Has anyone out there had a "Prostate Artery Embolization??

I had my PAE in April 2015. Prior to PAE I had retrograde ejaculation from BPH Meds. After my PAE my ejaculation came back slowly starting after about two weeks. It continued to get better and now it is back to a good ejaculation. All BPH symptoms are still gone. I get up 0-1 times a night to pee and pee with a great flow.

life is good.

Lawrence, I had my done on April 27, 2016 with Dr. Bagla.  Unfortunately I have no progress.  My median lobe was enlarged.  I do recommend this office though.  They are very professional.  I had no pain during or after the procedure.  I did have constipation for 16 days after.  Dr. Bagla added a stool softener (Colace) to his protocol.  Others also reported constipation.  Don't know if it is the high dose ibuprofen, conscious sedation, or the procedure itself.  Have it done by someone with experience.  Dr. Bagla is the most experienced in this country.

Please tell us more about this.... does PAE usually not work for enlarged median lobes?  Or was your case unusual?  

My problem is also an enlarged median lobe but my IR and urol think I'm an excellent candidate for PAE so your lack of sucess if of concern to me.

Thanks.

JJJJ: I also have had very minimal success w/ the PAE (after 9 months);  however, I not only had an enlarged median lobe but also had been catheterizing for 14 months at the time of the procedure.  So I had 2 strikes against me going in.  I do think the procedure is worth a try and may even do it again in the future (it did help a bit).

Camster:  don't give up yet - I'm hoping you'll see some progress before the 6 month post-op period ends.

Godd luck to you both!

Thanks for your report Cam.  I too have a large median lobe, or at least I did 3.5 years ago when a local Uro surgeon just outside of Washington DC attempted a Green Light laser PVP but had to abort it mid-procedure and convert me over to a conventional TURP.  It turned out that the complicaiton of the attempted PVP laser procedure that wasn't able to handle my prostate requiring the chageover to the conventional TURP didn't yield enduring results. Here I am with obstruction (cystoscopy verified) becoming a problem again already . Apparently the extra trauma and excessively bleeding varices (bulging veins) on my prostate that were hyper-vascular (surgical report's excact wording) handicapped the surgeon's ability to see what he was doing and hence the less than great outdome. I did get lot of relief for about 2.5 years but then the same old BPH symptoms began to increase to where I need another procedure of some sort once again so that I can urinate normally once again. -After enduring the PVP laser & TURP and messy long and painful recovery that started off with an indwelling catherter for an additional 8-10 days or so AFTER the procedure I'd endured. Is it any wonder that I'm now considering a PAE? However I fear that my large median lobe is liklely still a factor that might prevent PAE from working as you have report 6 weeks post PAE with Dr Bagla. Not that Dr Bagla is the problem. More likely the structure of my prostate is.  I wonder if the constipation you experienced had anything to do with some microspheres getting where they didn't best serve you?  There's no reason for an additional reply unless something changes significantly after more time passes. Please let us know if anything significantly better or worse developes as time passes. -Tx again for your report. It was quite helpful for us "large median lobe" folks.       -Lawrence

There was no non-target embolization that caused the constiptation.  

It is all about configuration of the prostate enlargement.  Size is not equal to symptomology.  One can have a large prostate and urinate okay.  

You would have to get an image study like an MRI for Dr. Bagla to see.  

PAE is not specifically targeted to the obstruction.  It is overall reduction of the prostate.  Outcomes are hard to predict.  

So if the problem is only the median lobe does PAE to reduce the whole prostate make sense?

It doesn't matter where the enlargement is because the arteries supply the entire gland and the median lobe is easily visualized during the procedure and does demonstrate significant shrinkage as well after the procedure. Results should be similar regardless of anatomy however clinical failures do agree with all procedures because of multiple overlapping syndromes which are causing the symptoms. Symptoms of BPH our complex and overlap with other pathology of the bladder, urethra, etc

Thanks for the correction - good to know in case i do it again.

When I had talked to Dr. Isaacson from University of North Carolina, he told me on the phone that he was getting 60 to 65% success with the enlarged median lobe.  Dr. Bagla and Dr. Pisco of Portugal said it was no problem for them.  When I asked Dr. Isaacson a tough question why there is this chasm on middle lobe success, he never responded to me. Maybe he was just plain being honest with me and not trying to exaggerate the statistics.  My urologist may want to do a prostate ultrasound when I see him in September.  He also ran a PSA.  If it went down, the prostate shrank.  The urologist said it's all about configuration of the prostate.  Some people have a large prostate and can urinate fine.  

For what I understand, PAE doesn't target a specific blockage but reduces the whole enlarged prostate.  This is why results are hard to predict.  

PAEdoc.  As I said in another statement, Dr. Isaacson told me on the phone that he wasn't getting good results with the enlarged median lobe, 60 to 65%.  I didn't understand why and he didn't explain it.  I understand he is a very honest man and pleasant to deal with.  But that threw me for a loop.  

Interesting. I don't know about "enlarged median lobe", maybe that is a very specific part of the prostate.  He did tell me that with "very enlarged prostates like mine (130cm), he was getting really good results because the shrinkage is so much greater as a percentage of the total....but yours may be about a specific region of the prostate, I really dont know.  And yes, I have found him to be very straightforward and honest in his judgments to stuff...

I found Dr. Isaacson to be extremely honest - with no sugar coating.

Then he was simply telling it like it is.  For whatever reason, maybe there is some problem getting to the middle lobe.  Just like Urolift, it has been contraindicated for enlarged median lobe.  I talked to the company rep and I was told that they should have the procedure worked out to address the middle lobe by year end.  

Please,  Did you speak to the Urolift company rep or a PAE rep who said a procedure for the middle lobe will be address by year end?

Hi Arlington,

Why is "catherizing for 14 months" a "strike"? Was it a Foley or self catherization?

JJ

I called the company who makes Urolift, NeoTract.  I talked to a rep at the company and got it straight from them.  I told him that Urolift doesn't address the median lobe.  He said that it is a relatively new product and they are expanding its use to address the median lobe by year end.  

A median lobe s a section of the prostate Thad has expanded into the bladder. I had a large prostate (128g) with a median lobe extending into bladder. after PAE by Dr Isaacson my prostate shrunk about 40% to 78g. All my BPH symptoms were relieved.i now get up 0-1 times a night and pee with great flow and no real urgency. 18 holes of golf without peeing. Life is good. I asked Dr Isaacson about success rates with Median lobe since I had such great results. He sad that when he reevaluated his data that results with a median lobe were just as good as those without median lobe.

Going by these posts, success rate of PAE in case of median lobe expanded into the bladder appears to be doubtful. I had PAE on March 29, no improvment so far, the procedure was completely pain-free, the IR Doc and this eam at Liverpool Sydney were great, they've had veru high succes rate so far. 

I had the post PAE ultrasound last week which shows PVR of 250 ml even with daily dose of Tamsulosin (400 mcg every 18 hours). The urologist I consulted for a seocnd opinion has warned me about possible kidney damage. This may be it for me - off to TURP. I had a pretty close shave with kidney damage about 3 months ago, with an eGFR of 41 (stage 3). It's just a matter of few weeks now, will have to give up on my attempts to avoid TURP. 

 

Hi Rama,

Thanks for posting. Sorry your PAE didn't bring any results so far. Did you have a pre-PAE and recent ultrasound to determine if there was any shrinkage of the prostate as a result of the PAE?

A pvr of 250ml is definitely leading to problems. I also got to the point that tamsulosin no longer worked for me after a few months. After two greenlights and a turp in just 4 years, my problem is that the prostate grows too fast. Prior to my turp in April 2015 it was 300g. After the turp it was 203g., and during the turp the remainder of the median lobe protruding into the bladder was removed. That median lobe was somewhere between 25g and 40g. on it's own. I presently have no luts symptoms at all and a pvr of 34ml, but have been taking dutasteride for the past 8 months to keep the prostate from growing. Due to other health issues I haven't gotten around to having the prostate measured again with a sonogram, though it was my intention to measure the size and pvr every 6 months.

Depending on the size of your prostate the turp recovery time can be anything from a few days to 6 weeks or so. My symptoms of extreme urgency went away after a couple of weeks, but the blood in the urine and the pain after urination lasted about 6 weeks. Recovery time for both greenlight lasers lasted 8-9 weeks. A good feature of the turp is your urologist can send removed tissue to the pathologist to check for cancer. Another thing to check after the turp is your hemoglobin count and iron values.  It took about 9 months for my hemoglobin to get back into normal range and my iron never did. But my situation was that the turp was done to stop a massive hematuria of the prostate, requiring emergency surgery and 8 pints of blood. A last point is that although there are different opinions on this I found the retro ejaculation to be a non issue for me. I can't say it diminished my pleasure in any way.

Hi Bob,

Part of the reason I posted is that TURP as an option seems to be heavily criticised in this thread. Thanks for replying with your encouraging results from TURP in spite of the blood loss from the surgery. The uro has warned me of the risk of bleeding. My prostate was about 60 cc pre PAE. Yet to get detailed results of the recent scan.

To my thinking it might be hard to visualise and block arteries to the median lobe which protrudes into the bladder without risk of embolising the bladder. That might account for the dismal success rate of PAE in this situation.

Hopefully having smaller prostate size will reduce the bleeding risk in TURP for me. Fingers crossed.

I guess TURP being the only way out for me, I have to start mentally preparing for it, much as I hated the possibility.

as per my MRI, I have  moderate median lobe

seen extending into the bladder neck, Dr. Bagla told me he can find a separate artery leading to the enlarged lobe and embolize it, and get good results, has anyone heard this before?

I have not heard of this before but Dr. Bagla would know about this since he has done so many of them. 

 I am trying to verify if this claim by Dr. Bagla of finding and separately embolizing the enlarged median lobe is really feasible,  normally doctors are attempting  to perform bilateral PAE, but often they end up with only unilateral due to difficulties in finding the right artery, in case of separate PAE for the enlarged median lobe this would be attempting to do a trilateral PAE, this would ad additional time, radiation exposure and likely cost more, even if feasible, so I never heard about this before on this forum or anywhere else so far, just wonder???