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This page tells you about the procedure known as Prostate Artery Embolisation. It explains what is involved and what the possible risks are. It is not meant to be a substitute for informed discussion between you and your doctor but can act as a starting point for such a discussion.
Your procedure will take place in the Radiology department. The radiology department may also be called the ‘X-ray’ or ‘Imaging’ department. It is the facility in the hospital where radiological examinations are carried out, using a range of x-ray equipment, such as a CT (computed tomography) scanner, an ultrasound machine and an MRI (magnetic resonance imaging) scanner.
Interventional Radiologists are doctors specially trained to carry out imaging guided complex procedures. They are supported by radiographers who are highly trained to carry out x-rays and other imaging procedures and specialist nurses who are highly trained in interventional procedures, sedation, recovery and patient support.
The prostate gland sits at the bottom of the bladder. Enlargement of the prostate is very common in older men and can lead to blockage to the flow of urine. Symptoms of prostate enlargement include needing to pass water more regularly and not being able to empty the bladder in one go.
PAE is a non-surgical way of treating an enlarged and troublesome prostate by blocking off the arteries that feed the gland and making it shrink. It is performed by an interventional radiologist (image guided surgeon), rather than a urologist, and is an alternative to a TURP (transurethral resection of prostate) or other prostate operations including laser surgery.
PAE is now the standard treatment offered to men with large prostates (over 150 ml) as an alternative to laser enucleation (HOLEP).
PAE is a treatment in which the blood supply to the prostate is permanently reduced by injecting small particles via a small tube inserted into an artery in the groin. This results in the prostate shrinking, which will reduce the symptom of urinary blockage.
Prostate artery embolisation is a fairly new procedure and NICE has deemed it safe, but there are some risks and complications that can arise, as with any medical treatment.
There may occasionally be a small bruise, called a haematoma, at the site of needle puncture into the artery and this is quite normal, especially if you are taking blood thinners. This should settle on its own it two to three weeks time. If this becomes a large bruise, with extending redness, and with pulsating mass, please kindly call our IR specialist nurses.
Then there is the risk of infection, you will be given antibiotics in recovery to take home with, and you need to take them for five to seven days after the procedure to prevent infection.
Most patients feel some pain afterwards, ranging from mild to severe. You will be given pain killers to go home with. The pain is a good sign that the prostate is responding from the PAE treatment, and do not feel worried about it. The pain may last up to seven to 14 days, but the pain is subsiding each day.
Depending on the size of the prostate, you might be catheterised on the day of the treatment. This is to prevent another complication from happening which is urinary retention as the prostate becomes inflamed after the PAE treatment.
You can also expect a burning sensation when passing urine, this is also normal response of your prostate from the treatment, you will be given a jelly with anaesthetics to relieve you from the burning sensation. If you feel the burning sensation even without passing urine, please call our specialist nurses as this could be an infection.
Non-target embolisation with damage to the bladder and rectum has been seen very rarely in larger overseas series. These risks appear small and will be discussed at the time of your consent for treatment. Complications directly related to the prostate include pain passing water and blood in the urine for a short while after the procedure. These symptoms normally resolve after a few days.
Post embolization syndrome is a group of symptoms including pain, fever, nausea, vomiting and other symptoms that may arise after your PAE treatment. Please notify your specialist nurses or your GP to check you. You may also proceed to A&E.
You need to watch out the following and inform our specialist nurses:
- If you are unable to pass urine normally and it causes discomfort in your lower abdomen or pelvic region
- Any signs of infection like fever and chills
- Any bleeding coming out from your genital
- Blood in the stool
- Lesions/ unusual discolouration in your genital
- Pulsating, tender, painful and enlarging haematoma/ redness on your groin
In your first clinic appointment, you will see the Urologist and Radiologist. They will discuss the different treatment options available to you and the risks involved.
If you would like to proceed with the PAE treatment, you will be advised to have an MRI of the prostate, CT scan, and ultrasound if you don’t have yet to check for suitability, and then you will be seen again in the clinic to discuss the results of the scans with the radiologist conducting the PAE clinic.
You will then have a nurse led pre-assessment during which, any relevant tests will be carried out. As a minimum, this will include blood tests such as PSA, renal profile, coagulation, full blood count, urine test, and ECG.
During this appointment, we will advise you about any medications you are taking, especially blood thinning treatments such as Warfarin. Please bring all your medications or a prescription list with you to this appointment.
You need to be come to the Imaging Department at the time instructed on your appointment letter. You may be asked not to eat for six hours before your appointment time, though you can continue to drink clear fluids up to two hours prior to your appointment. Nil by mouth instructions will be provided to you during the pre-assessment.
On arrival you will be checked into the department by a nurse. The nurse will fill in some paperwork and do some clinical observations-like blood pressure and pulse. The Radiologist will come and explain the procedure and sign off the Consent form with you. This is where you will have the opportunity to talk to the Radiologist doing your procedure and they will be able to address any concerns you may have.
You will be asked to put on a hospital gown. The procedure is usually carried out using the veins in your wrist or groin. If this is the case, you will be informed. The skin in the groin area may have to be shaved.
This procedure is commonly performed under local anaesthetic, however if you are expecting sedation, it is necessary that you have an escort to take you home and stay with you overnight. This is the policy for sedation, so please inform your CNS if you are expecting sedation and so you can make the necessary arrangements.
If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), then you must also tell your doctor about this.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with procedure, by law we must ask for your consent and will ask you to sign a Consent form. This confirms that you agree to have the procedure and understand what it involves.
The consent form is a form that both you and the operating doctor sign confirming that you have discussed the procedure and been informed of the risks/benefits/alternatives and have agreed to carry on with the interventional procedure. (You can have a copy of this form to take with you.)
Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will lie on the X-ray table, generally flat on your back. You need to have a needle put into a vein in your arm, so that you can have a sedative and painkillers if required. You may also have a monitoring device attached to your chest and finger and may be given oxygen through small tubes in your nose. The interventional radiologist will keep everything sterile and will wear a theatre gown and operating gloves. The skin near the point of insertion, groin or wrist, will be swabbed with antiseptic and covered with a theatre drape.
The skin and deeper tissues over the artery in the groin or wrist will be anaesthetised with local anaesthetic, and then a needle will be inserted into this artery. Once the interventional radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into this artery. Then the needle is withdrawn allowing a fine, plastic tube, called a catheter, to be placed over the wire and into this artery.
The interventional radiologist will use the X-ray equipment to make sure that the catheter and the wire are then moved into the correct position, into the other arteries which are feeding the prostate. These arteries are quite small and rather variable. A special X-ray dye, called contrast medium, is injected down the catheter into these prostate arteries, and this may give you a hot feeling in the pelvis. The interventional radiologist may then perform a CT scan like technique where the Xray tube rotates around the table and the images are then processed by a powerful computer to make sure no abnormal arterial connections are present.
Once the prostate blood supply has been identified, fluid containing thousands of tiny particles (microbeads) is injected through the catheter into these small arteries which nourish the prostate. This silts up these small blood vessels and blocks them so that the prostate is starved of its blood supply.
Both the right and the left prostatic arteries need to be blocked in this way. It can often all be done from a single artery puncture but occasionally two are required. At the end of the procedure, the catheter is withdrawn, and pressure is applied to prevent any bleeding.
Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, standing nearby looking after you. If the procedure does become uncomfortable, they will be able to arrange for you to have a painkiller through the needle in your arm. We will also use x-ray dye, and as the dye, or contrast medium, passes around your body, you may get a warm feeling, which some people can find a little unpleasant.
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about two to three hours.
You will be taken to the recovery area on a trolley. A recovery nurse will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. They will also look at the skin entry point to make sure there is no bleeding from it.
You will be recovered in one of our recovery bays for two hours if it is a puncture on your left wrist. You will be recovered for around four to six hours if it is a puncture on your right groin. You will be provided with food and drinks in recovery, provided that you are fully awake from sedation if you were sedated.
Recovery nurses will need to make sure you pass urine before going home (if you are not catheterised), to make sure there will be no urine retention as they send you home. You will be allowed to go home after this but will need someone to escort you. The nurses will let you know when they are happy for you to be discharged from recovery.
You will need to take it easy for the rest of the day, but you can resume normal activities the next day.
The Radiologist will talk to you after the procedure and will write a detailed report on the findings straight afterwards. The written report will also be available to your urologist.
If you have an indwelling bladder catheter, you will be seen in a special clinic in two to four weeks after the PAE treatment, where we will remove the catheter and test your bladder function.
All patients are followed up by a telephone call one day, one week and one month following the treatment. You will be booked for an MRI and Ultrasound within three months and then again in the PAE clinic three months after the treatment.
Some of your questions should have been answered by this page but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact:
British Society of Interventional Radiology
Website: www.
For general information about radiology departments, visit The Royal College of Radiologists
Website: www.
NHS Direct
For health advice or information, you can call NHS Direct on 0845 45647 or visit the website: www.
The NHS Clinical Knowledge Summaries
Website: www.
UCL Hospitals cannot accept responsibility for information provided by other organisations.
Please contact the Clinical Nurse Specialist (CNS)
Direct line: Interventional radiology CNS: 0797 487 5629
UCH Switchboard: 020 3456 7890
Address:
Interventional Radiology Imaging Department
University College Hospital
2nd Floor
235 Euston Road
London
NW1 2BU
Admin Queries Email: uclh.
Radiology Admin enquiries phoneline: 020 3447 3267
Website: www.
Procedures
The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map on page 18).
Travelling to the hospital
No car parking is available at the hospital. Street parking is limited and restricted to a maximum of two hours.
Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.
Tube
The nearest tube stations, which are within two minutes’ walk are:
- Warren Street (Northern and Victoria lines)
- Euston Square (Hammersmith & City, Circle and Metropolitan lines)
Overground trains
Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.
Bus
Further travel information can be obtained from http://
Hospital transport service
If you need (and are eligible for) transport, please call:
0202 3456 7010 (Mon to Fri 8am - 8pm) to speak to a member of the Transport Assessment Booking Team.
If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please call 020 7380 9757 to cancel your transport.
University College Hospital Area Map
Page last updated: 12 June 2024
Review due: 01 May 2026