What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is a benign (non-cancerous) condition that develops when the prostate gland enlarges. As the gland grows, it can squeeze the urethra, the tube in the penis connected to the bladder where urine flows through during urination, blocking the flow of urine. The bladder becomes thicker as it works to overcome this obstruction but over time it may weaken and lose the ability to urinate normally. Other symptoms include urinary frequency, urgency, frequent urination at night, dripping after urination, difficulty in starting urination.

Who is at risk for Benign Prostatic Hyperplasia?

• Nearly all men will develop BPH as they age.
• By 60, 50% of men will have some signs of BPH.
• This increases to 90% of men by age 85.

What does the research say about Benign Prostatic Hyperplasia?

• Prostate artery embolization (PAE) is an effective treatment for symptoms of BPH
• PAE has been demonstrated to be as effective as TURP in improving symptoms and quality of life in most studies
• Most studies show a much lower procedural risk with PAE compared to surgical alternative. There is less risk of urinary incontinence after surgical procedures, and reduced rates of retrograde ejaculation.
• Faster recovery rates

Benign Prostatic Hyperplasia (BPH) Symptoms

The symptoms of BPH are known as lower urinary tract symptoms (LUTS)

These symptoms include: 

• • Hesitancy
  • Poor and/or intermittent urine stream
  • Straining to urinate
  • Prolonged urination
  • Feeling of incomplete bladder emptying and dribbling
  • Frequent urination
  • Feeling sudden urgency to urinate
  • Urinating multiple times at night

If you are experiencing signs and symptoms of BPH and are finding it difficult to perform your daily activities and maintain your way of life, contact your primary care physician immediately. 

Prostate Artery Embolization (PAE)

In prostate artery embolization (PAE) an Interventional Radiologist (IR) passes a catheter (small tube) through an artery in the wrist or the groin using specialized x-ray equipment. The catheter is guided into the blood vessels supplying the prostate gland. Once the catheter is appropriately positioned, embolic material (small medical particles) are injected through the catheter and into the blood vessels feeding the prostate, cutting off its major supply of blood. This shrinks the prostate over time. The embolic material remains permanently in the blood vessels in the prostate. Once embolization is complete the catheter is removed. The entire treatment typically lasts 1-2 hours and is an outpatient procedure with fast recovery times.

Is Prostate Artery Embolization (PAE) Right for Me?

You may be a candidate for PAE if:  

• You are experiencing lower urinary tract symptoms of BPH
• You are experiencing side-effects of medications
• You do not want surgery
• You do not want the potential risks of surgery
• You are a poor surgical candidate

Key Advantages

PAE is a safe treatment option and like other minimally invasive procedures has significant advantages over conventional open surgery.

Benefits

• Multiple research studies demonstrating significantly improved urinary symptoms for most patients
• Same day procedure
• No general anesthesia required
• No risk of retrograde ejaculation
• No risk of urethral strictures
• No urinary incontinence frequently observed with surgical procedures
• Near zero risk of blood loss requiring transfusions
• Potential to improve sexual function

Risks

Although PAE complications are rare, any medical procedure carries some degree of risk. Despite the low risk factor, it is important to understand the potential complications associated with PAE. These include:

• Embolization of non-target organs (bowel, bladder, nerves, rectum, penis and buttock muscles)
• Post-embolization syndrome (post-procedure pain, fever, tiredness, and elevated white blood cell count similar to a flu)
• Small amount of blood in urine, semen, or stool for a short duration
• Leakage of blood at the vessel access site

Non-Invasive Treatment Options

• Medication is the most common treatment for mild to moderate symptoms of BPH.
• Alpha blockers
• 5-alpha reductase inhibitors
• Tadalafil

Side-effects of these treatments include sudden drop in blood pressure, abnormal ejaculation, intraoperative floppy iris syndrome (increases risks of cataract surgery), decreased libido, breast tissue development in men and more.

Surgical Treatments

Open prostatectomy

An incision is made in the lower abdomen to reach the prostate and remove the tissue. Patients with larger prostates (>80-100 cc) require open prostatectomy rather than trans-urethral resection of the prostate (TURP). Open prostatectomy is associated with a higher risk of bleeding requiring blood transfusion, erectile dysfunction, retrograde ejaculation, blood clots in the legs or pelvic veins which could occasionally cause clots traveling to the lung vessels and incontinence. Open prostatectomy requires hospitalization following the procedure.

Transurethral resection of the prostate (TURP)

A scope and cutting instrument is inserted into the penis and the inner part of the prostate is cut and removed. This surgery is limited to prostates <80-100 cc in volume. Up to 75% of men undergoing TURP can experience retrograde ejaculation. Other risks include urinary incontinence, erectile dysfunction, and urethral strictures.

Transurethral incision of the prostate (TUIP), Transurethral microwave thermotherapy (TUMT), Transurethral needle ablation (TUNA), Holmium laser enucleation of the prostate (HoLEP)

Similar procedures where a scope is inserted into the penis. The prostate gland is cut or destroyed using microwave, radio waves or laser, depending on the procedures. Risks of these procedures include retrograde ejaculation, urinary incontinence, erectile dysfunction, and urethral strictures.

Varicoceles

What is varicoceles?

• A varicocele is an enlargement of the veins surrounding your testicles in your scrotum. It is caused by faulty valves in veins leading to pooling of blood in the scrotal veins (pampiniform plexus). This can lead to shrinkage of the affected testicle – more commonly on the left – and lead to decreased testosterone levels. Varicoceles are a common cause of male infertility.

Who is at risk?

• 15% of all men develop varicoceles
• Increased weight

What does the research say?

• Repairing varicocele improves testicular function and sperm counts
• Varicocele embolization has similar success rates as surgical treatments

Varicocele embolization has lower complication rates compared to surgery

Symptoms Of Varicoceles

Common symptoms associated with Varicoceles

• None – most men with varicoceles have no symptoms.
• Dull ache in the testicles
• Lump in the testicles
• Swelling of the testicles
• Enlarged veins of the testicles (described as feeling like a “bag of worms”)
• Infertility associated with a low sperm count

Varicocele Embolization Treatment

In varicocele embolization an Interventional Radiologist (IR) passes a catheter (small tube) through a vein in the groin or neck using specialized x-ray equipment. The catheter is guided into the gonadal veins. Once the catheter is appropriately positioned, the veins are blocked off using metallic coils and chemical sclerosing agents. The entire treatment typically lasts less than 1 hour and is an outpatient procedure. Recovery typically takes less than 24 hours.

Is Varicocele Embolization Right for Me?

You may be a candidate if:

• You have pain in your testicle
• You have infertility
• You feel dilated veins in your testicle
• Have low testosterone levels
• Do not want surgery

Key Advantages

Varicocele embolization is a safe treatment option and like other minimally invasive procedures has significant advantages over conventional open surgery.

Benefits

• High treatment success rates
• Same day procedure
• No general anesthesia required
• Lower risk compared to surgery

Potential Risks

Although varicocele embolization complications are rare, any medical procedure carries some degree of risk. Despite the low risk factor, it is important to understand the potential complications associated with varicocele embolization.

These include: 

• Infection
• Occasionally mild pain which lasts less than one week.

Surgical Treatments

Varicocele ligation

This is a surgical procedure where a small incision is made in the scrotum and the veins are tied off. The complication rates with this procedure is low and recovery is less than one week.

Hemorrhoids

What are Hemorrhoids?

• Hemorrhoids are swollen veins in the rectum. They can cause itching, bleeding, and pain during defecation. Hemorrhoids are very common.

Who is at risk?

• Age 50 and older
• Family history
• Increased weight
• Straining during bowel movements
• Pregnant
• Low fiber diet

What does the research say?

• Hemorrhoid embolization is successful in decreasing bleeding
• Hemorrhoid embolization also improves quality of life and prolapse

Common symptoms associated with Hemorrhoids

• None – many people with hemorrhoids have no symptoms.
• Itching of the skin around the anus
• Bright red blood after using the toilet which is often painless
• Pain if a blood clot forms inside a hemorrhoid. In this case, you may also feel a lump
• Swelling of hemorrhoids outside of the rectum (prolapse) during a bowel movement

Hemorrhoid Embolization Treatment

In hemorrhoid embolization an Interventional Radiologist (IR) passes a catheter (small tube) through a vessel in the wrist or groin using specialized x-ray equipment. Once the catheter is appropriately positioned, the hemorrhoidal arteries are blocked off using metallic coils and/or small medical beads. Hemorrhoidal artery embolization is a painless procedure. The procedure typically lasts less than one hour. After the procedure, patients can return home the same day and get back to work the next day.

Is Hemorrhoid Embolization Right for Me?

You may be a candidate if:

• You have pain from hemorrhoids
• You have bleeding from hemorrhoids
• You feel dilated veins in your anus
• Do not want surgery

Key Advantages

Hemorrhoid embolization is a safe treatment option and like other minimally invasive procedures has significant advantages over conventional surgery.

Benefits

• High treatment success rates
• Same day procedure
• No general anesthesia required
• Lower risk than surgery

Potential Risks

• Although hemorrhoid embolization complications are expected to be extremely rare, any medical procedure carries some degree of risk. Despite the low risk factor, it is important to understand the potential complications associated with hemorrhoid embolization. These include: 
  • Infection
  • Bowel injury from non-target embolization

Surgical Treatments

Hemorrhoid ligation