In adult males, the prostate frequently grows until it compresses and obstructs the urethra, causing recurrent urinary afflictions that negatively impact men’s life quality. Benign prostatic hyperplasia (BPH) is one of the primary causes of lower urinary tract symptoms in older males. The symptoms include frequent and/or involuntary urination, repeated interruptions of night’s sleep to urinate, urgency, and even bladder pain. BPH is found in 50% of men older than 50, and the percentage increases with age. It is one of the costliest and most prevalent diseases in older men.
When BPH requires surgical intervention, the methods of choice are either transurethral resection of the prostate (TURP) or Holmium laser enucleation of the prostate (HoLEP). Both methods cut a part of the prostate to release the pressure on the urethra, but this causes many side effects and one major downside: male infertility. HoLEP is currently replacing TURP as the standard treatment for enlarged prostates, but it requires trained personnel and is even more expensive than the already costly TURP.
Medical research continues to explore alternative BPH treatments. And prostatic artery embolization is one of the most promising.
Prostatic artery embolization (PAE)
Pioneered in 2009 by Portuguese urologist Joéo Martins Pisco, this technique consists of inserting a catheter through the urethra and injecting microspheres of resin to block the blood flow through a prostatic artery. With reduced blood supply, the prostate softens and shrinks in size, returning normal urinary function to men. Patients that undergo prostatic artery embolization are generally discharged in the same day. Patients frequently report immediate improvements in urinary function and few or no side effects.
PAE can be performed on prostates of any size. The minimally invasive technique is a promising and cheaper alternative for patients who cannot or are unwilling to undergo traditional surgical procedures. It has been employed at the Portuguese S. Louis Hospital, in Lisbon, since 2009, with a high rate of improvement among patients (>85%).
Other health institutions around the world are now offering this treatment to patients, finding with similar results. The technique is being endorsed by an increasing number of internationally renowned urologists as an innovative and safe BPH treatment.
Ongoing research and debate
Despite many patients’ successful stories, it remains relatively unclear how exactly the mechanism behind the technique works. This is why PAE is still a matter of ongoing research. It also remains a non-consensual subject in the medical community, with many urologists arguing that there’s a lack of scientific data to corroborate the real effectiveness of prostatic artery embolization. The number of health institutions where PAE is performed also remains relatively low, although it is rapidly increasing.