Prostatic Artery Embolization procedure

Posted , 19 users are following.

As a health professional, I was worried about the effects of a TURP procedure. Although my urologist was against doing a PAE, saying he did not know about it and that it was experimental,  the research I had seen suggested it would be a good approach with no effects on sexual function and fewer complications that a TURP.

Since PAE is a relatively new procedure, the effects of it have been measured for a space of 3-5 years post-procedure in the research currently available.

I went ahead and had the procedure done 4 weeks ago. The results have been simply wonderful. All symptoms of BPH have dissappeared.

Prior to the procedure I had painful urination, weak flow, frequent urinary urges, around 100 ml of urine output each time I voided,and the ultrasound revealed that my bladder was almost full after urinating. I was concerned that it could lead to hydronephrosis in the future.

I now get up 2x a night to urinate. I measure my output at home, and my nightly volume exceeds 300 ml each time I go, sometimes to 400 ml or more.  My daytime urinary output is approximately 250 ml at each urination with no urges, no spotting, no burning sensation or a need to push using a valsava manuever. It just flows out naturally with no effort.

The research on it show that results are operator-dependent. That is, the more experience the doctor doing as, the more successful and less complications.

I flew from the west coast to have the procedure done at UNC Chapel Hill since their team, and Dr. Isaacson, have been doing well over a hundred of them. Great staff.

Please note that the PAE is a procedure that urologists do not perform. It is done by interventional radiologists. I have noted in a commentary that I read in a urology magazine, and in the attitude of my initial urologist, that there can be some prejudice about exploring a PAE since it is a procedure that would be done by someone who is not a urologist. It's outside their turf.  My urologist insisted that I needed a TURP - while guarranteeing me that I would have retrograde ejaculation for life afterward if I did the TURP. That is not an issue with a PAE. I positive side effect is that the interventional radiologist discovered during the procedure that I had a venous shunt from my penis to the prostate, which had an detrimental effect on maintaining blood flow when erect. He sealed it off during the procedure. It turns out that a number of men have this without knowing it.

It feels like when I was urinating 25 years ago. I am so relieved and happy about it that I wanted to share this with you in case some of this information is helpful.

I had the advantage to access to a number medical journals on the procefure, but google scholar on the internet will have good info.

A recent systematic review of PAE is titled:Short- to Midterm Safety and Efficacyof

Prostatic Artery Embolization:

A Systematic Review

Ziga Cizman,MD,MPH, AriIsaacson,MD, andCharlesBurke,MD


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  • Posted

    Congratulations on your sucessful PAE.

    Just 3 days ago I made an appointment with Dr Bagla in Virginia for Sept 27 to do a PAE on me.  I'll be travelling from Buenos Aires.  Even though they do the procedure here, Dr Bagla has more experience and also has many rave reviews.

    You are still getting up 2x nite, are you hoping for continued improvement? 

    My wife is an MD and neuro scientist.  She read Dr Pisco's study of 640 PAE patients and felt that it showed very good results.  The only issues were that the study was directed by Dr. Pisco and covered only the patients that went through his clinic.  

    Again, congrats on your new health.

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    • Posted

      Hi, I have heard of Dr. Bagla, he is very experienced. Good luck on your procedure. Regarding the 2x a nite, 1x or none would be better. I am 1 month post procedure, and maximum results are seen at around 3 months.

      Having said that, each time I go to the bathroom at night I am urinating over 300 ml, much of the time closer to 400 or more, so my bladder is likely filled and the cause of the 2x may be due to the amount of liquids I ingest.

      I have read Dr. Pisco's research. There are other reseach papers out there by others, and in other countries,  that also point to good results with PAE. Recently Stanford University contacted me to be a pt as part of a PAE research program; their doctors had gotten trained in Brazil, I was told.

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  • Posted

    Congratulations on your good response. I hope it continues to improve for you. Could you please give a few details about your BPH? For example, how big was your prostate, did you have a medium lobe, what was your psa? Also did you have much discomfort in the week following the PAE due to necrosis? And was the procedure done through the wrist radial artery or through the femoral artery - bilateral? Thanks and again good for you. Neil
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    • Posted

      Hi Neil,


      In response to your questions, my prostate size was 70 grams pre procedure. PAEs are usually recommended over TURP when the prostate exceeds 80 grams or so, simply for a size issue, but that depends on the circumstances.

      What's interesting clinically about the PAE is that size reduction is not the main driver in the symptomatic changes. I saw research that shows that the prostate grows back to 92% of it's pre PAE volume 3 years post procedure, yet the benefits at 3 years are largely unchanged from the first few months.

      It seems, it is a postulate, that the quality of the prostate tissue itself changes, that it is more yielding, similar to the benefits seen by taking an alpha receptor inhibitor. So the science has not fully caught up with how it works.

      Regarding my PSA. It was around 2.3 pre procedure, with a free score of around 24%. I have not checked either volume nor PSA since.

      The procedure was through the femoral artery. The interventional radiologist, Dr. Isaacson, published research showing that radial intervention worked as well, so before the procedure I asked him if he has going that way. He said no, that he had found it was easier to work with the equipment through the femoral artery.

      He warned me that for the first couple of weeks I could feel symptoms the same or even a bit more, to stay on the tamsulosin for a couple of weeks or so, that within a month I may not need it.  I stopped using it (I was using it before every 2-3 days only due to retrograde ejection issues) 9 days after the procedure because I was doing so much better, have not used it since.

      He warned me that for a day or so after the procedure I would likely feel soreness in the area. It felt like a bit of mule kick down there for about 24 hours, not too bad, but noticeable.  He also said that after the procedure, in the coming weeks it could feel like the symptoms came back and/or it could feel like I had a UTI, but that it was usually transient prostate inflammation.

      That happened to me, but it went away after 3 days or so.

      Yes, it was bilateral. Research shows it is more effective than unilateral.

      I think I answered all your questions, if I missed something or you have more, let me know

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    • Posted

      Hi 333health - thanks for answering all my questions and again all the best to you.

      I ask all these questions because I also had the PAE performed a week before yours at UNC. In my case my BPH was a 300gm prostate with no median lobe - just 2 very large lobes in the transitional zone clamping down on my urethra. I have been on Avodart and Xatral for 10 years. My psa is about 11 so the density is very low. I have also been extensively screened for PCa.

      Dr. Isaacson went throught my radial artery. He said I was the ideal candidate for PAE and easily performed a bilateral embolization with great success. But sadly I have not seen any improvement in 5 weeks. I had to restart self cath in the evening a few weeks ago and take out 350ml so I can sleep a few hours.

      Also I had absolutely no pain or discomfort at any time after the procedure which seems contrary to dynamic necorsis. I will be travelling again to Chapel Hill this Monday for a 3T MRI ( at my request) to see why the procedure has not worked for me. I fear I will be facing a robotic SP by December as my voiding continues to worsen. I am very discouraged by the outcome though Dr, Issacson and his staff were very kind. Thanks again for your repsonse and I all the best. Neil

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    • Posted

      Thanks jjjj - robotic sp is the da vinci robotic simple prostatectomy which basically reams out the inside of the prostate while leaving the capsule and nerve bundles and sphincters intact. Neil
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    • Posted

      Hey JJJJ  Please think before you do anything.  My friend was talked or force into haveing a Robotic prostatecteomy for prostate cancer.  He had a 21 needle biopsy 10 out of the 21 can back with cancer cells.  He doctor told him that his only chance was having this done.  He also told him that he would do a nerve bundle sparing so he can still have sex with no problem.  Now was 50 at the time.  Not getting any other information he said ok.  He just moved back to florida.  He is so depressed that he wants to die.  He can have sex unless he gives himself a shot in his penis and for a orgasm.  If he can get it it take him 1 1/2 hours to have a very mild orgasm.  My friend told me it not worth.  He get to tired and gives up.  He said he wish he would have waited.  He broke down the last time I saw him because he does not have a normal life anymore and just want to die.  A man at any age should not have to go through life.  He ask the doctor about it and all the doctor said was well you don't have cancer.   Makre sure you ghet all the information and don't have anything done before you way all the side effects of any procedure......Ken   

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