What Are MIIPs? / Large Prostate


What is a prostate? 

The prostate is a gland found only in men. The prostate surrounds the neck of the bladder, which holds urine. It is usually the size of a walnut, but the prostate often grows larger later in life. Many older men experience symptoms of an enlarged prostate. This condition is called benign prostatic hyperplasia, or BPH. 



What are the symptoms of an enlarged prostate?

An enlarged prostate can make it hard to pass urine, or urinate. This is because an enlarged prostate can partially block the flow of urine out of the bladder. Symptoms of an enlarged prostate are the following:

  • Needing to urinate frequently

  • Difficulty urinating, such as having a slow stream or having to strain to urinate

  • Not being able to control urination, having accidents

These symptoms usually start slowly and gradually get worse over years. In severe cases, an enlarged prostate can make it impossible to urinate normally, which can hurt the kidneys. It is important to talk to your doctor if you think you have problems due to an enlarged prostate. 



    What are the treatments for an enlarged prostate?

    There are several ways to treat the symptoms of an enlarged prostate, including the following:

    • Medicines taken by mouth to make it easier to urinate, prescribed by your doctor

    • Surgery to remove part of the prostate, performed by a surgeon called a Urologist

    • Procedure called a prostate artery embolization (PAE) to shrink the prostate, performed by a specialist called an Interventional Radiologist (IR) 



    What is PAE?

    PAE is a minimally invasive, image-guided procedure (MIIP) to shrink an enlarged prostate to make it easier to pass urine. It works by using special materials to block some of the blood vessels to the prostate. This causes less blood to flow the prostate so that it shrinks over time. The shrunken prostate does not block the flow of urine as much.

    For most patients, the prostate will shrink by approximately 20-40% over the 6 months following PAE. 



    What can I expect during a PAE?

    1. You will change into a gown and a nurse will put an IV in your arm so you can get medicines.

    2. You will lie flat on your back on a table in the procedure room equipped with moving x-rays.

    3. The nurse may or may not put a small tube through the penis into the bladder.

    4. The nurse will give you medicine through the vein to make you relaxed, comfortable, and drowsy. You

      will be able to breathe on your own and speak.

    5. The skin of your groin or arm will be cleaned and drapes will be placed over your body.

    6. After numbing the skin, the IR physician will put a thin plastic tube through a pinhole in the skin and into a blood vessel.

    7. The IR then uses moving x-rays to guide the small tube into the blood vessels that supply blood to the prostate.

    8. The IR then injects tiny particles through the tube to block off the blood supply to the prostate.

    9. The IR will remove the tube and will put a small bandage on your skin.

    10. The procedure usually takes 1-4 hours. Your doctor will likely let you go home later on that day or the next day. 



    What are the benefits of PAE versus the other treatments?

    Typically, patients suffering from symptoms due to an enlarged prostate are first treated with medicines. If medicines cannot control the symptoms well enough, other options are surgery or PAE.

    Surgery to remove part of the prostate (called a TURP) or all of the prostate (called a prostatectomy) can have side effects, including the following:

    • Impotence (also called erectile dysfunction, or difficulty maintaining an erection)

    • Problems with ejaculation

    • Urinary incontinence (accidents)

    PAE is a newer nonsurgical procedure that avoids these side effects. There are clinical trials evaluating this technique in the United States. It is available at select medical centers.

    Up to 80% of men report improvement of symptoms after PAE. They usually notice improvement starting 1-2 months after the procedure. 



      What are the risks of PAE?

      PAE is considered to be a low-risk procedure. Risks are rare but include:

      • Infection
      • Bleeding
      • Damage to surrounding tissues - if the special material goes to areas outside of the prostate, like the bladder or the intestines, it can damage those tissues reversibly or irreversibly 



      For more information about PAE:



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