Treatments we provide
Prostate Artery Embolisation
Prostate artery embolisation (PAE) is a minimally invasive treatment for benign prostatic hyperplasia (BPH), also known as an enlarged prostate. It is used to treat lower urinary tract symptoms caused by prostate enlargement, such as frequent urination, difficulty starting urination, a weak urinary stream and needing to urinate during the night.
PAE is performed by an interventional radiologist through a small catheter inserted into an artery. Tiny particles are used to reduce the blood supply to the prostate, causing it to gradually shrink and helping improve urinary symptoms. It is an alternative to surgical treatment for appropriately selected patients.
How is Prostate Artery Embolisation Performed?
Prostate artery embolisation is usually performed as a day procedure under local anaesthetic with sedation. A small catheter is inserted into an artery, usually through the wrist or groin, and guided using X-ray imaging to the arteries supplying the prostate.
Once the prostate arteries have been identified, tiny embolic particles are injected through the catheter to reduce blood flow to the prostate. The aim is to cause the enlarged prostate to gradually shrink, which can improve urinary symptoms over the following weeks and months.
The procedure is usually performed on both prostate arteries where technically possible. Procedure time varies depending on the individual anatomy and complexity of the prostate arteries.
Benefits of prostate artery embolisation
Prostate artery embolisation offers several potential benefits for appropriately selected men with benign prostatic hyperplasia (BPH), including:
- Minimally invasive treatment without prostate surgery
- Usually performed as a day procedure
- Improvement in urinary symptoms for many patients
- Short recovery time compared with surgical treatment
- Low risk of urinary incontinence
- Low risk of sexual dysfunction
- Does not require removal of prostate tissue
- May be an option for men with large prostates or those wishing to avoid surgery
Risks
Prostate artery embolisation is generally well tolerated, but as with any medical procedure there are potential risks and complications. These are uncommon but may include:
- Bleeding, bruising or infection at the catheter insertion site
- Temporary pelvic discomfort, urinary frequency or burning when passing urine following treatment
- Temporary difficulty passing urine, which may occasionally require a urinary catheter
- Allergic reaction to contrast material
- Injury to the blood vessels used to access the prostate arteries
- Non-target embolisation, where embolic particles unintentionally enter blood vessels supplying nearby structures
- Failure to achieve sufficient improvement in urinary symptoms or the need for further treatment
Assessment Before Prostate Artery Embolisation
Before prostate artery embolisation, an assessment is performed to confirm that your urinary symptoms are likely to be related to benign prostatic hyperplasia (BPH) and to determine whether PAE is an appropriate treatment option.
Assessment may include:
- International Prostate Symptom Score (IPSS) – to assess the severity of urinary symptoms
- Blood tests, including kidney function and prostate-specific antigen (PSA) where appropriate
- Urine testing if there is concern about urinary infection
- Imaging of the prostate and urinary tract to assess prostate size and anatomy
- CT angiography (CTA) in selected patients to assess the arteries supplying the prostate and assist with procedural planning
Additional investigations, such as prostate MRI, ultrasound or urodynamic testing, may be recommended depending on your symptoms, previous investigations and clinical circumstances.
Dr Ryan McConnell will review your symptoms, imaging and previous urological assessment and discuss whether prostate artery embolisation is an appropriate treatment option for you.
Recovery After Prostate Artery Embolisation
Most patients are able to go home on the same day or the following day after prostate artery embolisation. Recovery is generally relatively quick compared with surgical treatment for an enlarged prostate.
It is common to experience temporary urinary symptoms during the first several days after the procedure. These may include increased urinary frequency, urgency, burning when passing urine or pelvic discomfort. A small amount of blood in the urine or semen can also occur following treatment.
These symptoms usually improve as the initial inflammation and swelling of the prostate settles. Medication may be prescribed to help manage discomfort and urinary symptoms during this period.
Occasionally, swelling of the prostate can make it temporarily difficult to pass urine. If urinary retention occurs, a urinary catheter may be required until the swelling has improved.
Most patients can gradually return to their usual activities over the following days, although individual recovery varies.
Follow-up After Prostate Artery Embolisation
Follow-up is arranged after prostate artery embolisation to assess your recovery and improvement in urinary symptoms. Dr McConnell will review your progress after the procedure and may arrange further clinical assessment or imaging depending on your individual circumstances.
Improvement in urinary symptoms typically develops gradually over the following weeks and months as the prostate reduces in size. Longer-term follow-up can be used to assess symptom improvement and determine whether any further treatment is required.
Prostate Artery Embolisation FAQs
Prostate artery embolisation (PAE) is a minimally invasive, image-guided treatment for an enlarged prostate (benign prostatic hyperplasia or BPH). During the procedure, a small catheter is guided into the arteries supplying the prostate. Tiny particles are then injected to reduce blood flow to the prostate, causing it to gradually shrink and helping to improve urinary symptoms.
PAE is performed by an interventional radiologist and does not require surgical removal of prostate tissue.
Prostate artery embolisation may be suitable for men with urinary symptoms caused by an enlarged prostate (BPH), particularly when symptoms are affecting quality of life and medication has not provided adequate relief or is causing unwanted side effects.
PAE may also be considered by men who would prefer a minimally invasive alternative to prostate surgery, particularly where preserving sexual and ejaculatory function is an important consideration.
Not every patient with an enlarged prostate is suitable for PAE. Assessment usually includes your symptoms, prostate size and anatomy, previous treatments and appropriate imaging. Dr Ryan McConnell will assess whether PAE or another treatment option is most appropriate for you.
Prostate artery embolisation is effective in improving urinary symptoms caused by an enlarged prostate in appropriately selected patients. Most patients experience a meaningful improvement in symptoms and quality of life following treatment.
Improvement is usually gradual rather than immediate. Urinary symptoms typically begin to improve over the first few weeks, with further improvement occurring over the following months as the prostate reduces in size.
Individual results vary, and some patients may have persistent or recurrent symptoms that require further treatment. Dr Ryan McConnell will discuss the expected outcomes of PAE based on your symptoms, prostate size and individual anatomy.
Prostate artery embolisation (PAE) and surgical treatments such as TURP treat an enlarged prostate in different ways. TURP removes prostate tissue through the urethra, whereas PAE reduces blood flow to the prostate, causing it to gradually shrink.
PAE is minimally invasive, does not require surgical removal of prostate tissue and is usually associated with a relatively short recovery. It also has a lower risk of ejaculatory dysfunction than traditional prostate surgery. However, improvement after PAE is generally more gradual, and some surgical treatments may provide greater improvement in urinary flow or symptoms in appropriately selected patients.
The best treatment depends on factors including the severity of your urinary symptoms, prostate size and anatomy, general health, previous treatments and your priorities regarding recovery and sexual function. Dr Ryan McConnell can discuss PAE with you, while a urologist can advise on surgical and other prostate treatment options.
One of the potential advantages of prostate artery embolisation (PAE) is that it does not involve surgical removal of prostate tissue and has a lower risk of ejaculatory dysfunction than traditional surgical treatments such as TURP.
Most men maintain erectile and ejaculatory function following PAE. Some patients may also experience improvement in sexual function as their urinary symptoms and quality of life improve.
However, changes in sexual or ejaculatory function can still occur, and individual outcomes vary. If preservation of sexual or ejaculatory function is particularly important to you, this should be discussed when considering the different treatment options for an enlarged prostate.
Prostate artery embolisation usually takes around 1–2 hours, although the exact procedure time varies depending on the anatomy of the prostate arteries and the complexity of the procedure.
PAE is usually performed as a day procedure. After the embolisation, you will be monitored during recovery before being discharged home. Because sedation is generally used, you will need someone to take you home and you should not drive for 24 hours after the procedure.
Most patients go home on the same day as prostate artery embolisation and can return to light activities within a few days.
During the first several days, some patients experience temporary pelvic discomfort, urinary frequency, urgency or burning when passing urine as the prostate responds to treatment. These symptoms usually improve as the initial inflammation settles.
Many patients can return to normal daily activities within a few days, although strenuous exercise and heavy lifting should generally be avoided for approximately one week. Recovery varies between patients, and Dr Ryan McConnell will provide individual instructions following your procedure.
Prostate artery embolisation is generally a very safe procedure when performed by an experienced interventional radiologist. As with any minimally invasive procedure, there are potential risks and complications.
Common temporary side effects include pelvic discomfort, urinary frequency, urgency, burning during urination and mild bruising at the catheter insertion site. These symptoms usually settle over the first several days.
Less common risks include infection, bleeding, temporary urinary retention, injury to a blood vessel, non-target embolisation or an allergic reaction to contrast material. Serious complications are uncommon, and Dr Ryan McConnell will discuss the expected benefits, alternatives and individual risks during your consultation.