PAE shrinks an enlarged prostate by blocking its blood supply, relieving urinary symptoms without an operation on the urethra, with better preservation of sexual function in many men.
Benign prostatic hyperplasia (BPH) affects most men as they age. The growing gland squeezes the urethra, causing weak stream, difficulty starting, dribbling, urgency, incomplete emptying and waking repeatedly at night. Medications help some men but cause side effects in others, dizziness, fatigue and sexual dysfunction. Traditional surgery (such as TURP) works well but involves an operation through the urethra, a hospital stay, and a high rate of retrograde ejaculation.
PAE approaches the prostate from the inside of its blood vessels rather than through the urethra. Via a pinhole in the wrist or groin, a microcatheter is steered into the small arteries supplying the prostate, and microscopic particles are injected to reduce its blood supply. Over the following weeks the gland shrinks and softens, the pressure on the urethra eases, and urinary symptoms improve.
Review of your symptoms, flow studies and PSA, with CT or MRI to map the prostatic arteries and plan the procedure.
Performed under sedation through a single pinhole. Both prostatic arteries are treated. No instruments pass through the urethra and there is no cutting.
Most men walk out a few hours after the procedure. Mild burning with urination or pelvic discomfort for a few days is common and settles with simple measures.
Symptoms typically improve progressively over two weeks to three months as the gland shrinks. Follow-up confirms your progress.
The large majority of men experience meaningful, durable improvement in urinary symptoms and quality of life after PAE, and it is now supported by international guidelines as an option for selected men. Crucially, ejaculatory function is preserved in many patients, a common reason men choose PAE.
Expected after-effects include a few days of urinary frequency or burning and mild pelvic discomfort. Uncommon risks include temporary urinary retention, blood in the urine or semen, and rarely non-target embolisation. Some men have a partial response or need further treatment in later years; if so, all surgical options remain open.
TURP remains a very effective operation and for some men it's the right choice. PAE offers symptom relief close to or equivalent to TURP for many men, with no urethral instrumentation, no general anaesthetic and same-day discharge, and may have better preservation of sexual function, at the cost of a somewhat higher chance of needing repeat treatment in future years. Dr Tarr will lay out both honestly.
PAE preserves ejaculatory function in many men, and erectile function is usually unaffected. This is the key difference from TURP, where retrograde ejaculation is very common.
Often, yes. PAE has good published success at restoring spontaneous urination in men with retention, and it's a particularly good option for men who are poor surgical candidates.
Some men improve within a fortnight; for most the full benefit develops over one to three months as the prostate shrinks.
A short explainer on prostate artery embolisation from Dr Chris Rogan, an Australian interventional radiologist.
Watch on YouTube ↗