Prostate Artery Embolization (PAE) for Benign Prostatic Hyperplasia

Are you experiencing these common symptoms?

Weak urine stream
Urinary retention (which may require foley catheter placement)
Urinary urgency (the frequent urge to urinate)
Urinary frequency (having to urinate frequently throughout the day and night)
Dribbling at the end of urination
Urinary incontinence
Difficulty starting a urine stream
Painful urination or during ejaculation

With the bladder being obstructed by the enlarged prostate, there can be chronic urinary retention in the bladder, which could lead to urinary tract infections (UTIs), bladder stones, blood in the urine, and damage to the kidneys and/or bladder. Fortunately, there are treatment options such as prostate artery embolization, which can significantly shrink the prostate gland and improve lower urinary tract symptoms. At MIVA MEDICAL, we offer PAE which is completely non-surgical, minimally invasive and is performed on an outpatient basis using moderate sedation.

To find out if you’re a good candidate for PAE: Take Our Quiz!

What is enlargement of the prostate from benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is a benign (noncancerous) enlargement of the prostate, and the most common prostate condition in men over age 50. This common condition is seen in approximately 50 percent of men over age 50 and 70 percent of men over age 70. The prostate gland is part of the male reproductive system, located just below the urinary bladder surrounding the urethra, and mainly functions to provide the fluid that goes into semen. When the gland becomes enlarged, it can squeeze on the urethra, obstruct the bladder, and lead to many lifestyle limiting symptoms.

What is prostate artery embolization (PAE)?

Prostate artery embolization or PAE is a minimally invasive procedure for patients suffering from enlarged prostates, specifically, benign prostate hyperplasia or “BPH”. Using state-of-the-art technology and advanced minimally invasive techniques, the blood flow supplied to the prostate gland is targeted and diminished, causing the prostate gland to shrink.

During the procedure, a small puncture is made in either the wrist or the groin, and using image guidance, a tiny catheter is placed into the artery and navigated into the small arteries supplying blood flow to the prostate gland. Once the catheter is shown to be in a safe location for treatment, microscopic particles (which do not contain any medication or radiation) are slowly injected into the feeder arteries of the prostate until the flow is diminished. Following treatment, final images are obtained to ensure adequate delivery of particles. After the procedure, the catheter is removed. Recovery is quick with most patients being discharged in 1 hour following the procedure.

Prostate artery embolization as a treatment option for symptomatic enlargement of the prostate has recently been included in the acceptable treatment strategies by the American Urologic Association (amended in 2023). Unique to many other treatment strategies, this procedure is completely non-surgical, not requiring surgical access to the prostate gland through the penis, has a low-risk profile with a high success rate, and has been shown to preserve urinary and sexual function.

Frequently Asked Questions

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What are the current treatment options for symptomatic enlargement of the prostate?

Lifestyle modification

- Diet and exercise
- Avoiding caffeine and alcohol
- Limiting fluid intake in certain situations such as before going to bed

Medication management

- - Used to shrink the prostate gland, inhibit prostate growth, or limit symptoms
  - Used solely or in combination with other classes of medications to provide relief
  - Alpha-blockers such as tamsulosin (Flomax) relax prostate and bladder neck smooth muscle, reducing urine blockage and improving urine flow
  - PD-5 inhibitors such as Tadalifil (Cialis) relax smooth muscles of the lower urinary tract and thus can improve lower urinary tract symptoms
  - 5-alpha reductase inhibitors such as finasteride (Proscar) can block prostate growth or cause the prostate to shrink in some men.

Minimally invasive procedures

- Prostate artery embolization (PAE)
- Prostate urethral lift (PUL)
- Minimally invasive simple prostatectomy
- Transurethral needle ablation
- Prostatic stent placement
- Transurethral thermal therapies
- Aquablation
- High-intensity focused ultrasound (HIFU)

Surgery of the prostate

- Transurethral resection of the prostate (TURP)
- Open prostatectomy
- Transurethral incision of the prostate (TUIP)
- Laser surgery

What is prostate artery embolization (PAE)?

Prostate artery embolization or PAE is a minimally invasive procedure for patients suffering from enlarged prostates, specifically, benign prostate hyperplasia or “BPH”. Using state of the art technology and advanced minimally invasive techniques, the blood flow supplying to the prostate gland is targeted and diminished, causing the prostate gland to shrink.

During the procedure, a small puncture is made in either the wrist or the groin and using image guidance, a tiny catheter is placed into the artery and navigated into the small arteries supplying blood flow to the prostate gland. Once the catheter is shown to be in a safe location for treatment, microscopic particles (which do not contain any medication or radiation) are slowly injected into the feeder arteries of the prostate until the flow is diminished. Following treatment, final images are obtained to ensure adequate delivery of particles. At the conclusion of the procedure the catheter is removed. Recovery is quick with most patients being discharged in 1 hour following the procedure.

Prostate artery embolization as a treatment option for symptomatic enlargement of the prostate has recently been included in the acceptable treatment strategies by the American Urologic Association (amended in 2023). Unique to many other treatment strategies, this procedure is completely nonsurgical, not requiring surgical access to the prostate gland through the penis, has a low risk profile with a high success rate, and has been shown to preserve urinary and sexual function.

What to expect during prostate artery embolization?

At MIVA MEDICAL, prostate artery embolization is a well-tolerated procedure, performed on an outpatient basis using conscious sedation, with a recovery time of approximately 1 hour. Procedure time may vary depending on case complexity and prostate artery anatomy, though typically takes approximately 1-2 hours to complete. Home medications will be reviewed at the initial clinic visit, and most medications can be continued as prescribed, though we will inform you of any medications needing held for the procedure prior to procedure day. Patients are required to not eat or drink anything for 6 hours prior to the procedure, though can take small sips of water with their home medications. Patients will be prescribed medications following the procedure to minimize pain and inflammation, as well as minimize chance for infection. These medications will be sent to your pharmacy for pickup.

What are the risks associated with prostate artery embolization (PAE)?

PAE has a low risk profile, with rare complications, most of which can be easily treated. An in-depth conversation regarding the risks of the procedure will be discussed with you at MIVA MEDICAL prior to your procedure. Procedural risks include but are not limited to:

Pain
Bleeding
Infection
Inability to urinate temporarily
Blockage of non-prostate arteries during injection of particles

Careful technique and experience with prostate artery anatomy, as well as experience with embolization therapies using microcatheters can help to minimize procedural risk.

How does prostate artery embolization differ from other surgical procedures such as transurethral resection of the prostate (TURP)?

While both similarly improve lower urinary tract symptoms, PAE being a nonsurgical, minimally invasive procedure has several advantages such as:

lower risk of complications
ability to perform the procedure without having to obtain surgical access through the penis
No expected hospitalization
Faster recovery time

What is the recovery following prostate artery embolization?

Prostate artery embolization (PAE) is a well-tolerated procedure with a low risk profile, and short recovery. Most patients typically have minor symptoms such as mild pelvic pain/cramping, fatigue, and low-grade fever, lasting for a few days following the procedure. These symptoms are typically self-limiting, peak around day 3, and will gradually improve with time. Occasionally, patients may experience:

hematuria (blood in the urine)
urinary frequency (having to urinate often)
urinary urgency (feeling the need to urinate often)
dysuria (burning sensation during urination).

At MIVA MEDICAL, medications will be provided before, during, and after the procedure to minimize these symptoms. Patents will be instructed to not perform any strenuous activity such as heavy lifting or aerobic exercise for 5 days, though may otherwise resume most normal activities the day following the procedure. To ensure treatment success, patients will have one week clinic follow up and will also have a 3 month follow up with imaging also done at that time to assess treatment response.

How do I know if I am a candidate for prostate artery embolization (PAE)?

At MIVA MEDICAL, we perform physical exam, review medical history, and obtain any prior imaging studies, as well as utilize a scoring system to assess the severity of your lower urinary tract symptoms related to enlarged prostate. Based on this information, we can better assess if you would be a good candidate for PAE.

Is prostate artery embolization covered by insurance?

Yes, PAE is now recognized as an acceptable treatment option for symptomatic enlargement of the prostate, and most insurance carriers cover PAE. Contact us at MIVA MEDICAL, and we can help you find out if your specific plan covers this procedure.

Take Our Quiz To See If You Are A Candidate for BPH Teatment

I-PSS - International Prostate Symptom Score

"*" indicates required fields

Step 1 of 2

1. Incomplete Emptying

How often have you had the sensation of not emptying your bladder?

2. Frequency

How often have you had to urinate less than every two hours?

3. Intermittency

How often have you found you stopped and started again several times when you urinated?

4. Urgency

How often have you found it difficult to postpone urination?

5. Weak Stream

How often have you had a weak urinary stream?

6. Straining

How often have you had to strain to start urination?

7. Nocturia

How many times did you typically get up at night to urinate?

Hidden

Your Total IPSS Score is:

Score 1-7 Mild, 8-19 Moderate, 20-35 Severe

Quality of Life Due to Urinary Symptoms*

If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?

1-7 Mild ; 8-19 Moderate ; 20-35 Severe

Based on your response, you may be a good candidate for a minimally invasive treatment for BPH at Miva Medical.

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