Waking up multiple times a night just to use the bathroom is exhausting. Standing in front of the toilet, waiting for a stream to start, only for it to be weak and unpredictable, can easily ruin your day. If you are dealing with these frustrating daily realities, you are likely part of the millions of men suffering from Benign Prostatic Hyperplasia, commonly known as an enlarged prostate. Many men simply accept these symptoms as an inevitable part of aging, believing that nothing can truly be done.
Others decide to visit a doctor, hoping for a straightforward answer, only to be told that surgery is their best or only option. Surgery is the right answer for many men — but it is worth knowing the full range of options before committing to one. Getting a second opinion is a reasonable step in your healthcare journey, especially when considering treatments for an enlarged prostate (BPH).
At MIVA Medical, located in Independence, MO, we want patients across the Kansas City metro to know that surgery is not the only path to relief. One minimally invasive option, now recognized in the American Urological Association’s guideline, is Prostate Artery Embolization, or PAE. You deserve to understand all of your options before making a decision about your care.
The Heavy Toll of an Enlarged Prostate
Living with an enlarged prostate often feels like your bladder is dictating your schedule. Whether you are commuting to work, enjoying a round of golf, or simply trying to sleep through the night, the constant, sudden urge to urinate is always looming. Men dealing with BPH frequently report experiencing a weak stream, the feeling that their bladder is never completely empty, and embarrassing urgency that forces them to constantly map out the nearest restrooms.
The mental burden is just as taxing as the physical discomfort. Chronic sleep deprivation from nighttime bathroom trips can lead to daytime fatigue, irritability, and a lack of focus. Over time, men may begin skipping social events, avoiding long drives across the Kansas City metro, and quietly altering their lifestyles to accommodate their symptoms. You shouldn’t have to live your life on high alert just because of an enlarged prostate.
Why a Second Opinion Is Part of the Process
When men finally decide they can no longer live with their symptoms, they usually seek help from a urologist. Depending on prostate size, symptom severity, and overall health, the conversation often turns to daily medications or a surgical procedure such as Transurethral Resection of the Prostate (TURP). TURP has been the benchmark surgical treatment for decades and remains the right choice for many men.
PAE is a newer addition to that same menu of options. The American Urological Association’s 2026 guideline states that clinicians may offer prostate artery embolization using particle embolics for men with prostates of 50 cc or larger — a conditional recommendation supported by Grade B evidence. Importantly, the guideline also advises that a urologist should evaluate men considering PAE before the procedure, and that PAE should be performed by interventional radiologists specifically trained in it.
That is exactly how we prefer to work. A urologic evaluation confirms the symptoms are coming from BPH and rules out other causes; our role is to determine whether the arterial anatomy and prostate size make PAE a sound option for you. Seeking a second opinion isn’t about questioning your urologist — it’s about making sure every appropriate option has been considered before you commit to one.
Reference: Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026), Part III: Procedural/Surgical Management. J Urol. 2026.
What is PAE? A Non-Surgical Alternative
Prostate Artery Embolization (PAE) is a minimally invasive outpatient procedure designed to reduce the size of the prostate and relieve lower urinary tract symptoms. At MIVA Medical, procedures like PAE are performed by our board-certified, fellowship-trained interventional radiologists, Dr. Silas Williams and Dr. Travis Brown. Instead of cutting tissue or inserting instruments through the urethra, PAE targets the blood supply feeding the enlarged gland.
During the procedure, the doctor makes a tiny pinhole in the wrist or groin to access the arterial system. Using advanced, real-time imaging, they navigate a microscopic catheter directly to the arteries feeding the prostate gland. Small embolic particles are then released to reduce blood flow. Deprived of its excess blood supply, the enlarged prostate shrinks and softens over time, relieving pressure on the urethra so urine can flow more normally. Because the effect is gradual rather than immediate, improvement builds over weeks to months rather than appearing overnight.
Sources: Abt D, Hechelhammer L, Müllhaupt G, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338. PubMed
Comparing Your Options: PAE vs. Traditional Surgery
To understand where PAE fits alongside traditional surgery, it helps to compare them directly. Neither is universally better — each has clear strengths.
PAE is not simply a gentler version of surgery — it is a different trade-off. It carries fewer complications and a faster recovery, while TURP delivers greater and faster improvement in urine flow. Which matters more depends on your prostate size, your symptoms, and what you are willing to accept. That is a conversation worth having with both a urologist and an interventional radiologist.
Common Questions About Prostate Artery Embolization
Is the PAE procedure painful?
Most patients report very little discomfort during and after the procedure. Because PAE does not involve cutting or general anesthesia, the physical trauma to the body is minimal. Patients are given a mild sedative to keep them completely relaxed, and a local anesthetic is used at the tiny entry site. You may experience some mild pelvic pressure or frequent urination for a few days following the procedure as the prostate begins to respond, but this is typically easily managed with over-the-counter medication.
How quickly will I notice an improvement in my symptoms?
While every patient heals at their own pace, many men begin to notice an improvement in their urinary symptoms within two to three weeks. As the prostate continues to shrink over the following months, the urinary stream typically becomes stronger, the urgency decreases, and men find themselves sleeping through the night without interruption. The full benefits of the treatment are usually realized between three to six months post-procedure.
Am I a good candidate for PAE?
PAE tends to suit men with symptomatic BPH who have not found relief from medications, who have larger prostates, or who want to avoid surgery and its associated risks. The AUA guideline frames PAE as an option for prostates of 50 cc or larger, and prostate size is one of the first things we assess.
PAE is not right for everyone. It is generally not appropriate when urinary symptoms are caused by something other than BPH, when the prostate is small, or in men with severe atherosclerosis, significant kidney dysfunction, or a severe contrast allergy. The procedure also depends on pelvic arterial anatomy that can be safely navigated, which is why imaging review matters before any decision is made.
The honest answer is that some men are better served by TURP or another surgical option, and we will tell you if that is the case. The way to find out is a urologic evaluation followed by a consultation with an interventional radiologist who performs the procedure regularly.
Finding Relief in the Kansas City Metro
You do not have to travel far to find advanced, non-surgical care. At MIVA Medical, we proudly serve patients from Lee’s Summit, Blue Springs, Overland Park, and the greater Kansas City metropolitan area. Our state-of-the-art outpatient clinic in Independence, MO, is designed to provide you with the highest level of care in a comfortable, welcoming environment, far removed from the stress of a large hospital.
Taking the first step toward relief is often the hardest part, but getting a second opinion is a choice that can preserve your quality of life and give you peace of mind.
Take Back Control of Your Life Today
Stop letting an enlarged prostate dictate your schedule. If you are looking for an alternative to traditional surgery, we are here to help you understand your options. Learn more about how we treat an enlarged prostate or take the next step today.