Prostatic Artery Embolization procedure

Men's health
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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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Fantastic news for you.  Thanks for sharing your good news.

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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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I'm very happy for you!....Dr. Isaccson is super!...

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Thank you for sharing your experience. I hope to have this procedure done by Dr. Ari as well. I'm 32 and have had BPH since about 19.

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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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Congrats! Thank you for sharing!

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Were you on any BPH drugs like Proscar/Avodart, Flomax etc before your PAE and have you been able to get off them since? All the best.

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I too, contacted UNC Dr. Issacson and he said I could come there for the procedure but it wouldn't be covered insurance wise since it's a new procedure. They had some Federal grant money but it ran out so, I'd be on my own money wise.

I wound up having the procedure done @ Hackensack medical Center here in New Jersey by interventional Radiologists Dr. John DeMerritt. Like you, my Urologists wanted to do a SupraProstatectomy but, after considering the 7 day hospital stay with catheter, I decided to look elsewhere, much to my urologists chagrin.

Again, like you, all my BPH symptoms vanished with the P.A.E. procedure. No more emergency peeing sessions. No more getting up 6  to 8 times a night to pee for 5 seconds.

And, I'm no longer two horrible drugs, Finesteride or Tamsulosin.

Good luck with your continued recuperation and the shrinking of your prostate.

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Thanks for sharing your experience Gary. Could you please provide a little background on your BPH like the prostate size, median lobe, psa. How long did it take for your BPH symptoms to go away after your PAE? Did your doctor go through the femoral artery and did you have much pain/bleeding in the days following your PAE? Thanks for sharing.

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I am very happy for you. I bet your happy you did not listen to your urologist.  What did he say when you told him you did not need a Turp. To many doctor push the Turp because they get a kick back from the company.  A turp should be use for a last resort if you have not try all the other opinions Which over the last 10 year are many.  Thank God for them  Ken. 

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I am very happy for you. I bet your happy you did not listen to your urologist.  What did he say when you told him you did not need a Turp. To many doctor push the Turp because they get a kick back from the company.  A turp should be use for a last resort if you have not try all the other opinions Which over the last 10 year are many.  Thank God for them  Ken. 

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Hi Neil,

Thanks.

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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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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Yes, he was very kind and attentive before as well as after the procedure.

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Good luck, I wish you well. You have had this your adult life so far.

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Neil, I was on tamsulin for a couple of months before the procedure, nothing else. It would have been wiser to have been on it, or to have done the procedure earlier, since I had a bladder diverticulum that the urologist said very likely arose from acute urinary retention.

I found out by good fortune when I ordered a US of the abdominal wall on myself late in the Spring because I thought I had somehow gotten an inguinal hernia doing endurance cycling. 

The morning of the ultrasound the inguinal pain was gone, but since I knew that the imaging center had reserved that time for me, I did not want to just not show up. I thought it was the right thing to do, and also thought that things happen for a reason, so why not do it.

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So happy for your Gary, when we are younger we take things for granted. I never knew how happy I would feel taking a long relaxing pee until all this happened!

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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. 

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Hi Ken,

Funny you should ask about what he said, since I was not going to talk about it specifically unless asked. I have just written a book about healthcare and about the necessity to investigage, question, and freely ask doctors about their recommendations.

This wasn't just a urologist; it was the Chief of  the Urology Department in a well-known and very regional large hospital. He was visibly upset when I told him I wanted to do it.

First he said that he did not know about the PAE procedure, so I showed him the systemic review article, and I added that there was other promising short and mid-term research, and that UNC, Stanford and other prominent places were doing it.

He said it was experimental and that it was, his exact phrase "bulls..t"  He used that term three times in the conversation. When I pointed out that respected clinics around the country were doing them he said they were just out to make money. 

I picked my jaw off the floor at that one, and proceeded to tell him that an interventional radiologist in his hospital/health clinic had been given the ok by his own hospital  to do them, that he had been doing them for two years, and that I had talked to this radiologist, who said he was getting research-level results.

My urologist was still upset, and said his colleague was just giving anecdotal evidence.He said that TURP was the gold standard and that is what I needed, that I would eventually come back to him for it.

Needless to say, I moved on and had the PAE done.

Here's an ironic coda to the story, one that I have detailed in case it helps those  reading this who have a tendency to follow an authority figure's suggestions without really checking it out: the urologist did a cystoscope on me before we talked about the TURP. The cystoscope  gave me for the first time in my life, a UTI. The culture showed it was due to colonization, which came from the cystoscope.

Perhaps life was sending me a message not to follow his recommendation.