Prostatic Artery Embolisation (PAE)
Date issued: November 2024
For review: November 2026
Ref: B-527/LD/Radiology/Prostatic Artery Embolisation (PAE)
PDF: Prostatic Artery Embolisation (PAE).pdf [pdf] 207KB
This leaflet tells you about having a prostatic embolisation. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure. Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t been previously completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is Prostatic Embolisation?
Prostatic Embolization (PAE) is a relatively new way of treating an enlarged prostate by blocking the arteries that feed the gland and making it shrink.
It is a non-surgical procedure as opposed to a TURP
(Trans Urethral Resection of Prostate) operation which is performed in theatre by a surgeon.
Why do you need a Prostatic Embolisation?
You will have had previous tests to show you have an enlarged prostate which is causing you considerable symptoms. Patients with severe symptoms would normally undergo a TURP operation but your urology team have decided that an embolisation is the best treatment for you.
Are there any risks?
PAE is a safe procedure, but as with any medical treatment, there are some risks and complications that can arise.
You may experience a burning sensation and/or pain in the pelvic area.
Other complications involve blood in your urine, rectal bleeding or diarrhoea. Injected particles could reduce the blood supply to the pelvic area if they migrate.
It is common to have some bruising at the puncture site. This may be sore for a few days but will resolve.
Very rarely, significant bleeding or blockage of the artery can occur, which may require a small operation (less than 1 in 1,000). To help with possible infection antibiotics will be given to you 1 week prior to your procedure.
Most patients feel some pain afterwards; this is usually mild.
Post PAE syndrome symptoms include nausea, vomiting, fever, pelvic pain and frequent or painful urination. This usually lasts less than a week and can be treated with anti-inflammatories and antibiotics.
If you are unable to pass urine after the procedure, then a urinary catheter may be placed.
Are you required to make any special preparations?
Prostatic embolisation is usually carried out as a day case procedure under local anaesthetic.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
This is because the procedure may be painful, and you may need sedation.
If it is decided that the procedure will be performed with just local anaesthetic, then you may eat and drink normally.
A urinary catheter may be placed into your bladder by a nurse. You need to have a small needle put into a vein in your arm for a sedative and painkillers to be given.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
In the interventional radiology suite, which is located within the radiology department. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during a prostatic embolisation
The procedure will take place in the X-ray department, and you will lie flat on your back. You may have monitoring devices attached to your chest and finger and may be given oxygen. Your groin will be swabbed with antiseptic, and you will be covered with sterile drapes.
Local anaesthetic will be injected in the skin in your groin and a needle will be inserted into the artery. Sometimes both groins are used. A fine plastic tube called a catheter is placed into the artery.
The radiologist uses X-ray equipment to guide the catheter into the arteries, which are feeding the prostate. A special dye, called a contrast agent, is injected down the catheter into these prostatic arteries, and this may give you a hot feeling in the pelvis. Fluid containing thousands of tiny particles is injected through the catheter into these arteries to block them. Once the Interventional Radiologist is satisfied with the images, the catheter will be removed. Firm pressure will be applied to the skin entry point, for about ten minutes, to prevent any bleeding. Sometimes a special device may be used to close the hole in the artery.
Will it hurt?
When the local anaesthetic is injected, it will sting for a short while, but this soon wears off.
You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
If the procedure becomes painful then some medication can be given through the needle in your arm.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about three hours.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site.
You will stay in bed for at 2-4 hours depending on whether a closure device has been used or the Radiologist pressed on the groin for 10 minutes. You will be kept in hospital overnight and discharged the next day. Once at home, you should rest for 3 or 4 days.
Patients are advised to take at least one week off work following PAE.
Other Risks
Prostatic embolisation is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
website: www.hpa.org.uk
What are the results of embolisation
From the published data of 2 studies, over 70% of men will gain symptomatic improvement after PAE with reduction in prostate volumes and an increase in urinary flow rates. Difficulty in finding difficult or small prostate arteries may lead to technical failures in around 10% of cases. In case of failure traditional TURP surgery may be offered.
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
