Several treatment options are available when men are diagnosed with an enlarged prostate (benign prostate hyperplasia, or BPH). The most common surgical procedure for this non-cancerous prostate gland enlargement is transurethral resection of the prostate or TURP. But some men will not need to go under the knife. They can find symptom relief with a relatively new minimally invasive option called prostate artery embolization (PAE).
Instead of surgically cutting the prostate, this treatment involves introducing vascular catheters through tiny incisions to deliver particles into the prostate gland’s blood vessels. These inhibit blood flow to the gland and consequently, it shrinks, bringing symptom relief.
In this article, we´re going to compare PAE with TURP and other BPH treatment options.
Prostate Artery Embolization (PAE)
A doctor inserts a catheter into an artery in the patient´s groin and feeds it to the blood vessels that carry blood to the prostate. Once in place, tiny microspheres are injected into the catheter to reach the blood vessels and partially block blood flow to the prostate. Once one side of the gland has been treated, the doctor works on the other side.
The benefits of PAE include the following:
- It´s a non-invasive outpatient procedure. Patients can go home on the same day.
- Recovery time is significantly lower than surgery recovery times.
- Lower risk of urinary incontinence and sexual side effects.
- No retrograde ejaculation.
- Less discomfort and pain during and after the procedure.
- Performed under local anesthetic.
Risks of PAE
Complications are rare but may include:
- A temporary inability to urinate.
- Blockage of vessels outside the prostate.
Transurethral Resection of the Prostate (TURP)
TURP is performed after the patient has been given a general anesthetic. The surgeon then inserts a device called a resectoscope into the urethra. This is a thin metal tube with a camera, light and loop of wire. With the help of the light and the camera, the surgeon guides the resectoscope to the prostate. An electric current heats the wire, which is used to cut away sections of the gland. Finally, the surgeon will insert a catheter to pump fluid into the area to flush loose prostate tissue into the bladder, where it exits the body through urine.
The procedure takes one to two hours, and once completed, you´ll be taken to a ward to recover. The catheter is usually left in for a couple of days until you are able to urinate properly.
Benefits of TURP
TURP usually brings symptom relief quickly. Within a few days of the procedure, many men experience a stronger urine flow.
Risks of TURP
As with any type of surgery, there can be complications. Possible complications following a TURP procedure may include:
- Bladder injury.
- Loss of erections.
- Blood in the urine following surgery.
- Retrograde ejaculation.
- Difficult or painful urination.
- Post-TURP syndrome - a rare condition where too much fluid used to flush prostate tissue is absorbed by the body. This leads to blood volume, electrolyte and fluid imbalances.
Other BPH Procedures
In addition to PAE and TURP, several other procedures are available such as:
Transurethral incision of the prostate (TUIP) - a few cuts are made to the prostate to relieve pressure on the urethra, making it easier to urinate. No prostate tissue is removed. This procedure is often offered to men with smaller prostates. Compared to TURP, there is less risk of retrograde ejaculation. One potential downside is that some men may need a repeat procedure.
Laser prostatectomy - this procedure is similar to TURP except that a laser is used to vaporize prostate tissue instead of cutting it away. Because there is no surgical cutting, there are fewer side effects than TURP and a lower risk of complications.
Prostatic urethral lifts - for minor cases of BPH, prostatic devices can be inserted that help lift the gland away from the urethra, easing pressure and relieving symptoms. This minimally invasive procedure doesn´t affect sexual function and can be performed using local or general anesthesia. Patients return home the same day.
Transurethral needle ablation (TUNA) - a minimally invasive treatment that delivers radio waves through a special catheter incorporating needles. These heat and destroy localized parts of the prostate.
Transurethral microwave therapy (TUMT) - an outpatient procedure where a small microwave antenna is inserted through the tip of the penis into the urethra. Microwave heat destroys the prostate tissue blocking the flow of urine.
Open prostatectomy (open surgery) - this procedure is typically performed when the prostate is greatly enlarged. A surgeon cuts into the lower abdomen to reach and remove enlarged parts of the prostate.
Laparoscopic and Robotic Prostatectomy - an alternative way of performing an open prostatectomy. Surgeons use da Vinci® Surgical System, a sophisticated robot that lets them operate on and remove parts of the prostate with enhanced vision, control and precision. Miniaturized robotic instruments required for this minimally invasive surgery are passed through small keyhole incisions in the patient’s abdomen.
During this operation, the surgeon is usually seated at a computer console, from where they manipulate the instruments. The surgeon´s hands do not enter the patient´s body
MINT Performs PAE
At the Midwest Institute for Non-surgical Therapy (MINT), we specialize in prostate artery embolization. Goke Akinwande, MD, is the first physician in St. Louis to perform this procedure in an outpatient non-hospital setting.
For more information and to schedule a consultation, contact MINT today or book online at one of our 5 clinics, which includes Chicago, IL.
Photo attribution: Image by Prostooleh Freephoto @ Freepik