Prostatism (symptomatic enlarged prostate due to Benign Prostatic Hyperplasia, BPH)
In men, the prostate gland sits at the base of the bladder. It acts to deal with the flow of both urine and semen through the urethra, the tube which leads from the bladder. It is natural as men get older that the prostate gland begins to enlarge. This can be of no consequence, but the increase in size of the prostate gland can lead to symptoms, in particular difficulty in passing urine. When the flow of urine is affected by prostatism, it can lead not only to difficulty in initiating urination, but also passing only small volumes, needing to go frequently, dribbling when passing urine and, in the longer term, large residual volumes of urine in the bladder since the bladder can begin to become weaker and dilate. This latter problem can then lead to recurrent urinary infections and other issues.
Prostatism is very common in middle aged or older men and can markedly affect quality of life. As a result, many men seek treatment. Your GP/Urologist will have made the diagnosis of benign prostatic hyperplasia with various tests and if you are particularly symptomatic, the first stage of treatment usually involves drug therapy. However, this is inadequate in some men. Traditional surgical treatment would then be a TURP operation. TURP (trans-uretheral resection of the prostate) remains the established treatment against which all others are judged but has a number of potential complications/side-effects including retrograde ejaculation and erectile dysfunction.
This has lead many men to seek other options in their care including the new procedure of prostate artery embolisation (PAE). This procedure is analogous to uterine artery embolisation (UAE) in women and is an alternative non-surgical, day-case treatment for an enlarged prostate with reduced hospital stay and improved recovery time compared with the surgical treatments available (TURP, HoLEP, enucleation etc.).
PAE is a very new treatment which is gaining wide recognition both in the UK and around the world as a viable alternative to traditional surgery. Several completed and ongoing research trials have shown outcomes from PAE which are superior to drug treatment and often as good as surgery whilst the complication rate is lower than surgery. Research studies are not yet long lasting enough to say with confidence whether the outcomes from PAE are as durable as surgery but the signs to date are positive.
Dr Harding and his team took part in the widely respected UKRoPE study (UK Register of Prostate Embolisation) of PAE alongside TURP and were one of the top 5 centres contributing to this study. The findings were very similar to other studies around the world. Whilst PAE is not yet routinely available around the UK on the NHS, Dr Harding’s team at UHCW have been at the forefront of promoting the procedure and research around it. We have been offering it to both our NHS and private patients for 4 years with excellent results, in line with all the other top centres in the UK.
If you are interested in seeing whether PAE is suitable in your case, we can recommend local Urology Consultant colleagues with whom we work closely in our PAE programme to see you to ensure it is the right treatment for you.
The PAE procedure is done in an Interventional Radiology suite under local rather than general anaesthesia thus improving recovery times. It is a highly technical imaging based minimally invasive ‘pin-hole’ procedure requiring input from 2 Specialist Consultant Interventional Radiologists working together to ensure the highest standards. It takes around 3 hours but usually you can normally go home on the same day. It is normally pain free and you are transferred to the recovery ward afterwards. You usually need a few days’ antibiotics to ensure no infection in the prostate gland or urine. If the prostate gets inflamed, simple painkillers can be used to deal with the symptoms.
It is known from various studies that around 80% of men suitable for PAE will gain symptomatic improvement after PAE with reduction in volume in the prostate gland and improvement in urinary flow rates. We would expect to measure your symptom scores and quality of life measures with questionnaires regularly before and after PAE treatment to continue the research into the procedure. The technical complexities of treating such small arteries in the prostate means there is a technical failure rate of around 10%. In such cases, traditional surgery remains possible; as a result, many men prefer to try PAE first knowing that surgery remains a viable fall-back option.
With an appropriate referral from your GP or Urologist, Dr Harding can see you to discuss your situation, arrange further imaging tests (usually both MRI and CT are required) and refer you to sub specialist Urology colleagues for any further tests needed and a second opinion before deciding how best to proceed.
At the time of writing, the UKRoPE study results have only recently been published in an international journal (see below). On the basis of both these results, and a number of other world-wide studies of PAE, in the UK NICE have now issued clear clinical guidelines as to the place of PAE in the management of patients with BPH and recommend it as a safe procedure in patients appropriate for the treatment.
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