Prostate Artery Embolisation in Cyprus
Prostate Artery Embolisation (PAE) is a procedure in which Dr Zertalis uses ultrasound and X-rays (fluoroscopy) to navigate a fine tube (catheter) into the blood vessels supplying the prostate and inject fluid containing very small spheres (embolic particles) in order to block the small arteries and starve the prostate of its blood supply.
This makes the prostate decrease in size, reducing pressure on the urinary bladder and urethra and subsequently provide symptomatic relief.
PAE can also be used for controlling bleeding from the prostate gland.
Benefits
The urine from a normal kidney drains through a narrow tube (the ureter) into the bladder. The prostate gland is located under the urinary bladder and wraps around the water pipe (urethra).
Benign prostatic hyperplasia (BPH) is a very common disease and cause of enlargement of the prostate gland. The enlarged prostate compresses the urethra and disrupts normal flow of urine and emptying of the urinary bladder. This can lead to various symptoms including:
- Frequency (passing urine every 2 hours)
- Urgency (difficulty postponing urination)
- Nocturia (waking up at night to pass urine)
- Intermittent stream
- Weak stream
- Straining
- Incomplete emptying
PAE aims to reduce symptoms and improve quality of life. Symptoms usually resolve rapidly after treatment, the prostate gland is preserved, and medications and surgery can be avoided. Urinary continence, erectile and sexual function are not impaired by PAE, and the treatment itself has a very low complication rate.
Risks
Prostate Artery Embolisation is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: Some patients experience pelvic pain after the procedure, often described as a dull ache. This can vary from mild to moderate and can be managed with painkillers (analgesia).
Bleeding: Risk of bleeding that is significant is rare. Uncommonly you may get a small bruise at the needle entry point in the groin. Bleeding in the urine, sperm or faeces is uncommon and usually settles without further treatment.
Infection: This is uncommon complication. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Post-Embolisation Syndrome: This is a common inflammatory response of the body to the procedure of embolisation and starving the prostate of its blood supply. It can present as general weakness (fatigue), muscle ache (myalgia), and low-grade fever. This responds well to pain killers such as paracetamol and anti-inflammatories (ibuprofen).
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can still decide not to go ahead with procedure if you choose to do so.
Before the procedure
The procedure is performed under local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Where necessary a blood test may be required. A short and thin plastic tube (cannula) will be placed into a vein in your arm. A catheter will be placed through your penis into your bladder.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg (usually the right groin) will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic in your groin and place a fine plastic tube (vascular sheath) into the artery (common femoral artery).
Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) through the sheath into the arteries, which supply the prostate. X-ray dye (contrast) will be injected through the catheter to define the anatomy of your prostate. You may experience a warm feeling in the pelvis – this is normal. The arteries supplying the prostate are blocked by injecting small spheres suspended in liquid (particles). At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin for 10-15 minutes to prevent bleeding.
Every patient is different, however, expect to be in the radiology department for 1-2 hours.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for 24 hours. The catheter in the bladder will be removed on the day after the PAE at the latest, but possibly even on the day of the procedure.
You will be advised to rest at home for 48 hours. If you experience pain, weakness and mild fever this can be well controlled with pain killers and anti-inflammatory medication. Antibiotics will be prescribed for 5 days after the procedure. Please discuss return to work and exercise with Dr Zertalis as this varies between patients.
Dr Zertalis will organise a follow-up appointment 3-6 months after the procedure.
