Excellent article/editorial re PAE

Men's health
1

I thought this was an interesting article from a patient who had a successful PAE. I haven't watched the video lecture yet but he explains why the mechanism of this may be something that the drugs don't help. I've found flomax to be of negative benefit. 

https://www.bmj.com/content/361/bmj.k2537/rr

Here's some of that discussion: 

Why did the PAE work for my type of LUTS? KT Foo (see citation) has been explaining that some types of LUTS are primarily caused by adenomas, not prostatic size per se. Imagine internal adenomas as if they were marbles inside a tennis ball (the prostate) and you can imagine how, when all the adenomas expand, the prostatic cap resists and a reverse force is exerted back to compress the uethra. Or imagine two large adenomas as if croquet balls side by side growing so as to “squeeze” the urethra. Or imagine one large adenoma growing to as to kink the urethra, as if an “oxbow” bend in the channel of a river. A PAE can attack such adenomas, resolving the problem directly.

An MRI generated picture of an example of an “oxbow bend” case of a steep kink in a urethra induced by an enormous prostatic adenoma has been produced by Dr Mark Little in his Oxford Surgery video lecture cited below (minutes 31 – 36). The urethra is later straightened out after the patient has a PAE that destroys the adenoma, enabling the urethra to straighten.

This is why I suggest alpha blockers might not resolve this type of LUTS problem. They work by relaxing the sphincter. But, if the real cause of this type of LUTS is adenomatous in nature, alpha blockers might not address the root of that problem. PAE does.

PAE is going to be very popular. Lots of men will want to preserve full sexual function and avoid stricture, or other, risks. But it is not yet fully appreciated is LUTS drugs can have some tedious side effects and PAE may offer men at least the chance of avoiding drugs in cases where the true nature of the LUTS is adenoma-generated.

References:

Gao et al, Radiology 2014 Mar, 270(3): 920-928.

Foo, Asian J Urology 2017 Jul: 4(3): 152-157.

Little et al, Cardiovasc Interv Radiology 2017, May 40(5): 682-689.

Oxford Surgical Lecture “Prostate Artery Embolization in the Management of LUTS” https://www.youtube.com/watch?v=bcricbWiq1M

2

About 30 years ago my cousins husband was told that he had lipomas in his prostate. I'm not sure how the diagnosis was arrived at but he had a TURP. From your article it would seem quite likely that he had adenomas.

From Dr Tipster. Almost 16% of urology consultations are determined by prostate adenoma. After 40 years, over 50% of men suffer from a form of prostate adenoma , the number increasing in direct proportion with advanced age, reaching 90% at 85 years. 

The prostate is a structure, part of the male reproductive apparatus that surrounds the bladder. In men with normal androgen production, along with age, the gland tends to increase its overall volume (benignant hyperplasia), more pronounced in some areas, resulting in prostate adenoma that can cause strangulation of the urethra and urination problems.

Prostate adenoma is the most common noncancerous tumor of the over 60 years male, developed due to a deficiency in testicular activity. Prostate adenoma does not manifested in patients with reduced activity of the pituitary gland or in those who underwent vasectomy surgery (resection of the vas deferens through which sperm reach from the epididymis into the posterior urethra ) before the age of 40 years. The appearance of prostate adenoma is considered therefore an metabolism alteration, one of the factors being represented by testosterone.

3

Thanks Motto, the video was very informative.

4

Thanks for sharing, Motto. However, keep in mind that PAE is most effective with larger prostates. Hank