Prostate embolization

What is embolization Treatment?

Embolization is the intentional occlusion of the arteries of a tissue or organ by angiography. The organ does not die and lose its function but it shrinks significantly. Embolization has been successfully used in medicine for many years in stopping arterial bleeding, reducing or killing the cancerous tissue, and in the non-surgical treatment of uterine fibroids and testicular varicoceles. The use of embolization in prostate enlargement is more recent. It was first implemented in 2011 by Portuguese and Brazilian interventional radiologists and achieved successful results. Since then, prostate embolization has been applied in many countries around the world at many centers including ours.

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In prostate embolization, a puncture is made in the groin artery and a tiny catheter is advanced into the feeding vessels of the prostate. Then, by checking on the angiography screen, very small particles are slowly injected into these vessels. Once the arterial flow is stopped, the enlarged prostate starts to shrink and over time becomes smaller. Since the prostate tissue around the urethra also becomes smaller, the periprostatic compression becomes less making urination easier.

 

 

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The prostatic embolization has been used for many years and has become a well-known procedure. Many studies have shown that embolization may improve the symptoms of BPH without causing complications seen in TURP. However, these studies also showed that embolization may be less effective than TURP: In about one third of the patients, there is no improvement in BPH symptoms although embolization is technically successful. Additionally, embolization is suitable only in large prostates over 80 grams or more. In smaller prostates, it is technically more difficult, time-consuming and less effective. Since it requires an angiographic intervention, embolization may also be not suitable if the patient has renal insufficiency or severe atherosclerosis which may be the case in many elderly patients.

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In our center, we have been performing embolization for BPH for more than a decade. Although we have never seen a major complication, a roughly 40% of our patients were not satisfied with their improvement. In our opinion, this relatively weak result is due to the insufficient shrinkage of the periprostatic tissue which causes compression in BPH. In embolization, the shrinkage of this area is dependent on the overall degree of shrinkage of the prostate after embolization. In other treatments such as cryoablation, rezum or TURP, the treatment is targeted directly to the periprostatic tissue making them more effective in this area. 

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In our experience, cryoablation was more effective than embolization in treating BPH. The reason is that embolization affects the periprostatic tissue indirectly by reducing the overall size of the prostate whereas cryoablation hits directly the prostatic tissue as in TURP. Unlike TURP and other urologic interventions however, cryoablation does not harm the urethra, sperm channels and sphincters and thus, there are no side effects like retrograde ejeculation, impotance, incontinence and urethral narrowing. Unlike embolization, TURP and other interventions, cryoablation can be performed in both small and large prostates. For these reasons, our treatment of choice in BPH is transperineal cryoablation at our centers.