial artery in the wrist via a 2-3mm incision. Xray and iodine contrast are used to perform angiograms of the vessels. Small non-biodegradable particles are injected into the prostate gland vessels to cause shrinkage of the prostate.
Does prostate artery embolisation really work?
It is recognised around the world as a safe and effective way to treat benign prostatic hyperplasia. NICE (National Institute for Health and Care Excellence) in the UK is the largest national body that develops health recommendations and give guidance on treatment for diseases. They have reported on the benefit of prostate artery embolisation back in 2018. While the procedure has been performed around the work since 2010.
Prostate artery embolisation and TURP have similar outcomes with improvements in urinary symptom scores and peak urine flow rate. Prostate artery embolisation have lower risk of sexual dysfunction and other complications. The recovery afterwards is relative fast with no overnight hospital stay required. The reduction in prostate volume has also shown to be long lasting.
Can I have surgery in the future after prostate artery embolisation?
It is not absolutely effective in every patient. However by having this less invasive procedure first does not prevent you from having green light laser or TURP surgery in the future. If embolisation is effective, it means avoiding surgery and some potential major side effects.
Are there any risks associated with
Prostate artery embolisation?
Major complication is rare.
You may get some dull pelvic pain and temporary increase in lower urinary tract symptoms after the procedure.
Uncommon complications could include:
- bladder or rectal ulceration
- sloughing of tissue
- and infection of the gland.
Failure to achieve a significant result or improvement in symptoms can also happen.
Am I a candidate for prostate embolisation?
Not everyone is suitable for the procedure. Patients are carefully assessed at our clinic and your case is discussed between our interventional radiologist and the urology surgeon. You must complete the international prostate symptom score (IPSS) prior to the procedure. Other causes of lower urinary tract symptoms need to ruled out such as infection/inflammation of the prostate and malignancy.
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