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

What is prostatic embolization?

Prostatic embolization is a minimally invasive treatment for benign prostatic hyperplasia (non-cancerous enlargement of the prostate) 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.

What are the symptoms of benign prostatic hyperplasia?

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

  • Difficulty in urinating
  • Weak and intermittent urine stream
  • Urine leakage and end leakage
  • Urinary retention and incontinence
  • Incomplete bladder emptying
  • Interrupted sleep or trouble sleeping
  • Urinary tract infections

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

Unlike classical treatments, prostatic embolization is a non-surgical treatment for benign prostatic hyperplasia. Therefore, it is a therapy free of the side effects of direct surgery. Thus, during the treatment, a small puncture is made in the groin under local anesthesia (for catheterization of the artery) and its completion is monitored with a sophisticated imaging system to ensure that it is correctly performed. The final objective is to plug the prostate arteries and achieve its progressive reduction in size.

Benefits of prostate embolization

The advantages of prostatic embolization are:

  • Performing the technique in day hospital regime (without hospital admission or with 24-hour admission).
  • Rapid recovery (48-72h).
  • It does not produce sexual dysfunction.
  • Absence of complications associated with the surgery, since it is not a surgery in itself.
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How should the patient prepare for prostatic embolization?

Before deciding to perform this treatment, it is necessary a review by the specialist in Urology to rule out the possibility of prostate cancer, which would contraindicate this technique. In addition, the Prostate Specific Antigen (PSA) must be determined, an ultrasound to analyze the state of the bladder, and urinary flowmetry to assess the degree of obstruction. A quality of life test should also be performed.

There are few contraindications for performing prostatic embolization. They are basically severe vascular disease and allergy to the iodinated contrast used during the technique.

If the patient has a very large prostate, far from being a contraindication, it is a condition that favors the success of the technique. On the other hand, small prostates of less than 30 grams would not be ideal for the treatment.

What will the treatment consist of and what aftercare will be necessary?

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

After the operation, the patient’s medication needs are limited to anti-inflammatory drugs and antibiotics for one week.

Medical discharge from the first hours allows patients to quickly return to normal life.

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, who have performed more than 1,000 successful procedures.

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There are also scientific studies 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 study comparing prostate embolization and prostate surgery, with also satisfactory results.

In 2018 both the American Food and Drugs Association (FDA) and the English Public Health Agency (NICE) recommended the use of prostatic embolization.

Alternative treatments to prostatic embolization

Depending on how advanced the prostate disease is and the severity of the symptoms on the basis of the IPSS scale, 3 major groups of therapies can be differentiated for patients with mild, moderate or severe symptomatology:

  • Patients with mild or moderate symptomatology can receive medical treatment with medication from the 5 alpha reductase inhibitors or alpha blockers group. In general, these drugs are poorly tolerated because they produce side effects. In the case of 5 alpha reductase inhibitors, they cause a decrease in sexual desire, retrograde ejaculation and erectile dysfunction. Alpha-blockers cause headache, fatigue and high blood pressure. All of them act on the symptoms but do not stop prostate growth.
  • The surgical alternative is recommended in cases with severe symptoms. It is the transureteral surgery, the transureteral resection or TUR. This surgery only removes part of the tissue that surrounds the urethra and causes the difficulty or impossibility of urination. In even more severe cases, open surgery or prostatectomy, which consists of complete resection of the prostate, may be necessary. However, it is a technique with more complications.
  • Other minimally invasive techniques such as laser may 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 through the penis.