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
0 likes, 175 replies
kenneth1955 333health
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caringbah 333health
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333 you're experience is typical. I too had an excellent result from my PAE but I must say I have a very low opinion of urologists since then.
They seem to have never heard of the Hippocratic Oath.
Instead of reccomending the best proceedure for their patients they cling to their outmoded and harmful methods. They even spread misinformation about the efficacy of PAE all because they want to keep the BPH franchise to themselves.
I would warn anyone here with BPH problems to not believe the advice they receive from a urologist without getting a second opinion from an interventional radiologist.
333health caringbah
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Caringbah your point is very valid. While there are many good, knowledgeable and caring urologists, this procedure takes part of their proverbial bread away from their table, as well as primacy of treatment. and we are all human.
For example, a govt study showed that doctors who have a financial interest in imaging centers tend to order imaging studies between 30 and 50% more often for a number of conditions than doctors who don't, everything else being equal.
Yesterday I had a new patient who presented with symptomatic right testicular varicose veins, the pain is getting worse since he does manual labor, but said he had refused the surgeon's recommendation for surgery. I told him that he should consider having an embolization procedure instead, and to see an interventional radiologist for a consult.
kenneth1955 333health
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18R18 333health
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I could have written your text, every word of it.
I am also a MD, my urologist was also against PAE and exactly 23 days after my PAE I feel exactly like you.
If my prostate grows again in 3 years I will embolize again, as simple as that.
The sad side is that urologists all over the world just don`t tell patients about PAE.
caringbah 18R18
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Dear 18r,
I totally agree with you. I would call this conduct unprofessional. Urologists have a duty of care to educate themselves about the best methods of treating BPH.
In my own experience with BPH I consulted three urologists...one wanted to do TURP, the other Holep, and the third wanted to do open surgery on me. Each called their proceedure the "gold standard" .
I then found about PAE and had it done 18 months ago.
The overall impression I had of urologists was that they are a greedy, arrogant bunch more concerned about their own bottom line rather than the best interests of their patients.
richp21 333health
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Les3178 333health
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Congratulations on picking the winning procedure.
I had a TURP 10 years ago. I had been getting up 4 to 7 times a night. I did then get some retrograde action, but not always.
In the ensuing years, my BPH continued. I'm now 68. I was back to being up 4 times a night. I was considering another TURP, and was not happy that it was the only option. Then I heard about the PAE in a podcast of the Radio National's Health Report in November 2015. (I'm in Melbourne, Australia). I asked my urologist about the procedure, and he didn't think it was a good idea to be leaving dead tissue in the body. He was at least aware of the procedure.
I persisted. The procedure did not appear to be available in my city. My doctor found a local interventional radiologist - Dr Dinesh Ranatunga. He does the procedure under the guidance of Dr Glen Schlaphoff who is based in Sydney. You can read elsewhere that Dr Schlaphoff is the guru for this procedure!
These two gentlemen did my bilateral PAE on 29-Aug-16 through the radial artery. Dr Schlaphoff came down from Sydney. I had a general anaesthetic and was under for 5h15m. And now after such a short time, just 13 days later, I couldn't be happier. There was no pain. Just a feeling that something had happened behind the bladder. I didn't sleep much on the night the PAE was done, and was peeing every 20 minutes or so with the intervals increasing as morning arrived. Since then, matters have improved dramatically. I've been up just once a night, every night since. And that is totally acceptable. I hear it just gets better and better.
I appreciate that for me it is early days yet, and am not scheduled to see Dr Ranatunga for another two weeks. But so far, I'm delighted.
Once the PAE procedure becomes well known, more and more men will be demanding it. The procedure is a huge leap forward compared to the TURP. The side effects are miniscule compared to an almost certain guarantee of having your sexual equipment or functioning damaged with a TURP. Sex seems to be important to us men! Who knew?
So I'm telling everyone I can about PAE. I haven't yet got to the stage of wearing a button that says "Ask me about my PAE", but I think the cause warrants that level of support.
Thanks for publishing your story. Anyone in Australia who needs more details is welcome to contact me.
Les
randy_85492 Les3178
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333health Les3178
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Great post, Les, and its wonderful to see your results.
About your urologist's comment that it was "wasn't a good idea to leave dead tissue in the body": it is striking to hear this type of response.
Embolization for different tissues has been taking place for many years, and safely. It has been for many years for a number of conditions, including but not limited to uterine fibroids, for tumors of the extremities, for testicular varicosities, for severe prostatic and bladder hemorraghing (how could a urologist not know that?) Arteriovenous malformations, hepatocellular carcinoma, etc.
If your urologist is really interested in the histology of prostatic tissue post-PAE, you may want to look up and send him the following research article, found in the Brazilian journal of urology:
The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia.
The authors include some of the pioneers in PAE, such as Carnevale.
George Camara-Lopes, Romulo Mattedi, Alberto A. Antunes, Francisco C. Carnevale, Giovanni G. Cerri, Miguel Srougi1 , Venancio A. Alves1 , Katia R. M. Leite
randy_85492 333health
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I had a REZUM procedure ~ 2 weeks ago...I am on a direct catheter for a month so it's hard to tell if the procedure will help at this time...I have experienced a large amount of blood in my urine two different times since the procedure. My urologist states that's normal and to not be concerned. Nevertheless, I am concerned....Should I be?..l.
Howard31850 333health
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333health Howard31850
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Hi Neil,
I don't think that I responded particularly quickly to the PAE. A couple of other people on this thread had a PAE and said that they had similar experiences. The research I have seen shows that those that respond well to a PAE (aprox. 80% or so from what I remember in the literature) see significant changes in a month. It seems 3 months is the time to wait forthe maximum changes to be seen.
One condition that research shows PAE does very well with is acute urinary retention. That is, the bladder stays pretty full after you urinate. The concern with that is that the urine could end up moving in a retrograde fashion back up the jets to the kidneys, and damage them. I had that, among other things. And operator experience, research shows, makes a difference for this procedure.
I had a patient come in about 5 weeks ago with symptoms and signs of portal hypertension and other issues, including low urinary flow.
The CT scan showed that his kidneys had been damaged by urinary backflow and the specialist that I referred him to told him he needs to be on dialysis. Last time I saw him, last week, he said he had a catheter and a bag under his pants to collect the urine. They had tried direct lines from the kidneys to the bag but he moved and dislodged them.
I shuddered to think that could have happened to me if I had not done an ultrasound in that area because I wante to check myself for a possible sports-induced inguinal hernia. The US person asked, incidentally, if I had used the bathroom before the procedure, because my bladder was full. I knew I had a problem then. I had urinated a couple of minutes before the procedure.
On the subject of acute urinary retention, which a lot of men with BPH have (if you urinate and little comes out, then, of course, a lot usually stays in the bladder). This isn't medical advice, and a good urologist would know this and more what to do, such as more complex and necessary urodynamic testing and CT scan with contrast, but one thing to consider is a simple and inexpensive test that can be easily paid out of pocket, if necessary. Not everyone has adequate insurance coverage, can tolerate the contrast agents, or the money to pay for more sophisticated testing.
There is another advantage to this: it can be an inexpensive way of getting a pretty good sense for the size of your prostate, all done at the same time.
An ultrasound of the bladder before and after urination usuall costs a little over a hundred dollars or so in most local private imaging centers. It shows pre and post functional urination bladder volume, or post void residual. Normally, the amount of mls,( millileters) of urine post urination should be close to zero.
Most young men, and the research on this varies, have around 350-400 or so mls of urine when they go to the bathroom. As we get older, that number drops to around 250 mls each time, but the total daily amount urinated stays the same, which is why older men go to the bathroom more.
If you buy a cheap transparent four-dollar plastic urinary container with the mls listed on the side, (ebay/amazon wth free shipping) you can get a sense for what your output is. That is what I do with mine, and at home, I get a rough sense for output. Hopefully with time mine with increase.
If you are under a 100 ml or so with your urinary output, as I was, you could be having significant urinary retention. I had it, and it likely created a diverticulum because of the pressure I was using to try to get the urine out.
Stones usually are created in a diverticulum over time which can make it harder for UTIs to get eliminated, since the organisms can nest there. I have them and now need to see about getting them out.
I mentioned another advantage to the ultrasound: performed pre-void, with a full bladder, it can be an inexpensive way of getting a pretty good sense for the size of your prostate, all done at the same time, same cost.
The digital rectal exam by your friendly urologist or general practitioner, (hopefully someone who can't palm a basketball), can only feel the central part of the prostate, although they can get a sense for the hardness/tone etc of what they do palpate.
The manual exam does not reveal the total volume of the prostate. There is a rectal probe that can be used as part of an ultrasound that can give a very good idea of the size of the prostate as well as give other info. There is good research on this, and getting an ultrasound for this would be inexpensive.
The problem is, when I spoke to the medical director of a large multi-location imaging center in my area about it, because I wanted to start ordering as an inexpensive screening test, he said that they were not doing them because urologists still preferred to use the digital exam. As a result, this imaging center had not wanted to invest in buying probes that would not be used.
Whatever procedure you end up going under, the urinary measuring bottle is a good way to track urinary outflow progress. Even if you haven't had a procedure, over time using it will give you a sense for whether your output is increasing or decreasing.
If it gets to be low enough, consider getting checked so that you help to avoid what happened to the patient I mentioned.
I hope this info is of help, Neil. Perhaps other people on this thread who had a PAE can chime in.
Howard31850 333health
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Thank you very kindly for this helpful response ( I wish you had a first name I could address as 333 sounds like an android!).
I did have all the US tests you mentioned back in April as well as a cytstoscopy in June. My bladder did shows signs of hypertrophy and trabeculation but there no stones (signs of calculus) or diverticula. Also there was no median lobe or signs of bladder floor elevation. All this was remarkable given that my prostate was measured by a TRUS 5 years ago at 150gm and in April by another TRUS at almost 300gms. All this data was why Dr. Isaacson thought I was an ideal candidate for PAE and indeed my procedure was an outstanding technical success but so far a clinical failure.
Here's my coda: Tomorrow I fly (from Toronto) back to UNC to have a 3T-MRI of my prostate to understand better what is/is not happening. I will report my findings here. Thanks again "unit 333" for all your good advice and time - I'm sure we all learn a lot from you and appreciate it greatly. Neil
andrewcalgary Howard31850
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Howard31850 andrewcalgary
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andrewcalgary Howard31850
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Neil,
don't forget to get CD from your MRI, as well as MRI report, you can easily transfer MRI images free using wetransfercom website(up to 2GB) I used it to send it to some MRI experts in europe, or just send your CD, to Dr.Busch, as I did, he charges $200 USD, for second opinion and has a habit to call you personally and discuss your images in detail, as was in my case and as others reported or whoever you think is the most qualified,
let us know how your visit turned out,
Andrew from Calgary
Howard31850 andrewcalgary
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randy_85492 Howard31850
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Neil, I'm sorry to hear that your PAE doesn't seem to be successful...And, it's too soon to know whether my REZUM will be successful too...I'm just hoping and praying at this time....Likewise, I will pray that you find a successful treatment for your prostate problems....Take Care!...
Howard31850 randy_85492
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garyh1954 333health
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Dear 333, you seem as one of the more knowledgeable people on this site, I'd like to ask you a question. I've been on Finesteride/Tamsulosin for a few years with a prostate of 220 in size. After my PAE in June 2016, I experienced immediate relief from the urinary stuff associated with BPH> From the med's I incurred retrodgrade ejaculation. I still have that condition, even with the PAE in June. My recent visit to the Uro guy, he said he thought it would take another month before I could expect normal ejaculation, mostly because of Tamsulosin.
Any thoughts on this.
gary