Prostatic artery embolization (PAE) is a minimally invasive treatment that helps improve lower urinary tract symptoms caused by an enlarged prostate, with lower risk of the sexual side effects such as retrograde ejaculation or erectile dysfunction, which can occur from surgery.

PAE is performed by an interventional radiologist (IR), a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions without surgery.

Are You a Candidate?

Prostatic artery embolization (PAE) is a proven minimally invasive procedure for men who are not satisfied with their current medications or treatment or do not wish to undergo or are ineligible for surgery. An interventional radiologist (IR) can determine if you are a candidate for PAE. Physical exams may include a urine test (urinalysis) and a digital rectal exam to help assess the size of your prostate. In some cases, a prostate-specific antigen (PSA) test is done to help rule out prostate cancer. (Prostate cancer and BPH are not related, but they can cause some of the same symptoms.)

Your Interventional Radiologist may ask you how often you have urinary symptoms of BPH, how severe they are, and how much they affect your quality of life.

For more information about PAE, including patient testimonials, link to our Froedtert South success story

Blockage caused by BPH

What is BPH?

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. The likelihood of developing an enlarged prostate increases with age. More than half of all men in their 60s and as many as 90% aged 70-89 years have some symptoms of BPH.

As the prostate gets bigger, it may constrict or partly block the urethra, causing lower urinary tract symptoms (LUTS) such as:

  • Urinary frequency
  • Dribbling at the end of urinating
  • Inability to urinate
  • Incomplete emptying of bladder
  • Incontinence
  • Difficulty starting urination
  • Straining to urinate or weak urine stream

For some patients, these symptoms interfere with sleep, further reducing their quality of life.

Before a PAE Procedure

Depending on your IR’s procedural protocol, a Foley catheter (a thin, hollow tube held in place with a balloon at the end) may be inserted into your urethra and positioned in your bladder to provide a reference point for the surrounding anatomy.

Catheter being inserted through a small incision on the thigh.

During the PAE Procedure

During PAE, you are given a local anesthetic and mild sedation medication, but remain awake.

The PAE procedure begins with a tiny incision in your upper thigh or wrist. The IR uses this incision to insert a catheter into your arteries and guide it near your prostate.

Catheter being inserted through a small incision on the wrist.

Once the catheter is in position, an arteriogram (an X-ray in which dye is injected into the blood vessels) is done to map the blood vessels feeding the prostate.

The catheter is now preventing the blockage from BPH.

Next, tiny round particles each about the size of a grain of sand, are injected through the catheter and into the blood vessels that feed your prostate, reducing its blood supply.

After the PAE Procedure

In most cases relief begins to occur within days as the prostate shrinks, relieving pressure on the urethra and improving symptoms.

PAE Benefits

Both transurethral resection of the prostate (TURP) and open prostatectomy are surgeries that can result in higher rates of retrograde ejaculation (ejaculation into the bladder rather than out through the urethra), impotence, and urinary incontinence. There have been few reports of these side effects caused by PAE.

Possible Risks

The greatest risk comes from non-targeted embolization, the injection of microspheres into arteries not supplying the prostate, potentially causing severe complications. PAE is a challenging procedure that should only be performed by experienced and properly trained interventional radiologists possessing a strong understanding of pelvic vascular anatomy.

Patients may experience “post-PAE syndrome” for days following the procedure, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.

Other risks include hematoma at the incision site, blood in the urine, semen, or stool; bladder spasm; or infection of the puncture site or prostate.

IR image.

Interventional Radiology

Prostate Artery Embolization (PAE) is a procedure related to the discipline of Interventional Radiology, and there are many other services that our excellent Interventional Radiologists at Froedtert Health perform.

Our Doctors

Michael Ginsburg, M.D.
Michael Ginsburg, M.D. Interventional Radiologist