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Prostate Artery Embolization (PAE) for Benign Prostate Hyperplasia (BPH)

HIT : 4,723DATE : 2017-01-26

 

Prostate Artery Embolization (PAE) for Benign Prostate Hyperplasia (BPH)

More than 50% of men aged 60-69 years and as many as 90% aged 70-89 years have some symptoms of BPH.  As life expectancy increases, so does the occurrence of BPH.  Symptoms of BPH include difficulty urinating, more frequent and urgent urination, especially at night and a weak urine flow.  While BPH is not a cancer and not life-threatening, the quality of life for the affected men can be quite miserable. 



 

 

Medical treatment is usually the first-line treatment option, but patients who cannot tolerate medication, whose disease is refractory to medical treatment or who develop complications of BPH are considered for surgical treatment.  Transurethral resection of the prostate (TURP)  has been the gold-standard surgical treatment.  While showing its effectiveness, significant complications are encountered such as retrograde ejaculation in over 80% of patients and bleeding, sexual dysfunction, incontinence, and dilutional hyponatremia up to 20% of patients.

 

Prostate artery embolization (PAE) is a new treatment that blocks the blood supply to the enlarged prostate.  Unlike surgical therapy, it is minimally invasive, usually performed with a single femoral artery puncture without prolonged Foley catheterization.  Local anesthesia rather than general anesthesia is used, and the procedure may be performed as outpatient procedure, with patient discharge typically occurring 4-6 hours after the procedure.  The procedure time is about 2 hours to treat both right and left branches of the prostate artery.  Furthermore, major complication is rare, and typical complications of urologic surgeries, including blood loss requiring transfusion, bladder incontinence and erectile dysfunction have not been reported with PAE.  At the same time, the high technical and clinical success rates up to 91% have recently published.


 

In conclusion, PAE is a promising, minimally invasive procedure to treat the lower urinary tract symptoms due to BPH without complication.  Moreover, this procedure is performed under local anesthesia and may be done on outpatient basis since no significant pain following procedure.  



Fig. 1 shows the enlarged prostate, about 75 grams. Fig. 2 shows PAE.  Fig. 3 is 30 day follow up MRI image showing volume reduction by 38.7% (to 46 grams)





Park Sang JunProfessor

  • Daejeon seon Hospital,Radiology,Chief
  • Korea University Anam Hospital,Clinical Assistant Professor
  • Hallym Kandong Song shim University Hospital,Assistant Professor,Fellowship Instructor
  • Korea University,Graduate School of Medicine, M.S/Ph.D.
  • Korea University,Medical College