Benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate, can cause frequent urination, weak stream, increased urgency, and nighttime urination. While not life-threating, these symptoms can diminish a patient’s quality of life.
Aaron Eifler, MD and Sean Golden, MD are UW Interventional Radiology (IR) physicians who offer prostate artery embolization (PAE), a minimally-invasive treatment option for patients who seek relief from BPH but are unable or hesitant to undergo more invasive, surgical treatments like holmium laser enucleation of the prostate (HoLEP) and Transurethral resection of the prostate (TURP).
Surgical treatment typically requires the patient to undergo general anesthesia, instrument insertion through the penis, and a Foley catheter for a short time post-procedure. Alternatively, interventional radiologists perform PAE through a small skin nick in the wrist with conscious or no sedation. It typically does not require insertion of a Foley catheter. There is also a lower risk of bleeding, incontinence, and sexual dysfunction following PAE compared to surgical options.
Prior to undergoing PAE, patients are evaluated by an interventional radiologist in clinic to determine if they are a good candidate. While many patients with BPH can benefit from PAE, preexisting conditions like severe plaque in the arteries or inability to receive iodinated contrast can disqualify them from the procedure. Patients are also asked to consult with a urologist to discuss surgical alternatives and overall management of their BPH.
The relatively short procedure typically lasts two or three hours. Patients are given medication via an IV to help them relax, and then a local numbing medicine is used to numb the skin in the wrist. The interventional radiologists insert a small tube called a catheter into an incision made in the wrist and thread it through blood vessels until it reaches the prostate arteries. Once there, small beads are infused through the catheter, which build up in the arteries and reduce the blood supply to the prostate, causing it to shrink with time.
Most patients are discharged the same day as the procedure, after an initial one-to-two-hour observation in a recovery unit. In the first week post-procedure, patients should avoid heavy lifting but are otherwise able to resume normal activities. Patients may experience a temporary worsening of urinary frequency, urgency, or burning with urination after the procedure, but these symptoms typically resolve after seven to ten days and can be managed with over the counter painkillers. While some patients notice improvement in BPH symptoms within a few weeks, full efficacy typically takes three to six months to achieve.