It is a minimally invasive procedure that does not require hospitalization, as it is performed with local anesthesia. Like catheterization, a tiny 2 mm diameter flexible tube (catheter) is inserted into the femoral artery (groin). Under the guidance of an X-ray machine (angiograph), this tube travels to the prostate and a substance made of acrylic resin harmless to the body (like sand grains) is injected into the prostate to reduce blood low. After this, the prostate begins to decrease in size and relieves obstruction of the urethra allowing the passage of urine.
We have presented the results of our studies in several international and national urology and interventional radiology meetings. Recently, our group was recognized as a world reference in this technique and we began to train doctors from several countries who are participating with us in a multicenter international study coordinated by the USP Faculty of Medicine Hospital (Hospital das Clínicas), and supervised by the Food and Drug Administration (FDA). The goal is to replicate our results obtained at USP in different countries. Consequently, the technique has been achieving growing credibility, being established as an alternative treatment for patients with urinary difficulties due to BPH.
In the study initiated in June 2008, eleven patients with acute urinary retention who had to place a catheter due to BPH were treated. These patients were on the waiting list for a procedure called Transurethral Resection of the Prostate (TURP, in which the prostate channel is "scrapped" from the inside). Prior to embolization (PAE) patients were evaluated by the urologist (rectal examination required), and routine preoperative blood tests (including prostate specific antigen (PSA) evaluation, urinalysis, urodynamic study, ultrasonography and magnetic resonance imaging of the prostate were solicited.
Treatment success in the baseline study was 91%, with a reduction of approximately 30% in prostate size. Of the 11 patients treated in the initial study, 10 were able to urinate spontaneously on the days following the procedure, with catheter removal within a mean period of 12 days post embolization. After these positive PAE results in patients using a bladder catheter, we decided to treat patients who had symptoms of BPH, however, still did not use a catheter. The same success rate was observed and up to now, more than 300 patients have been treated. It should be emphasized that the evaluation by the urologist is indispensable for this new procedure.
Of note, it should be clear that PAE was not intended to treat BPH, but rather the symptoms due to BPH. Embolization may provide partial or complete improvement of symptoms of the lower urinary tract (prostatitis) that occur as a result of prostate enlargement by BPH.
The main advantage of PAE is that it is a minimally invasive procedure, which means that the patient can go home on the same day; moreover, it is not performed by the urethra, but rather by a puncture in the groin, with local anesthesia and excellent results. It is indicated to treat prostates of any size. In addition, it does not interfere with the patient's sexual function. Embolization does not preclude the performance of other traditional surgical treatments (TURP, laser, laparoscopy or robotics). As a matter of fact, PAE might facilitate traditional surgeries because it reduces prostate vascularization, reducing the risk of bleeding.
When the gland measures up to 90 grams the traditional surgical treatment is TURP. Open prostatectomy is usually indicated for prostates larger than 90 grams.
It is worth mentioning that BPH is a highly prevalent disease, associated with old age and testosterone (the main male sex hormone). It is estimated that 90% of men will develop the disease at some point in their life. Despite being a benign disease, the symptoms of BPH compromise the patient’s quality of life, and those who live with him. The main urinary symptoms are weak urine stream and difficulty urinating, voiding dysfunction, intermittent urine flow, increased urinary frequency, feeling of incomplete emptying of the bladder, urgency to urinate and, in some cases, urinary incontinence.
For diagnosis, it is up to the urologist to observe a possible increase of the volume of the prostate through rectal exam. In addition, PSA testing should be performed to rule out the presence of prostate cancer. In symptomatic patients, complementary tests such as ultrasound and urofluxometry are necessary, as they help to evaluate the repercussion of prostatic obstruction on the urinary tract (bladder, ureters and kidneys). Patients who are candidates for prostate embolization should also be evaluated by magnetic resonance imaging, since it is much more detailed than ultrasonography.
The Prostate Artery Embolization (PAE) technique was conceived in 2007 at the Harvard University (US), where I and other physicians from that university worked in an experimental study in dogs that aimed to evaluate PAE viability, efficacy and safety in dogs with enlarged prostates. We wanted to know if the animals' prostates would be reduced in size after being obstructed by the embolization technique. The results of the study were very satisfactory and demonstrated efficient prostate reduction, and were presented at the American Congress of Interventional Radiology in Washington DC, March 2008.
In June 2008, when I was already back in the hospital of the Faculty of Medicine of the University of São Paulo (USP), we started the treatment of patients with urinary obstruction (using a bladder catheter) because of Benign Prostatic Hyperplasia (BPH). The study was coordinated by me and the urologist Alberto Azoubel Antunes, demonstrating our team’s world pioneering technique.
Watch an explanatory video.
is very important
of men will develop the disease
Próstata é um órgão importante. Embolização é um tratamento eficaz na home deste site você encontra explicação sobre embolização próstata e tratamento hiperplasia, embolização hiperplasia, embolização tratamento hiperplasia, próstata tratamento hiperplasia, embolização próstata hiperplasia através, reforçando, através cateter a próstata hiperplasia tem cura com embolização da próstata
Click here to watch a video made in partnership with John Hopkins Hospital, Maryland, USA, which explains how embolization works.
* Prof. Dr. Francisco César Carnevale - CRM 69.646
is the Director of the Interventional Vascular Radiology Department of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo.