PAE for enlarged prostate—what do I need to know?

Well, in the words of the nurse in recovery, "is going to get worse before it gets better". My Uro's practice does a PAE/Aqua combo procedure so I did both about 5 days apart. The PAE procedure is easy and painless, but the inflammation will quickly make your symptoms much worse. I though I was going to get a catheterization but managed to squeak through. Aquablation 5 days later was actually a relief. They say it takes a month to see improvement with the PAE. My opinion, but I don't think PAE is as effective as aqua or lasts as long for people with larger prostate. It doesn't cause RE, but most will experience a reduction in semen. It is not risk free and not pain free. The aqua will require a catheter for 3-5 days for most. The PAE/combo reduces bleeding and I only needed a catheter for overnight. Pretty pain free compared to PAE in my case. Similarly will take 3-4 weeks before you start to feel normal, but increase in flow is almost instantaneous. There is a 20% chance of RE. I preferred the Aqua, but I had a large median lobe and most less invasive procedures weren't an option for me. Just my thoughts, hope that helped. Doc said the combo should last at least 10-15 years... we'll see.

Is there a reason why you did PAE first? Also why did you select aquablation over Holep?

I chose PAE the first time round because it was non-surgical, no hospital stay, promised mild sedation. Looking back, the results were underwhelming. I had less daytime frequency for about a year, but no improvement overnight.
About 2 years post PAE I was talking to urologists again regarding a more durable surgery. HOLEP seemed to be one of the most durable, since it removes the entire inner of the prostate, but also allows the surgeon to cauterize. I think HOLEP has one of the lowest chances of bleeding, and only an overnight hospital stay, though I now hear some surgeons let you go home same day.
I again had no overnight frequency improvement at first, but am making progress by getting pelvic floor therapy. A PAE doc likely won't support you with pelvic floor PT, but in my opinion a good urologist would and should. The surgery alone is not always enough as I have learned. One also has to develop an attitude to controlling the symptoms, and I am a believer in the PT that teaches you "mind over bladder" pardon the pun!

@southwest why did you select Holep over aquablation?

@scien123
HOLEP as i understand, because it cauterizes, there is less chance of bleeding. between good luck and the surgeon’s skill i had almost no bleeding.
it was a choice of practicality too. these surgeons seem to all do 2 different procedures, i guess to have a fallback. “my” surgeon does HOLEP and REZUM, and he told me my prostate was too big for REZUM. Yes I could have checked into other procedures, but that would have involved new appointments with different doctors,and would have taken months. I did not want to wait that long. HOLEP was one ofbthe shorter hospital stays, little or no pain, less bleeding. It was time for me to finally do something and i chose HOLEP.
My 2 cents 🙂

@scien123 it's a thing my Uro's practice does. PAE followed by Aqua. Estimates a lot of the bleeding risk, speeds recovery, 24 hour catheter following Aqua. There's a study out there in the combo procedure, just Google PAE /AQUABLATION combination.

@vtredwolf
What practice are you using? Experience is important…..

Potomac Urology in Northern Virginia. Been pretty satisfied with their practice.

@plynhky Dr. Ari Isaacson at IR Centers in Raleigh. Off my meds and extremely pleased with the results.