Prostate Artery Embolization in South Africa
Enlarged Prostate Treatment also known as the Prostate Embolization (PAE) is the cutting-edge procedure performed to help improve urinary symptoms caused by an enlarged prostate without the risk of sexual side effects. Prostate enlargement treatment shrinks the prostate thereby relieving symptoms without surgery or side effects like sexual dysfunction, incontinence (inability to control urination), retrograde ejaculation (ejaculation into the bladder), impotence or bleeding.
The prostate receives its blood supply from the prostatic arteries, which arise singly or paired on each side of the pelvis. Super selection and embolization of the prostatic arteries leads to death of a large proportion of the gland. Shrinkage of the gland follows, with subsequent reduction of LUTS.
Prostate artery embolization appears to be a safe and effective alternative to more traditional treatments for benign prostatic hyperplasia. This is minimally invasive treatment, is known to offer symptom relief to men suffering from enlarged prostate.
Prostate Artery Embolization Procedure
Patients who undergo Prostate Artery Embolization treatment are awake during the procedure. They do however receive very light sedation. Local anaesthetic is used to numb the skin around the groin when the femoral artery is accessed with a slender flexible plastic tube (catheter).
Under x-ray guidance, the arteries supplying the prostate are identified. Once the vessels have been accessed using very small catheters, small, spherical synthetic spheres/particles are injected to block off the blood supply. These particles are inert and non-absorbable. They do not cause any side-effects. Starved of blood supply, the prostate begins to shrink thereby relieving the symptoms of BPH.
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Traditional Surgical Prostate Treatment
Transurethral resection of the prostate (TURP) is the gold- standard surgical treatment. It is effective, with IPSS reduced on average by 70%; however, as many as 20% of patients have significant complications, including bleeding, sexual dysfunction, incontinence, and dilutional hyponatremia. Open prostatectomy is the procedure of choice for prostates larger than 80–100 cm3, but it is an invasive surgical procedure with concomitant morbidity and extended hospitalization.
Several other less invasive therapies have been popularized in the past two decades, including photoselective vaporization of the prostate, transurethral needle ablation, transurethral microwave therapy, and holmium laser enucleation of the prostate. The most promising results have been produced with the laser therapies, which achieve similar results to those of TURP, but with fewer complications and side effects. Data on long-term efficacy of these newer therapies are lacking.
PAE is the only treatment for BPH which doesn’t impair sexual performance. All other treatment options described have some sexual side effects.
Benign Prostatic Hyperplasia (BPH)
LUTS are common complaints resulting from BPH, consisting of incomplete bladder emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. These symptoms are quantified by using the International Prostate Symptom Score (IPSS), which assigns a severity score of 0 to 5 to each of these seven symptoms. A total score of 0–7 is considered mild, 8–19 is moderate, and 20–35 is severe.
An eighth question termed the “bother score” pertains to the patient- perceived quality of life related to LUTS, ranging from 0 (delighted) to 6 (terrible).
Patients who cannot tolerate these drugs, whose disease is refractory to treatment, or who develop complications of BPH while receiving medical therapy are considered for surgical therapy.