Not everyone with BPH needs immediate treatment, but for those with moderate to severe symptoms that interfere with daily life, PAE can be an excellent option. Ideal candidates for PAE include:

• Men over 50 with enlarged prostates (>30 cc in volume)
• Those whose symptoms are not well-controlled by medications
• Men who prefer to avoid traditional surgery or are not surgical candidates
• Individuals without active urinary tract infections or prostate cancer
• Patients with normal or manageable kidney function and no allergy to contrast dye

A detailed evaluation, including physical exams, imaging tests (like MRI or ultrasound), and lab work, helps determine whether PAE is the right fit. An International Prostate Symptom Score (IPSS) higher than 15 is often used to assess the severity of symptoms.

Before the Procedure:

Before the procedure begins, you will typically undergo some evaluation. A complete pre-procedure evaluation may include:

• Digital Rectal Exam (DRE) to assess prostate size and rule out cancer
• Urinalysis to check for infections
• Prostate-Specific Antigen (PSA) Test to screen for prostate cancer
• Imaging tests such as ultrasound or MRI
• IPSS questionnaire to score the severity of symptoms

The PAE procedure is performed in a specialized radiology suite using real-time imaging guidance (like fluoroscopy). Here’s what typically occurs:

• You’ll receive local anesthesia to numb the entry site— either the groin (femoral artery) or wrist (radial artery)—where the catheter will be inserted.
• General anesthesia is not required, meaning you’ll be awake but comfortable during the procedure. Sedation may be given to keep you relaxed.
• A small incision is made at the entry point.
• A tiny catheter is guided into the arteries that supply blood to the prostate using X-ray imaging.
• A contrast dye is injected through the catheter to map the exact location of these vessels.
• Once the prostatic arteries are identified, microscopic beads (embolic particles) are injected through the catheter to block the blood flow to the prostate. This is done on both sides of the gland.
• The catheter is removed, and a small bandage is applied. No stitches are needed.

Because the prostate’s blood supply is now reduced, the gland begins to shrink over the next several weeks, relieving the pressure on the urethra and improving urinary symptoms.

PAE typically takes 1.5 to 2 hours to complete. Since it is minimally invasive, most patients are discharged the same day and can return to normal activities within a few days. Full relief of symptoms may take a few weeks to become noticeable as the prostate gradually shrinks.

Post-Procedure and Recovery:

Most men return to work within 2–5 days. However, following your PAE procedure, it’s important to follow these care guidelines to ensure a smooth and safe recovery:

• You may resume your normal diet immediately after the procedure.
• Drink plenty of fluids over the next 24 to 48 hours, unless your doctor has advised otherwise.
• Staying well-hydrated helps flush the contrast dye used during the procedure from your kidneys.
• Avoid alcoholic beverages for at least 24 hours post-procedure.
• Avoid strenuous activity, such as climbing multiple flights of stairs, for 24 hours.
• Do not lift heavy objects (more than 6–9 kilograms) for 7 days or until the puncture site is fully healed.
• Do not drive for at least 24 hours after the procedure.
• Keep the catheter site clean and dry for 5 days

Wound Care:

• Remove the bandage the day after the procedure.
• Clean the site gently with soap and water, then dry thoroughly.
• Apply a fresh adhesive bandage daily for 3 days.
• Do not use powders, creams, or lotions on the site for at least 5 days.
• Keep the area clean and dry to prevent infection.

Patients may notice continued improvement in urinary symptoms over a period of several weeks. Full benefits, including a 20–40% reduction in prostate size, are typically seen within 3–6 months.

Common Symptoms to Expect:

Some mild symptoms are normal during recovery and should resolve on their own:

• Increased frequency of urination, mild pressure in the lower abdomen, or slight burning when urinating (up to 7–14 days)
• Blood in the urine or semen (7–21 days)
• Mild discomfort, pressure, or urge to have a bowel movement while urinating
• A small amount of blood in the stool (4–7 days)
• Low-grade fever under 101.5°F (38.6°C) for a few days (up to 7 days)
• Bruising or tenderness around the puncture site, which may take up to 2–3 weeks to fully resolve

Contact your healthcare provider immediately if you experience any of the following:

• A fever above 101.5°F (38.6°C)
• Inability to urinate
• Symptoms that do not improve with prescribed medications
• A growing lump or one that pulses at the catheter insertion site
• Signs of infection such as redness, warmth, drainage, or increased pain at the puncture site

As with all medical procedures, PAE carries some risks. Although it is generally very safe, it should only be performed by an experienced interventional radiologist. Compared to surgery, PAE offers a significantly lower risk of urinary incontinence and sexual side effects, such as erectile dysfunction or retrograde ejaculation.

While serious complications are uncommon, some side effects may occur, such as:

• Hematoma (bruising or bleeding) at the catheter insertion site (groin or wrist)
• Blood in the urine, semen, or stool for a short duration
• Bladder spasms or irritation
• Infection at the puncture site or within the prostate (managed effectively with antibiotics)

Rare Complications

• Urinary tract infections (UTIs) occur in approximately 3–5% of patients. These are typically mild and treatable with antibiotics.
• Penile ulceration is a very rare complication affecting fewer than 1 in 200 patients. These ulcers are temporary, typically healing within 2–3 weeks and can be managed with topical treatments and pain relief without causing permanent damage.