Prostate Artery Embolization for BPH. Anyone have it done?

I too had a large median lobe. If my bladder would get too full i could not ho at all. Seven weeks out from aquablation. And going very well now.

@riccja
I am now 10 days post PAE, and have the following observations:
1. My recovery went very well
2. Frequent urination during the day lasted 3 days and has now subsided
3. Noturnal urination went from 4 times the first few days, to once now
4.I experienced none of the side effects noted in the post procedure instructions. The plug they put in dissolved and now you cannot even tell where it was put in.
5. I took most of the post procedure meds. All of the CIPRO, all of the steroids. I did not need any pain medication. And the phenazoptridine I took for a day or two, and then stopped.
6. I did not experience any flu like symptoms that the post procedure instructions noted I might experience.

What I do have is burning on urination. However I had that after a cystoscopy that was performed 5 months prior to this procedure and never went away. So it would be difficult to attribute that to the PAE, and most likely a result of an abrasion of the urethra when the cystoscopy was performed.

I have had cystocopies in the past with no pain afterwards, but this one the onset was immediate. And so far I cannot convince my urologist to determine the cause of the pain. He merely said to do pelvic exercises. My preference would have been some test of the uretha wall to see if there is an abrasion or a stricture. But, unfortunately I cannot order that myself.

Overall so far, I would say PAE is by far the best option for enlarged prostates. I did quite a bit of research on the subject before deciding, and my urologist said he was a big fan of PAE, with the caveat, that the person doing the procedure needs to do a lot of them every year. He mentioned most Interventional radiologists in Las Vegas do perhaps one or two a year , if that.

So he uses Blue Ocean International, who comes into his surgery center and performs it there.

The only question then that remains is how long it will be effective, and when I can stop taking the meds I took pre procedure . Flomax , Donepezil and Gemtesa.

Good information. Here’s my question: Just so I’m clear, is an enlarged prostate the reason that it is getting difficult (sometimes very difficult) to urinate with a steady stream? Sometimes I have to strain my stomach muscles 6 or 7 times to try to dribble even very small amounts, sometimes not even close to emptying my bladder. Is PAE a procedure that will help?

@leaddogy2k
As with anything the answer is it depends. Have you had an MRI or a ultrasound of the prostate, and if so what is the size of the prostate?
How long ago was the onset of the difficulty in urination?
My suggestion is to see a good urologist, and get one or both of these done. And then one would have more information to decide what the etiology of your symptoms are.

Now I say a good urologist, as with any profession there are plenty of bad ones out there. That is where you have to do some research on urologists in your area.

What PAE does if it is successful, is shrink the size of the prostate by cutting off the blood supply to the prostate. Of all the options out there for managing an enlarged prostate, it seems to be the best. Side effects if done correctly are minimal, as opposed to the other procedures that to me seem very risky surgeries.

My thought is PAE is a no brainer for those that wish to reduce the size of their prostate.

As far as you condition, there are medications that can help you deal with the retention. I had the opposite, as I had urgency during the day and evening. At the worst I was up 5 or 6 times a night, and during the day had to deal with it also. That was where flomax and Gemtesa came in for me. Gemtesa for day time urgency and Flomax for the evening. And it helped dramatically. Gemtesa however is around 550 a month if you purchase it in the US, if you go to Canada, its 300 for 3 months. That is what I did.

But now I am 17 days post PAE, and in hindsight I am convinced I made the correct decision. I am up now 1 time in the evening, and almost no day time urgency. In another week or so I will try to wean myself from the meds i have been taking to see if the PAE can control it without meds.

Of the list of side effects given pre pae, the only one I had was the frequent urination for the first two days. That was it. No other side effects. The procedure took about 2 hours.

The only risk I feel is the exposure to the DYE from a Pre procedure CT Angiogram, and the exposure to the dye during the PAE procedure. But, I had a comprehensive method for dealing with the dye pre and post procedure. And so far it appears it had little to no effect on my kidneys.

@riccja
Thank you so much for the clear and thorough answer.

I have not had an MRI. I am currently taking Tamsulosin but its effect has diminished to almost zero.

I do have a Urologist I have seen twice in the past 2-3 years who has discussed PAE with me, but it was determined at that time that I didn’t need it yet. I’ll make an appointment to revisit that.

Can you expound on the dye exposure implications and how you minimized your risk?

Again, much thanks.

@leaddogy2k
First you want to have blood work to determine your EGFR. But be careful, as EGFR is completely dependent on age and Creatinine levels. I was taking a pre workout supplement and it lowered my EGFR 20 pts! The test Cystatin C measure kidney function with out the rather simple calculation of EGFR. I feel its more reliable as Creatinine can be affected by many different things.

As far as the dye. I took NAC 600 mg twice a day , 2 days before and 2 days after. This is not a method that is accepted everywhere and the studies are mixed. But since it has no downside, I did it. Also after the PAE in recovery you want to have a Saline drip for hydration. That is what most interventional radiologists suggest.

Then make sure you are very well hydrated before and after the procedure. I forget the water intake, but it is readily available.

As far as an interventional radiologist, my urologist gave me very sound advice, He said that he is a big fan of PAE , but most IR only do one or two a year where I live. So he uses a company that specializes in PAE that does 1000s a year. Or have it done at a major medical facility like UCLA.

Let me close this that until you have an MRI, you will be completely in the dark as to the cause of your retention. That should give you some clues as to why, and then you can make an intelligent decision as to what your options are.

@leaddogy2k I would add that i had a similar situation with my urologist, meds only, for about 8 years. Other than the annual PSA test and periodic flow checks that was it. Never did a cystoscopy and every time I asked about procedures he dismissed them as not necessary yet. When he retired and I went to a new practice they immediately did cystoscopy, showed me a large median lobe and the damage being done to my bladder. They basically told me that my Urologist had not provided the proper level of care. I tell you this because I also know that I was complicit in allowing him to kick the can when I knew I needed more help, but I was afraid of the procedures. I ended up having a combination PAE/Aquablation procedure a few months ago. The procedures were both easy with pretty minimal pain and quick recovery due in part to having a PAE a week prior to the Aqua. My recovery was quick and 3 months later I'm a new man. I do experience some additional frequency sometimes which i attribute to waiting to long. I should have had the procedure several years earlier. For me the PAE was worse than the aquablation in some ways, but it alone wasn't a good option due to the large median lobe, not were some other less invasive methods. I hear folks worried about the potential for RE, but I say the discomfort of severe BPH which it sounds like you have or the impact of delaying proper treatment if much worse.

@leaddogy2k

Yes, PAE is working for me. Had it September 18th 2025 and today is December 14th. Urine flow is great. I see my Urologist January 15th and he'll probably take me off of alfuzosin and Dutesteride. Didn't have any issues with the dye.

Thank you all for taking the time to reply. I appreciate you sharing your experience and knowledge. I’m seeing my urologist in early January.