Benign Prostatic Hyperplasia and Prostatic Artery Embolization (PAE)

What is Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia is a common, non-cancerous enlargement of the prostate gland affecting more than 70 percent of men older than 70 years of age. Enlargement of the prostate can result in obstruction of the outflow of urine from the bladder resulting in lower urinary tract symptoms.

What are the Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia?

Signs of benign prostatic hyperplasia may include:

  • Incomplete bladder emptying with urination
  • Frequent urination
  • Weak urinary stream
  • Urinary urgency
  • Straining with the initiation of urination
  • Waking up multiple times from sleep to urinate

How is Benign Prostatic Hyperplasia Diagnosed?

A physician will obtain a medical history and perform a physical exam as well as utilize screening questionnaires such as the International Prostate Symptom Score (IPSS) to gauge the severity of lower urinary symptomatology. If the physician is concerned that benign prostatic hyperplasia is the cause of lower urinary tract symptoms, several additional tests can be pursued to confirm this diagnosis.
These tests may include:
  • Ultrasound: An ultrasound test uses sound waves to create a picture of the bladder and prostate.
  • CT or MRI: Imaging studies where X-rays or a magnetic field are able to generate a cross sectional image of the abdomen and pelvis. These provide a picture of the prostate and surrounding structures.
  • Urinary flow studies: Evaluate the flow of urine over time and subsequent ultrasound to calculate the amount of urine remaining in the urinary bladder after voiding.
  • Laboratory testing: Analysis of the urine to look for blood in the urine or infection. Blood tests to ensure that urinary symptoms are not related to a cancer of the prostate gland.

How is Benign Prostatic Hyperplasia Treated?

Several medications exist which can improve the lower urinary tract symptoms of benign prostatic hyperplasia. A three month trial of medical therapy is pursued to assess for degree of symptomatic improvement. If insufficient improvement with medical therapy or side effects of medical therapy are not tolerated there are numerous procedural options which can be considered.

Several surgical options exist for the treatment of benign prostatic hyperplasia including surgical removal of the prostate (prostatectomy), surgical removal of the portion of the prostate surrounding the urethra (transurethral resection of the prostate), and a variety of additional minimally invasive surgical therapies.

In additional to surgical options, Denver Health offers prostatic artery embolization (PAE), a minimally invasive way to treat benign prostatic hyperplasia which does not require a significant surgery. Through a small incision in the skin in the groin or wrist, using x-ray guidance, a catheter is directed into the arteries which supply the prostate. Small particles are injected into the arteries blocking the blood flow to the prostate causing the gland to shrink and improving urinary symptoms.

What to Expect After PAE Treatment

Typically, a hospital stay is not required after prostatic artery embolization. Pelvic pain, pain with urination, and frequent urination are common for the first few days after the procedure and oral pain medications are prescribed as needed. Most men are able to return to normal activity in about one week.

Recent studies have demonstrated equivalent improvement in lower urinary tract symptoms after prostate artery embolization as compared to the gold standard surgical option Transurethral Resection of the Prostate (TURP). The rate of major complication from prostatic artery embolization is less than 0.5 percent.

If you are interested in learning more about prostatic artery embolization and meeting with one of our physicians, please call 303-602-4150.

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