Prostate Artery Embolization (PAE)

Best suited for

• Men with moderate-to-severe BPH symptoms (IPSS ≥ 13) who want to avoid TURP, laser surgery, or Rezum.
• Patients with very large prostates (>80g, often >150g) where traditional surgery carries higher risk.
• Men prioritizing preservation of sexual function and antegrade ejaculation.
• Men on blood thinners or with cardiac comorbidities who are poor candidates for general anesthesia.
• Patients in urinary retention with an indwelling catheter who want to regain spontaneous voiding.

How it works

1. 1Tiny puncture in the radial artery (wrist) or femoral artery (groin) under local anesthesia and light sedation.
2. 2A microcatheter is navigated through the aorta and internal iliac arteries into the prostatic arteries using live fluoroscopy and CBCT mapping.
3. 3Microscopic embolic particles (300 to 500 µm) are released to selectively block blood flow to the enlarged prostate tissue.
4. 4Both prostatic arteries (left and right) are typically treated in the same session.
5. 5Symptoms improve over 4 to 12 weeks as the gland infarcts and shrinks (typically 20 to 40% volume reduction).

Prostate artery embolization, step by step

Wrist access, then catheter navigation to the prostatic arteries, then microsphere embolization. The gland shrinks over the following weeks.

1. 1. Radial artery access

   Local anesthesia is given at the wrist and a 2 mm catheter is introduced into the radial artery. There is no groin puncture, no surgical incision, and no general anesthesia.

2. 2. Navigation to the prostatic arteries

   Under live X-ray guidance, a microcatheter is steered down through the aorta and into the small branches of the internal iliac arteries that feed the enlarged prostate.

3. 3. Particle embolization

   Calibrated microspheres are injected to selectively block blood flow to the prostate's enlarged tissue. Surrounding nerves, the urinary sphincter, and the ejaculatory mechanism are not disturbed.

4. 4. Prostate shrinks and flow improves

   Deprived of its blood supply, the prostate shrinks 20–40% over the following weeks. The urinary channel opens, urinary flow improves, and most men reduce or stop their BPH medications.

Benefits

• No risk of retrograde ejaculation, unlike TURP, Rezum, or UroLift.
• Preserved erectile and sexual function.
• No urethral catheter required for most patients after the procedure.
• Effective even for very large prostates (>80g) where other options are limited.
• Performed under local anesthesia with sedation. No general anesthesia required.
• Same-day discharge. Back to desk work within 2 to 3 days.

Possible risks

• Post-embolization syndrome (low-grade fever, pelvic discomfort, mild nausea) lasting 2 to 5 days, managed with NSAIDs.
• Mild bruising at the wrist or groin access site.
• Rare bladder or rectal wall irritation.
• Non-target embolization is uncommon with experienced operators (<1%).
• Approximately 10 to 15% of men may need a second PAE or alternative procedure over time.

PAE vs. other BPH procedures

Preparing for your procedure

• Recent prostate MRI and uroflow on file. PSA reviewed to rule out cancer.
• Hold blood thinners as directed (usually 3 to 5 days before; some can continue).
• Light meal in the morning. Clear liquids only after.
• Arrange a ride home. No driving for 24 hours.