Some FAQs are also on the "For Potential Patients" page. There are several more here.
References about PAE in the press and medical literature are here.
What happens during our clinic visit?
You and I will meet at my clinic. This is your chance to get any answers to any questions you may have. And it is my opportunity to decide if PAE is right for you. I do that by listening to you tell me about your symptoms and by reviewing your medical history.
I will perform a physical exam, listening to your heart and lungs and abdomen, and feeling the artery pulses in your legs.
I will not do a prostate exam. We are going to get an CT of your pelvis and/or an MRI of your prostate if you want to proceed with PAE and that will tell me much more about your prostate then I could learn from a physical exam or your prostate.
I will perform a physical exam, listening to your heart and lungs and abdomen, and feeling the artery pulses in your legs.
I will not do a prostate exam. We are going to get an CT of your pelvis and/or an MRI of your prostate if you want to proceed with PAE and that will tell me much more about your prostate then I could learn from a physical exam or your prostate.
Will insurance pay for PAE?
Most plans do.
We will check with your insurance company to make sure they are not going to deny the procedure. We will send them all the records to show that PAE is appropriate for you. And if they want to speak to me I will call them.
If after all of that your insurance company still refuses to cover PAE, Methodist Hospital will speak to you about a cash price for the procedure.
We will check with your insurance company to make sure they are not going to deny the procedure. We will send them all the records to show that PAE is appropriate for you. And if they want to speak to me I will call them.
If after all of that your insurance company still refuses to cover PAE, Methodist Hospital will speak to you about a cash price for the procedure.
Does PAE hurt?
No. But after the procedure you will have mild to moderate pain for a few days, sometimes longer.
During the procedure you will feel a warm sensation during the injections. But no pain.
And you will be quite relaxed as we are giving you medicine to help with anxiety.
If your anatomy allows, I will perform a nerve block (just like what a dentist does to numb your mouth) during your PAE that will decrease any pain coming from your pelvis for the first day or two after your procedure.
Most men with feel a burning sensation in your pelvis for several days. Often Advil is sufficient to take care of this discomfort, but I am there for you if you need stronger medicine. You may also feel an increase in urgency and frequency for the first several days after PAE, but this is self-limited...it will go away on its own.
Most of the time these post-embolization symptoms stop after several days but can continue for a week to 10 days. It is rare to last more that 2 weeks. I recommend you take a week off after PAE to give yourself time to recover.
Some men will have blood in the urine for a time and you could even pass fragments of tissue as the prostate shrinks. This tissue is usually very soft and does not hurt like passing a kidney stone, but can still cause discomfort. You may temporarily see blood in your semen or bowel movement.
An uncommon issue that can happen after PAE is non-target embolization that causes an ulcer on the penis. These ulcers respond well to local wound care but can take a month or two to heal. If you develop an ulcer I will refer you to a wound care specialist who will assist you with the local wound care as you heal.
During the procedure you will feel a warm sensation during the injections. But no pain.
And you will be quite relaxed as we are giving you medicine to help with anxiety.
If your anatomy allows, I will perform a nerve block (just like what a dentist does to numb your mouth) during your PAE that will decrease any pain coming from your pelvis for the first day or two after your procedure.
Most men with feel a burning sensation in your pelvis for several days. Often Advil is sufficient to take care of this discomfort, but I am there for you if you need stronger medicine. You may also feel an increase in urgency and frequency for the first several days after PAE, but this is self-limited...it will go away on its own.
Most of the time these post-embolization symptoms stop after several days but can continue for a week to 10 days. It is rare to last more that 2 weeks. I recommend you take a week off after PAE to give yourself time to recover.
Some men will have blood in the urine for a time and you could even pass fragments of tissue as the prostate shrinks. This tissue is usually very soft and does not hurt like passing a kidney stone, but can still cause discomfort. You may temporarily see blood in your semen or bowel movement.
An uncommon issue that can happen after PAE is non-target embolization that causes an ulcer on the penis. These ulcers respond well to local wound care but can take a month or two to heal. If you develop an ulcer I will refer you to a wound care specialist who will assist you with the local wound care as you heal.
Do you perform PAE through the penis?
No!
PAE is done from inside of your artery. It is similar to a heart catheterization. I place a tiny tube into the femoral artery at the top of your leg, through a tiny nick in the skin. Nothing goes in your penis, unless you need us to place a catheter into your bladder to empty the urine. That can happen to men with severe BPH; we are prepared to help you if it happens to you.
PAE is done from inside of your artery. It is similar to a heart catheterization. I place a tiny tube into the femoral artery at the top of your leg, through a tiny nick in the skin. Nothing goes in your penis, unless you need us to place a catheter into your bladder to empty the urine. That can happen to men with severe BPH; we are prepared to help you if it happens to you.
I've heard this can leave me impotent. Or when I orgasm it squirts back into my bladder instead of out the tip of my penis
Nope, you are confusing PAE with TURP. Those sexual dysfunction issues you are asking about can occur after a TURP; but you have no risk of that happening with PAE. So if you don't want to risk being impotent (unable to get an erection) or retrograde ejaculation, try PAE first.
Will I dribble urine after this procedure? I don't want to wind up incontinent.
PAE does not cause incontinence, though I have had a few patients tell me they did dribble for a short period of time in the first week or two after PAE. I believe this is a combination of the inflammation from the treatment and the changing size of your prostate. It is, however, temporary.
TURP or prostatectomy are much more likely to can cause long term incontinence. If you don't want to be stuck wearing Depends for life, try PAE.
If the muscle of your bladder has been irreversibly damaged by nerve injury, radiation, or chronic over dilation, shrinking your prostate with PAE, reaming out a core with TURP or laser, or even removing your prostate will not help.
TURP or prostatectomy are much more likely to can cause long term incontinence. If you don't want to be stuck wearing Depends for life, try PAE.
If the muscle of your bladder has been irreversibly damaged by nerve injury, radiation, or chronic over dilation, shrinking your prostate with PAE, reaming out a core with TURP or laser, or even removing your prostate will not help.
My prostate is so large my urologist is telling me I have to have a prostatectomy. Could PAE work instead?
Yes!
All of the early patients we studied with PAE were facing prostatectomy as their only other option. Once your prostate is over 90 grams, TURP, laser, Rezum, and all of the other surgical methods to ream it out from inside your penis tend to fail. Urolift will not work when the prostate is that large, either. So the surgical option becomes prostatectomy (though some urologists are reporting success with laser with prostates up to 150g)
Unfortunately, all of the negative things that a TURP can cause, like ED and incontinence, are much more likely with a prostatectomy.
Oh, all of those things except for retrograde ejaculation, because during a prostatectomy the tubes that carry your semen into the penis are removed. You will never again ejaculate, retrograde or otherwise.
These early patients taught us that PAE causes none of those problems. Even when your prostate is over 90 grams.
With PAE, not only will you continue to ejaculate normally, you will remain fertile. Not sterilized and impotent.
And when it comes to PAE, the bigger the prostate, the better! As of 2022 we know of no upper limit in size of the prostate for PAE to work.
All of the early patients we studied with PAE were facing prostatectomy as their only other option. Once your prostate is over 90 grams, TURP, laser, Rezum, and all of the other surgical methods to ream it out from inside your penis tend to fail. Urolift will not work when the prostate is that large, either. So the surgical option becomes prostatectomy (though some urologists are reporting success with laser with prostates up to 150g)
Unfortunately, all of the negative things that a TURP can cause, like ED and incontinence, are much more likely with a prostatectomy.
Oh, all of those things except for retrograde ejaculation, because during a prostatectomy the tubes that carry your semen into the penis are removed. You will never again ejaculate, retrograde or otherwise.
These early patients taught us that PAE causes none of those problems. Even when your prostate is over 90 grams.
With PAE, not only will you continue to ejaculate normally, you will remain fertile. Not sterilized and impotent.
And when it comes to PAE, the bigger the prostate, the better! As of 2022 we know of no upper limit in size of the prostate for PAE to work.
My issue is blood in my urine, not emptying my bladder. Can PAE help with that?
Blood in the urine is called hematuria. It is called "gross hematuria" when the urine is discolored with blood, or frankly bloody.
People may also have a volume of blood in the urine that is so small it does not discolor the urine, this is called "micro hematuria"
There are many disorders that can cause hematuria. If your doctor determines that your cause is your prostate, PAE can work just fine to stop it.
People may also have a volume of blood in the urine that is so small it does not discolor the urine, this is called "micro hematuria"
There are many disorders that can cause hematuria. If your doctor determines that your cause is your prostate, PAE can work just fine to stop it.
What is the chance PAE will work to help me? Now and years from now?
80% of patients will have significant improvement in their symptoms following PAE. Six years after PAE almost all of that original 80% are still enjoying the benefit; so YES it does provide lasting relief of symptoms.
If PAE does not work for you, you can still have TURP or prostatectomy.
If PAE works for you but your symptoms eventually do come back, you can have PAE again.
If PAE does not work for you, you can still have TURP or prostatectomy.
If PAE works for you but your symptoms eventually do come back, you can have PAE again.
I have the symptoms of BPH, can I have PAE right away?
That depends on what you have done to date to try to control the symptoms. There are several excellent medicines available for BPH. These work so well that most men never have to have a procedure or surgery. If you have not tried these yet, I will recommend we give some of them a trial. If they work for you and get you to where you are happy, then no need for PAE. If they dont work or they have bad side effects we will proceed with PAE. If you have already tried them and failed, we may proceed without delay.
How do you evaluate my prostate before and after PAE?
There are two excellent imaging exams for the prostate and the prostate arteries. I may order one or both of them to assess you.
1) Prostate MRI: This will show us if there are any areas in your prostate that are suspicious for cancer. Most of the time there aren't any suspect areas. In which case we now have an excellent baseline picture of your prostate we can use after the procedure to check you progress or to problem solve if PAE doesnt work as well as we expected.
2) Pelvic CT angiography: This is a CT scan done with high resolution to allow me to plot out the blood supply to your prostate. There can be one, two, or more arteries from each side of the pelvis. The CTA will allow me to decide before your PAE which arteries need to be treated and helps the procedure go a lot faster.
Prostate ultrasound: This is a quick and relatively inexpensive exam that I used to order for my patients; oddly enough, even though it is the least expensive way to image the prostate, insurance no longer pays for prostate ultrasound unless it is done for a biopsy. So I no longer order it.
I don't typically do a prostate exam during out clinic visit. You have been prodded enough; I want to give you a break. I will learn much more from the above studies than I can with my finger.
1) Prostate MRI: This will show us if there are any areas in your prostate that are suspicious for cancer. Most of the time there aren't any suspect areas. In which case we now have an excellent baseline picture of your prostate we can use after the procedure to check you progress or to problem solve if PAE doesnt work as well as we expected.
2) Pelvic CT angiography: This is a CT scan done with high resolution to allow me to plot out the blood supply to your prostate. There can be one, two, or more arteries from each side of the pelvis. The CTA will allow me to decide before your PAE which arteries need to be treated and helps the procedure go a lot faster.
Prostate ultrasound: This is a quick and relatively inexpensive exam that I used to order for my patients; oddly enough, even though it is the least expensive way to image the prostate, insurance no longer pays for prostate ultrasound unless it is done for a biopsy. So I no longer order it.
I don't typically do a prostate exam during out clinic visit. You have been prodded enough; I want to give you a break. I will learn much more from the above studies than I can with my finger.
Is PAE covered by Medicare
Yes, PAE is covered by Medicare.
My urologist is very opposed to the idea of PAE. Should I be worried?
Most urologists hate the idea that we interventional radiologists have come up with another way to treat BPH and they are not involved. It is nothing short of heresy in their eyes. This is because for years of training and then practice they came to believe that no doctor should treat the prostate unless he/she is a urologist. This is a very old-school way of thinking; that your prostate is their turf.
Protecting their turf does not help you if you want to solve your BPH symptoms without surgery.
If your urologist is adamant that you do not have PAE, I can refer you to a forward thinking urologist who accepts that PAE is a safe and effective alternative for appropriately selected men who want to avoid surgery (and incontinence, impotence, and retrograde ejaculation).
Protecting their turf does not help you if you want to solve your BPH symptoms without surgery.
If your urologist is adamant that you do not have PAE, I can refer you to a forward thinking urologist who accepts that PAE is a safe and effective alternative for appropriately selected men who want to avoid surgery (and incontinence, impotence, and retrograde ejaculation).
What are the risks of PAE?
PAE has fewer side effects than TURP or other prostate surgeries, but it has it's own risks.
Since we work through the artery, there is a risk that artery could bleed, though this is very rare as long as you follow our guidance of keeping your leg(s) still for 2-4 hours after your PAE (we will tell you how long)
Almost every man will have discomfort in the prostate and/or bladder for 7-10 days after PAE. This can feeling like a burning sensation, or an increase in urgency to empty your bladder. It can feel like a UTI. It is the inflammation going on after the PBH nodules die and your body working to deal with that dead tissue that causes these sensations. We will prescribe medications to help alleviate it, but expect to feel it. This is why we recommend you take a week off of your work or daily activities.
Some men will see blood in their urine, semen, or stool for a short time after PAE.
Non-target embolization is the term used when the little particles we inject get to another structure we are not trying to embolize. If this happens to an artery going to the penis, a skin ulcer can develop. This is a rare complication, happening 1-2% of men. When it happens, the ulcer might heal on its own in just a few days, or it might take longer, in which case we will get you in to see a wound care specialist who will help you heal the lesion.
Since we work through the artery, there is a risk that artery could bleed, though this is very rare as long as you follow our guidance of keeping your leg(s) still for 2-4 hours after your PAE (we will tell you how long)
Almost every man will have discomfort in the prostate and/or bladder for 7-10 days after PAE. This can feeling like a burning sensation, or an increase in urgency to empty your bladder. It can feel like a UTI. It is the inflammation going on after the PBH nodules die and your body working to deal with that dead tissue that causes these sensations. We will prescribe medications to help alleviate it, but expect to feel it. This is why we recommend you take a week off of your work or daily activities.
Some men will see blood in their urine, semen, or stool for a short time after PAE.
Non-target embolization is the term used when the little particles we inject get to another structure we are not trying to embolize. If this happens to an artery going to the penis, a skin ulcer can develop. This is a rare complication, happening 1-2% of men. When it happens, the ulcer might heal on its own in just a few days, or it might take longer, in which case we will get you in to see a wound care specialist who will help you heal the lesion.