Prostatic embolization

Prostatic embolization is a minimally invasive treatment for benign prostatic hyperplasia (non-cancerous prostatic enlargement) and associated symptoms.

It is one of the most common diseases in men, affecting a significant percentage of men over 60 years of age, affecting up to 80% of patients over 80 years of age.

In cases of benign prostatic hypertrophy this gland enlarges,
and affects 80% of patients over 80 years of age.

What are the symptoms of benign prostatic hyperplasia?

Benign prostatic hyperplasia usually manifests with a series of symptoms that diminish the patient’s quality of life:

  • Difficulty urinating
  • Weak and intermittent urine stream
  • Leakage and dribbling
  • Retention and incontinence
  • Incomplete bladder emptying
  • Interruption of sleep
  • Urinary tract infections

Prostatic embolization as a non-surgical treatment for benign prostatic hyperplasia

Unlike classic treatments, prostatic embolization is a non-surgical treatment for benign prostatic hyperplasia and, therefore, free of the side effects of direct surgery. Thus, a small puncture is made in the groin under local anesthesia (for catheterization of the artery) and its correct performance is monitored at all times with a sophisticated imaging system. The final objective of the technique is to precisely plug the prostate arteries in order to achieve their progressive reduction in size.

Advantages of prostate embolization

The advantages of prostatic embolization are as follows:

  • Performed on a day hospital basis (without hospital admission or with a 24-hour admission).
  • Rapid recovery (48-72h).
  • No sexual dysfunction.
  • Absence of classic complications associated with surgery, since it is not a surgery.

How to prepare for prostatic embolization?

Before making the decision to undergo this treatment, a check-up by the Urology specialist is necessary to rule out the possibility of prostate cancer, which would contraindicate embolization. In addition, the determination of the Prostate Specific Antigen (PSA), an ultrasound scan to check the state of the bladder and urinary flowmetry to assess the degree of obstruction should be performed. It is also important to perform a quality of life test.

There are very few contraindications for the performance of prostatic embolization. They consist basically of severe vascular disease and known allergy to the iodinated contrast used during the technique.

The existence of a very large prostate, far from being a contraindication, is a condition that favors the success of the technique. On the contrary, small prostates of less than 30 grams would not be tributary to the treatment.

What will prostatic embolization and aftercare consist of?

The technique is performed by the specialist in Interventional Radiology with a 24h admission or day hospital regime, with local anesthesia as it is not painful. The arterial catheterization will be performed in the angioradiology room, which is equipped with a sophisticated radiological imaging system that allows the arteries of the prostate to be precisely identified and plugged with the injection of small spherical particles.

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After the operation, the medication required by the patient is limited to anti-inflammatory drugs and antibiotics for one week.

The medical discharge home from the first hours allows patients to quickly return to normal life.

Injection of small particles into the prostate gland

Is there scientific evidence for the technique?

Prostatic embolization is a minimally invasive technique that began to be used in 2009. The pioneers of the technique were Dr. Pisco in Portugal and Dr. Carnivale in Brazil, and they have performed more than 1,000 successful procedures.

Scientific studies have already been published with the medium and long-term results of a large number of patients with satisfactory results.

In Spain, the Hospital de Navarra has published the results of a comparative study between prostate embolization and prostate surgery, also with satisfactory results.

The Hospital de Navarra has presented the results of a study
results of a study on prostatic embolization

In 2018 both the American Food and Drugs Association (FDA) and the English Public Health Agency (NICE) recommend the usefulness of prostate embolization.

Several national and international agencies
recommend the use of prostatic embolization.

Alternatives to prostatic embolization

Depending on how advanced the prostatic disease is and how severe the symptoms are according to the IPSS scale, 3 main groups of alternative therapies can be distinguished for patients with mild, moderate or severe symptomatology:

  • Patients with mild or moderate symptomatology may be tributary to medical treatment with medication from the group of 5 alpha reductase inhibitors or alpha blockers. In general, these drugs are poorly tolerated due to the side effects they produce. In the case of 5 alpha reductase inhibitors, they produce a decrease in sexual desire, retrograde ejaculation and erectile dysfunction. In the case of alpha-blockers, the general symptoms are headache, fatigue and high blood pressure. All of them act on the symptoms but fail to stop the growth of the prostate.
  • The surgical alternative is applied in cases with severe symptoms. This is transureteral surgery, transureteral resection or TUR. With this intervention only part of the tissue surrounding the urethra is removed, which makes urination difficult or impossible. In even more severe cases, open surgery or prostatectomy may be required, which consists of complete resection of the prostate. However, it is a technique with a greater number of complications.
  • Other minimally invasive techniques, such as laser, can be effective only in the case of small prostates. Complications of these techniques are duct stenosis, sexual dysfunction, urinary incontinence and, in a significant percentage of patients, retrograde ejaculation or “dry ejaculation”, where semen backs up into the bladder and is not expelled from the penis.