The prostate is a walnut-shaped gland located at the base of the urinary bladder in men, and is an integral part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen, which is essential for a man’s fertility. However, as men get older, a condition called Benign Prostatic Hyperplasia (BPH) can cause the noncancerous enlargement of the prostate gland. Benign Prostatic Hyperplasia is also called Benign Prostatic Hypertrophy or Benign Prostatic Obstruction. About 50% of men will experience BPH by the age of 60, and up to 80% by the age of 70. This means that a significant portion of the male population is affected by BPH. This condition can cause a range of bothersome symptoms, significantly affecting the quality of life of those affected.
There are several treatments available for an enlarged prostate, including medications, surgeries, and procedures with smaller or fewer cuts.
Alpha blockers: These medications relax the smooth muscle of the bladder neck and prostate, making it easier to urinate. They are especially effective for people with somewhat smaller prostates.
5-alpha reductase inhibitors: These medications shrink the prostate by preventing hormone changes that cause it to grow. They may take up to six months to work well and can have sexual side effects.
Tadalafil (Cialis): This medication is often used to treat erectile dysfunction.
Prostatic Artery Embolization (PAE) : During PAE procedure, tiny particles are injected into the arteries that supply blood to the prostate gland, causing the blood vessels to narrow and reducing the blood flow to the gland. This causes the prostate tissue to shrink and relieves the symptoms. It comes with fewer risks and allows for a quicker recovery.
Transurethral resection of the prostate (TURP): A scope is inserted into the urethra, and the surgeon removes all but the outer part of the prostate. This can result in a stronger urine flow soon after the procedure.
Transurethral incision of the prostate (TUIP): The surgeon makes one or two small cuts in the prostate gland, which may be an option for small or slightly enlarged prostates.
Transurethral microwave thermotherapy (TUMT): This procedure involves placing a special catheter through the urethra into the prostate area, where microwave energy destroys the inner portion of the enlarged prostate gland. This option is used only for small prostates in specific situations because the treatment might be needed again.
Laser therapy: High-energy lasers are used to destroy or remove overgrown prostate tissue, and options include ablative procedures and enucleation procedures. A prostate lift, water vapor thermal therapy (WVTT), and robotic waterjet treatment are other options for easing symptoms of an enlarged prostate.
Open or robot-assisted prostatectomy: This surgical procedure involves making one or more cuts in the lower stomach area to remove prostate tissue. It is associated with a higher risk of needing donated blood due to bleeding.
PAE is a minimally invasive procedure which aims to reduce blood supply to the enlarged prostate, leading to its shrinkage and thereby alleviating associated symptoms. Here’s how it works:
Benign prostatic hyperplasia is the most common prostate problem for men older than age 40. About 50% of men will experience BPH by the age of 60, and up to 80% by the age of 70. This means that a significant portion of the male population is affected by BPH.
There is no direct correlation between BPH and prostate cancer. Individuals with BPH are not inherently more prone to prostate cancer. However, it is essential for everyone, regardless of BPH presence, to undergo routine prostate cancer screenings, including PSA blood tests and DRE, for early detection of any potential cancer.
Prostate cancer develops in the prostate gland and often does not cause symptoms in its early stages. However, as it progresses, it can lead to symptoms such as weak urine flow, pain during ejaculation or urination, and frequent urges to urinate. Additionally, prostate cancer may spread to the bones, lymph nodes, or other parts of the body. Treatment options for prostate cancer include radiation therapy and surgery.
On the other hand, BPH (benign prostatic hyperplasia) shares similar symptoms with prostate cancer but is not cancerous and does not increase the risk of developing cancer. BPH also does not spread to other parts of the body. Treatment options for BPH include medications, surgery, and minimally invasive procedures.
If left untreated, enlarged prostate may cause worsening urinary symptoms and significant discomfort. It can lead to urinary tract infections, urinary incontinence, blood in the urine, and the development of bladder and kidney stones. In severe cases, it may lead to kidney failure and the inability to urinate, requiring the placement of a catheter into the bladder. As the prostate enlarges and symptoms worsen over time, seeking the help of an expert medical practitioner becomes increasingly important.
An enlarged prostate is a natural part of aging for many men and is generally not dangerous by itself. However, the associated symptoms can be bothersome and may affect your quality of life.
Your healthcare provider will review your medical history, ask you questions, and perform a physical examination, including a digital rectal exam to check your prostate. They may also order additional tests to evaluate your symptoms and bladder function, such as a urinalysis, a prostate-specific antigen (PSA) blood test, urodynamic tests, cystoscopy, transrectal ultrasound etc.
BPH is not contagious. It cannot be spread to another person.
According to current research, Prostatic Artery Embolization (PAE) is an effective procedure for prostate enlargement. Around 75 to 85 percent of men treated with PAE see improvement in their symptoms.
PAE is covered by insurance plan. However, the level of coverage may vary based on the specific plan. It would be better to ascertain from our coordinators and the insurance provider if it is covered and about any out-of-pocket fees.
The individuals showing the following symptoms can be a candidate for PAE.
Frequent or urgent need to urinateIncreased frequency of urination at nightDifficulty to start urinationWeak urine stream or a stream that stops and startsDribbling at the end of urinationInability to completely empty the bladderUrinary tract infectionInability to urinatePatients who have a malignant tumor, atherosclerosis, twisted pelvic floor and those with unusual prostatic vessel anatomy cannot undergo PAE procedure. Our medical practitioner will determine if you are a good candidate for the procedure, based on the results of various diagnostic tests, including:
PSA levelsProstate ultrasoundA urodynamic pressure studyA cystoscopy (to examine the lining of the urethra and bladder)Uroflowmetry (to evaluate urine flow)PAE is performed inside arteries. Nothing is inserted into the penis.
The treatment is not painful, so you won't need a general anaesthetic. A local anaesthetic will be applied where the catheter is inserted. You may feel a warm sensation during the injection of the beads, but no pain.
This can vary depending on the severity of the patient's condition. The typical duration of a Prostate Artery Embolization procedure is approximately one hour.
The recovery period for PAE is very brief. You might be able to go back to work within 3-7 days following the treatment.
You will be allowed to go home on the next day of the procedure, provided your condition is deemed appropriate for discharge by our healthcare team.
Compared to open surgery, PAE has a significantly lower risk of causing erectile dysfunction. Studies consistently show that men undergoing PAE can maintain or improve their erections.
PAE is a highly successful procedure, with up to 90-95% of patients enjoying symptom relief. This is backed up by numerous studies that have looked at the efficacy of the treatment.
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