BPH and Prostate Embolization

Benign (non-malignant) prostate hyperplasia, or BPH, is an extremely common disorder affecting some 70% of men over the age of 70 years and the majority of men 60 and older. It negatively affects the quality of life of 25% of men in this age group. Symptoms can include having to urinate frequently (frequency), urinating multiple times during the night (nocturia), and having to urgently urinate (urgency). However, BPH may also cause the presence of blood in the urine (hematuria), straining to start your urine stream (which may even result in an inguinal hernia), and the formation of a bladder stone or calculus. Your doctor may perform a rectal exam, prostate ultrasound exam, MRI exam of the prostate, a blood PSA test, urodynamic exam, and even a prostate biopsy in order to evaluate your BPH and to ensure there is no prostate cancer present.  Surgical options for the treatment of BPH include Transurethral Resection of the Prostate, or TURP, and several laser procedures. TURP is generally ineffective for prostates with a volume larger than 90 ml. 100% of men undergoing TURP will develop the permanent sexual dysfunction of retrograde ejaculation. Bleeding, pain, infection, and prostate regrowth are other potential complications of TURP. Laser procedures can result in burning on urination, bleeding, and urine leakage that may last up to 3 months post-operatively.

Prostate embolization (PAE) is a minimally invasive alternative to TURP and laser procedures. A recent Society of Interventional Radiology Position Statement concluded that PAE is a safe and effective treatment for BPH in cases of very large prostate volumes, prostate hemorrhage, men requiring chronic bladder catheterization, males trying to avoid sexual dysfunction due to retrograde ejaculation (occurring in100% of TURPs), and patients requiring BPH therapy but also who are being treated with anti coagulation therapy to prevent stroke due to atrial fibrillation, or A-fib.  PAE has been very successful with improved urinary obstructive symptoms, control of hematuria, and freedom from chronic bladder catheterization. No significant complications have occurred during any of Embokare’s prostate embolizations. A serious complication rate of only 0.5% for PAE has been reported in the literature. PAE can almost always be conducted as an outpatient procedure, using IV sedation, with either little or no post-op pain. Our state-of-the-art imaging capabilities at Embokare, ensure correct placement of the particle-delivery catheter within the prostatic artery, thus avoiding non-target embolization of the bladder or bowel.

The actual success rate of alleviating urinary obstructive symptoms between TURP vs embolization are very comparable. The major difference is between the two approaches is that embolization has significantly fewer unpleasant side effects.