Having PAE next week, what can I expect the next day?

@plynhky I found him on youtube being interviewed..he has called me personally and we have done a telehealth appointment to review all my tests. I feel he has experience and they really don't have any experienced specialized radiologists in my area (Orlando) that I know of.

I used Dr. Bodmer, out of Anne Arundel Urology in Annapolis, MD. Very competent and highly recommended by my urologist. He was the first to explain how experience is very important. He's done over 2,000 of these procedures and it appears that's all he does. He was training an observer during my procedure.......

All the Dr.'s say regarding sex is to expect some blood in the semen for up to a month. Most say wait at least a week for sex, if not longer.

The coffee, tea and juices are just common sense as the procedure can impact the bladder too. Soda is just as bad too. All these irritate the prostate and bladder, so it just makes sense to take a break and only drink pH neutral fluids during recovery, water being best......tbh, I've never drank so much water in my life as this past week.

Every day you'll improve, you'll see.......let's hope it's all worth it!

@sshz At least I have great tasting well water to drink. It is probably the most common drink in our house. If I think I’m hungry I’ll have a glass of water first. Even the food I’m eating is closer to pH neutral. No need to have an antacid tablet in a week.

General comment; were any of you who had PAE already wearing a catheter? I am using one and my doctor will do the procedure and then remove the catheter about a week later.

@slopez2026 I was not wearing a catheter. I wish you the best of luck with the procedure.

I considered PAE 2 years ago but ended up deciding against it. In hind sight, I made the right choice.

PAE works by eliminating the blood supply, the gland shrinks (atropy) over several weeks and decompresses the urethra.
During the procedure, millions of microscopic beads (embolic agents) are injected into these blood vessels, permanently cutting off the nutrient and blood supply to the hyperplastic prostate tissue.

Tissue removed : ~25% to 40% reduction via volume atrophy; 10 year durability as prosate revascularises and regrows.

Tissue removed (eg Holep): ~50% to 80%+ of the central tissue is cleared; a permanent life-long fix.

Because BPH is a progressive, hormonally driven condition, any tissue left behind will continue to grow over time. As PAE only shrinks the tissue rather than remove it, the prostate will sprout new blood vessels (revascularise) and cause symptoms to return years "in a few years time" necessiting another prostate reduction procedure.

UPSIDE: unlikely retrograde ejaculation as bladder neck muscle is spared which means there is tissue left behind to keep growing.

DOWNSIDE: Expect blockages in week one. Pack a small bag you can take with you to ER in case of emergency.

@heath2026 It seems that leaving 20 to 50 percent of prostate tissue behind with HoLEP would allow regrowth to happen within ten years.
For me the main upside of PAE is not having to deal with incontinence during the healing time. I was not ready for leakage for up to a year. Also it buys me time to consider HoLEP or Aquablation.
I’m on day six and have had no blockages. Knock on wood.
RE was not a consideration for me. I’ve been on tamsulosin for so long that it has already been happening for quite a few years.
I’m guessing that you had a very good experience with HoLEP. I am glad you did. I was not positive I would get the same.

Had Greenlight in 2012. That was a very easy procedure as catheter removed same day, and I left hospital that afternoon. It is the 4 week recovery of Greenlight that needs monitoring. Why? Because Greenlight burns off prostate tissues, and leave them in the bladder, requiring the body to eventually reject them over the next 4 weeks. Those these dead tissues gets flushed out bit by beat. Sometimes when the tissues are too big, they momentarily block your urinary bladder giving you a BIG FRIGHT, but the jelly like waste is soon sucked out by gravity!

When Greenlight treated BPH regrows as it 100% will, you get a "monster cave" as the regrown prostate tissue is different (Fibrous and bleeds easily). Greenlight, TURP and many others do not leave a smooth clean hollow cut of of the prostate capsule, like Holep. These methods merely create a jaggeed tunnel; when these jagged surfaces regrow over the years, you can imagine what it is like.

Holep is like hollowing out the orange, leaving the peel. I have felt totally NO PAIN since awakening from the anasthetic - just the sharp stinging of voiding that turns to dull and then disappearing by a week. Holep wasn't as advanced in 2012; greenlight was then, but in 2026, it really is outdated and primitive. The tissue hollowed out of the entire prostate capsule is sent to a lab to check for cancer etc (normal procedure) The lasered tissue in greenlight is left in the bladder to decompose and be ejected by the body through urination.

HOLEP should totally replace the old gold standard TURP (which really sounds barbaric!). But in reality the machinery for Holep is very costly and many hospitals don't want to invest in it for now. Also the TURP surgeons don't want to learn HOLEP which is much more complicated to learn. Hence the current roadblock to wider embrace of Holep. Incontinence is generally for a few weeks, not the whole year. Whether one recovers well from incontinence depends on the patient's history - have they been stuck on catheter for a long time prior to the procedure. Also long term use of BPH medication can weaken the bladder cause longer incontinece post procedure.