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Prostate Artery Embolisation

The prostate gland surrounds the outlet of a man’s bladder. Benign prostatic hyperplasia (BPH)
is essentially an enlarged prostate gland. It is a very common condition in older men. By the age
of 70, approximately 80% of men have an enlarged prostate. As the prostate enlarges, the layer
of tissue around it stops it from expanding, which causes the gland to press against the urethra
(the passage through which urine flows).

What are the symptoms?

 In many men an enlarged prostate does not cause any problems. If symptoms do occur they may include:
  • weak urine flow
  • hesitancy in passing urine
  • sensation that the bladder is not empty after passing urine
  • increased frequency in passing urine

What is prostate embolisation?

Prostate embolisation is a minimally-invasive procedure that blocks the arteries that supply
blood to the prostate. The procedure is performed under local anaesthetic. During the
procedure, a radiologist uses an x-ray camera to guide the delivery of small particles to block
the prostate arteries. The small particles and contrast dye (liquid used to make injuries or
diseases visible on scans) are injected through a thin, flexible tube called a catheter.

What are the benefits of prostate embolisation?

Prostate embolisation for benign prostatic hyperplasia is a new procedure which is considered
when other forms of treatment are deemed unsuitable or high risk. The procedure has only been
carried out in a few thousand patients worldwide but early results are encouraging. The majority
of patients who have had it done show a reduction in the size of the prostate as well as an
improvement in their symptoms.
 

What are the risks of having prostate embolisation?

Prostate embolisation is considered a safe procedure. However, as with any procedure, there
are some risks.
  • Any procedure that involves placement of a catheter inside a blood vessel (artery) carries certain risks. These risks include damage to the blood vessel and bruising or bleeding at the puncture site. When performed by an experienced radiologist, the chances of any of these events occurring are very small.
  • There is a small risk of infection, but this can usually be treated with antibiotics.
  • Very rarely there is a chance that small particles can lodge in the wrong place and deprive normal tissue of its oxygen supply. In an attempt to avoid these complications, the doctors pay close attention to the pattern of the blood vessels in the pelvis, noting that the path of the vessels can be different in each individual. Despite this there is a very small risk of injury to the bladder, rectum and genitals because of their close proximity to the prostate.
  • Occasionally patients may have an allergic reaction to the x-ray contrast dye used during prostate embolisation. These episodes range from mild itching to severe reactions that can affect breathing or blood pressure. Patients undergoing prostate embolisation are carefully monitored during the procedure, so that any allergic reaction can be detected immediately and treated by the doctors.
  • There is the possibility that the procedure will fail due to an inability to embolise the arteries completely or a failure of response to the treatment.

Are there any alternatives?

Treatment is not always necessary for BPH, however, if you do need treatment there are several options. Your urologist will discuss with you any alternative options they think ma be suitable, including medicines and surgery.

How is embolisation performed?

You do not need to have a general anaesthetic (where you go to sleep) but you will be given a sedative, which will relax you and make you feel sleepy.
 
You will be positioned on the x-ray table. Your groin area may be shaved. The area will then be
sterilised and covered with a surgical drape.
 
The radiologist will numb your right groin with a local anaesthetic injection. A fine, flexible,
plastic tube about as thick as a spaghetti strand (catheter) is inserted into an artery in your
groin. Using x-ray monitoring to check its position, the radiologist guides the catheter into both
your prostate arteries (right and left). Only when the catheter is precisely positioned does the
radiologist inject fluid, containing tiny particles, through the catheter. This flows into the prostate
arteries and blocks them off. The particles are made from a plastic-like material called polyvinyl
alcohol and are about the size of grains of sand. They will remain in your body permanently. In
over 30 years of use, they have not shown any harmful effects.
 
The procedure can take up to two hours.
 
Once the embolisation is completed, the catheter is taken out and the radiologist will press on
the puncture site in your groin for about ten minutes to stop bleeding. You will not need any
stitches or dressings.
 
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