Prostate artery embolization (PAE) • Varicocele embolization
1. BENIGN PROSTATIC HYPERPLASIA
The prostate gland is a part of the male reproductive system that resides below the urinary bladder. As part of the male aging process, the prostate gland may gradually increase in size due to normal changes in male hormone levels. As the prostate gland increases in size, it may begin to put pressure on the adjacent bladder and urethra (the conduit that brings urine from the bladder to the external environment), causing troubling urinary symptoms. This condition is known as benign prostatic hyperplasia (BPH).
The symptoms caused by BPH are referred to as lower urinary tract syndrome (LUTS). Initial symptoms may include frequent urination, difficulty starting urination, weak urinary stream, or inability to completely empty the bladder. Ultimately, urinary obstruction can become so severe that the bladder loses its ability to push urine out of the body altogether and can even lead to kidney failure. At this stage, often men are treated with a tube (Foley catheter) placed via the urethra into the bladder to relieve the pressure.
Medical and Surgical Treatment
Initially, BPH is treated with lifestyle changes and medications. However, the medications have a known risk of undesirable side effects, particularly in the category of sexual dysfunction (e.g., impotence, decreased semen production, etc.).
The traditional surgical method to treat BPH is by means of a transurethral resection of the prostate (TURP). This surgery is performed by a Urologist, who advances a large tube through the urethra until it reaches the prostate gland and then shaves prostate tissue to relieve the narrowing. This procedure requires general anesthesia and at least 2 days of hospitalization, and invariably a Foley catheter is left in place for several weeks to drain the urine until the postprocedural bleeding stops. This surgery also runs the risk of nerve injury with irreversible sexual impotence. Other variations of this surgery exist, but they have not shown any improvement in long term results or a decrease in complications. Finally, TURP is not typically offered for prostate glands that are larger than 90 grams. If your gland is 90 grams or larger, your urologist may offer a complete resection of the prostate which is a major surgery with even higher risks of complications.
Prostate Artery Embolization (PAE)
Prostate artery embolization is a minimally invasive treatment that helps improve lower urinary tract symptoms caused by BPH. The interventional radiologist will guide a small flexible catheter into the vessels that supply blood to your prostate through a tiny incision made in the groin or wrist. Once the catheter is in the artery supplying the prostate, the interventional radiologist injects tiny particles that block the blood supply to the prostate, depriving the gland of oxygen and nutrients. As a result, the prostate will begin to shrink, improving symptoms usually within days of the procedure.
Patients experience a significant improvement in their quality of life as their urinary symptoms improve. Patients who have been taking medication for their BPH are normally able to stop taking them, and, often, patients with indwelling Foley catheters for urinary decompression can have their catheters removed.
PAE offers much quicker recovery than surgery and lowers the risk of complications. Patients can go home the same day of the procedure and do not require general anesthesia, instead receiving monitored sedation through an IV access. Patients can resume normal activities within a few days. Furthermore, the risk of certain complications, such as sexual dysfunction, is much lower when compared to surgery.
We offer state of the art imaging equipment and the most experience in the Space Coast performing PAE, both factors that are particularly important for a successful procedure.
2. TESTICULAR VARICOCELES
A varicocele is a grouping of abnormally enlarged veins within the scrotum. Normally, drainage of blood from the scrotum and testicles is assisted by valves within the gonadal (testicular) veins. When functioning appropriately, these valves help blood drain in one direction away from the scrotum. However, when these valves do not function appropriately, blood may not drain appropriately and may begin to pool within the veins in the scrotum. The veins become enlarged and may cause testicular pain and tenderness. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. This is thought to happen because the warm blood in the dilated veins increases the temperature in the scrotum, which can reduce sperm production. Varicoceles can be treated by a Vascular and Interventional Radiologist by means of a procedure known as varicocele embolization.
A very small skin incision is made at a site in the groin or neck, and a long, thin, hollow plastic tube (catheter) is then maneuvered through the venous system until it reaches the gonadal veins. Tiny coils and sclerosing agent are then injected through the catheter, resulting in permanent blockage (embolization) of the veins. Over time, this prevents pooling of blood and these abnormal veins shrink or disappear. The procedure is nearly painless and done under sedation, avoiding the need for general anesthesia. Patients are able to return home the same day as the procedure and resume normal activities within a few days. When compared to surgical alternatives, varicocele embolization is equally as effective and has a lower risk of complications and a shorter recovery time.