Prostate artery embolization

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Had PAE at St Louis University hospitals, Dr Pereira and associates in the Interventional Radiology department in April 2017.  Fantastic result with minimal inconvenience.  Discovered the procedure indirectly with a family connection to the company that supplies the instruments for the PAE.  The procedure has been very recently been competely approved, insurance, etc, but is available at a limited number of sites. 

The most inconvenient part was traveling from Kansas City to St Louis, University hospital.  Many interested patients are not aware of the availability of the procedure in their area and travel unnecessary distances to have the procedure performed. 

A directory, formed by the groups,hospitals offering the procedure (as the NET information site)  would be helpful, since this procedure is a wonderful advancement for MEN and is the future of BPH treatment. 

The Doctors and staff and hospital at St Louis University hospital is outstanding.  Being aware during the procedure and seeing the doctor thread the cannula thru my Femoral artery (small needle stick into the artery after local anesthesia of the area) was totally painless and very interesting. 

I am enjoying the fantastic result, no urgency, frequency and complete bladder emptying -- like I am a kid again.

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  • Posted

    Marvin,

    If you don´t mind could you please post some information?

    #1 Weigh of your prostate before PAE

    #2 Worst symptoms you had

    #3 Which hotel did you stay and (cost and how many days)

    #4 Did the doctors made first an arteriography and one day after PAE?

    Thank you

     

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    • Posted

      I do not know prostate weight pre PAE. PSA escalated to 8. Biopsy showed chronic and acute inflammation. Urgency and frequency and incomplete bladder emptying, void 4 to 6 times at night and some difficulty starting stream. Tired all day. Rating on IPSS survey at 22, now 3 and I feel it should be zero. SLU has a list of hotels that give a hospital rate. Chose Holiday inn express from their list and was located well. No ammenaties, but located well. There are well appointed hotels nearby. Very highly recommend Dr. Pereira and interventional radiology group at SLU. Scheduled procedure one week after arteriogram since fit my schedule. Need to inquire if they do procedure on day after arteriogram. I feel sure that they would attempt to accomodate traveling patients.
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  • Posted

    That's great news Marvin! Sounds like you have had amazing results!

    One thing that puzzles me about PAE: since it blocks off most blood flow to the prostate, what happens if sometime later a man developes an infection in the prostate. Without blood flow,how can it be treated with antibiotics?

    Can you share more info? How long was the procedure? Were you asleep or under local anesthetic? How was your recovery? Did you need a catheter afterward and if so, for how many days? What is the cost of the procedure (I understand insurance will not cover it)?

    Thanks!

    Michael

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    • Posted

      Sorry Marvin, I see that you were awake during the procedure under local.  I wonder if this is similar to having an angiogram. Local anesthetic and catheter inserted through femoral artery, that is.

       

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    • Posted

      All parts of the prostate are not supplied by the prostate artery.  The parts that were not destroyed by stopping the blood flow to them have normal circulation.  This is similar to surgically removing part of the prostate and those parts not removed, if they have sufficient blood flow will react wilthin normal limits.  An infection in remaining areas would be treated normally with drugs and the part destroyed by the embolization is not there to be concerned about. 

      My procedure was actually less than 2 hours in the operating room.  The interventional radiologist said that this was actually very little time, since my arteries are large and easily navigated.  This is why the pre arteriogram is done to judge the size and shape of the arteries for accessibility.  I understand that the procedure could take several hours longer if there are small arteries or other blockages.  The doctor was very careful and deft in his manipulations.  There was a cather placed before the procedure, I would assume that most BPH patients would need to empty their bladder frequently and could be a problem in the middle of a procedure.  The catheter was removed approximatey 2 hours after I left the operating room and was dismissed.  Local anesthetic was injected into the femoral artery area and the access canula inserted--no pain or sensation.  The first night was nothing unusual but the process of tissue necrosis in the prostate started to appear the next day in the form of swelling and I discovered that there was an available restroom at least every 15 to 30 minutes along the interstate route from St Louis to Kansas City.  Urgency was extreme since I could not come close to emptying my bladder at each stop.  That night and the next night (not so much during the days), there was difficulty in starting a stream and sometimes I doubted that it would start and almost considered going to the ER for catherization.  But a little loss of sleep and some keeping calm and patient paid off.  I was prescribed Naproxen sodium for pain and anti inflammatory.  I told Dr. Pereira that they might consider starting the  anti inflammatory 48 hours prior to the procedure as dentists and oral surgeons do before removal of wisdom teeth.  It takes 48 hours for the full effect of the NSAID to take effect.  I believe that my first two nights would have less distressing with this protocol. Dr Pereira said that they would change their protocol to include this strategy.  (I am a dentist and also with my urologist diagnosing chronic and acute inflammation on the prostate biopsy, Ibuprophen bid solved almost all my prostate issues but I cannot stay on that forever so pursued an interventional approach.  On the third day, I was more able to urinate easily and empty completely in years.  Within 2 weeks, the irritation of my urethra from the cather was completely resolved and at three months, I feel like a kid standing at the urinal.  As far as pain, if you have had a prostate biopsy, the only discomfort was very similar to the irritation post prostate biopsy,which is very little.   The cost was less than one hundred dollars to me, in deductibles and copays.  The procedure has been very recently, in the  last week or so, been accepted by insurance companies and I would check with your insurance again to see if coverage is available.  I now my insurance paid out approximately $3500 to the hospital and doctors from the EOBs that I saw. 

      From the viewpoint of risk of unanticipated injuries and side effects, the risk is very low.  TURPS and lasers and other procedures are essentally performed blindly or inexactly and can result in incontinence and impotence from unforseen colatteral damage. Ask the doctor about that for more informed estimates and comparisons. 

      Life is much better now, I sleep at night and am not frequently going to the restroom during the day. 

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    • Posted

      Dear marvin48288, did Dr. Pereira told you something about your prostate median lobe (if it was protuding to the bladder neck) and how he will manage it? Or did he told you something about that?

      Thank you

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  • Posted

    So very glad to hear of your good results, marvin 48288.  Do us all a favor, and follow up with us periodically.  Thank you.
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