Prostatic artery embolization in Jordan
علاج تضخم البروستات بالقسطرة (الانصمام عن طريق الجلد)
Prostatic artery embolization (PAE) is an interventional radiology procedure that treats the symptoms of benign prostatic enlargement by reducing the blood supply to the gland, so it gradually shrinks and presses less on the urinary channel. It is performed through a fine catheter introduced from an artery in the upper thigh or the wrist under local anaesthetic, with no surgical incision and no instruments passed along the urethra. PAE is usually discussed with men troubled by lower urinary tract symptoms such as a weak stream, frequent night-time voiding, sudden urgency, intermittent flow and a feeling of incomplete emptying, when medication has not been enough or its side effects were not tolerated, or when other medical conditions or a very large gland make conventional surgery riskier. Some men dependent on an indwelling catheter may also benefit. All of this is decided by clinical examination and joint assessment by a urologist and an interventional radiologist, not from reading about the procedure. The limits of PAE must be stated plainly. It does not remove the prostate and it does not treat prostate cancer, so cancer has to be excluded beforehand by examination, blood tests and imaging or biopsy where indicated. It does not correct a weak bladder muscle, a neurogenic bladder or a urethral stricture, which are separate causes of difficult voiding that will not respond to closing prostatic arteries. Improvement is gradual over weeks to months rather than immediate, the procedure does not guarantee that medication can be stopped, and symptoms may return over time and need further treatment. As for sexual function, embolization is generally considered less likely to affect ejaculation than some operations performed through the urethra, but it is not free of complications. Discuss post-embolization symptoms such as burning on passing urine, urgency and a small amount of blood in the urine or semen for a short period, and the possibility of temporary urinary retention, so that your expectations are realistic before you consent.
Procedure steps
- 1
Urological assessment and exclusion of other causes
You are assessed with a clinical and digital rectal examination, a symptom questionnaire, urinary flow and post-void residual measurement, urine testing, prostate-specific antigen and imaging of the gland, while cancer, urethral stricture and bladder dysfunction are excluded before the procedure is agreed.
- 2
Preparation and arterial access
After the agreed fasting and preparation, the puncture area in the groin or wrist is cleaned, local anaesthetic is given and a thin sheath is placed in the artery. You normally stay awake with monitoring of blood pressure, pulse and oxygen, and light sedation or preventive antibiotics may be given at the doctor's discretion.
- 3
Pelvic angiography and mapping of the prostatic arteries
Contrast is injected and the pelvic arteries are imaged in several projections to map the prostatic arteries precisely, because their anatomy varies between individuals and shares branches with the bladder, rectum and penis. This mapping step is what protects neighbouring tissue from unintended embolization.
- 4
Bilateral embolization with microparticles
A microcatheter is advanced into the artery feeding the gland and calibrated microparticles are released gradually until flow slows, then the same is repeated on the other side, since bilateral treatment is the rule. Imaging is checked continuously to avoid particles reaching unintended vessels.
- 5
Haemostasis, monitoring and follow-up
The equipment is withdrawn, the puncture site is closed by compression or a closure device, and you are observed for several hours with attention to your ability to pass urine. The result is measured at follow-up visits after weeks and months using symptom scores, flow measurement and gland volume, not on the first day.
Before the procedure
Tell your doctor about every medicine and supplement you take, particularly blood thinners, antiplatelet drugs and diabetes medication, and do not stop anything on your own but ask how it should be adjusted. Report any previous reaction to contrast and any kidney disease; blood tests for kidney function and clotting plus a urine test are usually arranged, since an active urinary infection postpones the procedure. Bring your prostate-specific antigen result, imaging and biopsy reports if you have them, and your symptom questionnaire. Fasting is usually six to eight hours, with sips of water and approved tablets allowed. Only shave the puncture area if you are asked to, wear comfortable clothes, and arrange for someone to drive you home, because driving on the same day is not advised.
After the procedure
If the puncture was in the groin, keep the leg straight and rest for a few hours, keep the dressing clean and dry for the first day, and avoid heavy lifting, strenuous effort and baths for about three to seven days. Drink enough fluids. Burning on passing urine, urgency, frequency, a small amount of blood in the urine or semen, and pelvic or low back discomfort for a few days are expected as post-embolization symptoms and are managed with the painkillers prescribed. Improvement in flow appears gradually over weeks to months. **Go to the emergency department immediately if you cannot pass urine at all with lower abdominal swelling and pain, develop a high fever with shivering, pass heavy bleeding or clots that block voiding, have severe pelvic or rectal pain, notice coldness, pallor or numbness of the leg or hand on the puncture side, or see a rapidly expanding swelling at the puncture site.**
Expected duration
The procedure usually takes one to three hours, and most patients go home the same day or after a single night of observation.
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