ENLARGED PROSTATE – PROSTATIC ARTERY EMBOLIZATION (PAE)
Dr. Pradeep Muley, Head Interventional, Radiologist, Fortis Hospital, VasantKunj
A male reproductive gland that produces the fluid that carries sperm while ejaculation is known as the Prostate. An enlarged prostate means the gland has grown bigger and it usually happens to all the men as they grow older. The prostate is located around the urethra, through which urine passes out of the body.
It is also called Benign Prostate Hyperplasia (BPH). It cannot be considered as a cancer, and also doesn’t raise any risk for prostate cancer. Its actual cause is still unknown. Testicles may play a role in the growth of the gland. But a eunuch men who has been castrated at a younger age, they do not develop BPH. If the testicles are removed after a man develops BPH as a result the prostate begins to shrink in size. Digital rectal examination, prostatic specific antigen (PSA), transrectal ultrasound, urine analysis etc are some of the diagnostic test to recognize the BPH.
Symptoms for Prostate Gland Enlargement:
- Hitch starting urination & weak urine stream.
- Dribbling at the end of urinating.
- Urgent need to urinate albeit not being able to completely empty the bladder
- Blood in the urine
- Straining to urinate
- Hankering like to urinate three or more times per night.
Development of enlarged prostate increases with the age, it has also been said that every men will face an enlarged prostate if they live long and BPH is so common. If there is a disease the treatment is also there but the choice of the treatment is based on the severity of your symptoms and to the extent they are affecting your daily life or routines. There are certain surgeries to get rid of this disease. Most of the surgeries are temporary and are required to done again after a period of time only one was found to be affective and that is transurethral resection of the prostate (TURP). The surgery is effective enough to stop the symptoms but there are complications of such types of surgeries as TURP required a doctor to insert a device up the urinary tube and remove the prostate. Any type of prostate surgery cause side effects such as blood loss, blood in the urine, semen flowing backward into the Bladder instead of out through the penis during ejaculation, water intoxication and urine incontinency, loss of bladder control etc.
Now a procedure has been developed and that is “Prostatic Artery Embolization” or PAE. This surgery is far better than TURP. Under this surgery the patients are admitted to the hospital at the day of the procedure. Embolization is performed under local anesthesia by unilateral approach, usually the right femoral artery. Initially, pelvic angiography is performed to evaluate the various arteries. Then an angiography catheter is introduced in right femoral artery advanced in the ostium of the prostatic artery before embolisation. For embolization, PVA particles are injected causing slow flow or near stasis in the prostatic vessels with interruption of the arterial flow and prostatic gland opacification. When embolization of the both prostatic arteries is finished, the catheter is removed. After 6-8 hours patients can start walking. As a result the men undergoing this surgery will not feel a pain at all. He will be able to walk after few hours and leave the hospital after the procedure is done. PVE has many advantages like can be performed on any size prostate unlike TURP, contains no side effects like TURP does, no blood loss or risk of blood transfusion, no sexual dysfunction, no surgical ugly scars and also makes the faster recovery