The prostate gland surrounds the outlet of a man’s bladder. Benign prostatic hyperplasia (BPH) is essentially an enlarged prostate gland. It is a very common condition in older men. By the age of 70, approximately 80% of men have an enlarged prostate. As the prostate enlarges, the layer of tissue around it stops it from expanding, which causes the gland to press against the urethra (the passage through which urine flows).
In many men, an enlarged prostate does not cause any problems. If symptoms do occur, they may include:
• weak urine flow
• hesitancy in passing urine
• sensation that the bladder is not empty after passing urine
• increased frequency in passing urine
• passing blood in the urine
Your doctor has recommended treatment because your prostate is causing problems.
Prostate embolisation is a minimally-invasive procedure that blocks the arteries that supply blood to the prostate. The procedure is performed under local anaesthetic. During the procedure, a radiologist uses an x-ray camera to guide the delivery of small particles to block the prostate arteries. The small particles and contrast dye (liquid used to make injuries or diseases visible on scans) are injected through a thin, flexible tube called a catheter.
Prostate embolisation for benign prostatic hyperplasia is a new procedure which is considered when other forms of treatment have not worked, are deemed unsuitable or too high a risk. The procedure has only been carried out in a few thousand patients world-wide but early results are encouraging. The majority of patients who have had the procedure show a reduction in the size of the prostate as well as an improvement in their symptoms.
Prostate embolisation is considered a safe procedure. However, as with any procedure, there are some risks.
- Any procedure that involves placement of a catheter inside a blood vessel (artery) carries certain risks. These risks include damage to the blood vessel and bruising or bleeding at the puncture site. When performed by an experienced radiologist, the chances of any of these events occurring are very small.
- There is a small risk of infection, but this can usually be treated with antibiotics.
- Very rarely embolisation material can lodge in the wrong place and deprive normal tissue of its oxygen supply. To try to avoid these complications, the doctors pay particularly close attention to the pattern of the blood vessels in the pelvis, noting that the path of the vessels can be different in each individual. Despite this, there is a very small chance of injury to the bladder, rectum and genitals due to their close proximity to the prostate.
- Occasionally patients may have an allergic reaction to the x-ray contrast dye used during prostate embolisation. These episodes range from mild itching to severe reactions which can affect breathing or blood pressure. Patients undergoing prostate embolisation are carefully monitored during the procedure, meaning any allergic reaction can be detected immediately and treated by the doctors.
- There is a small possibility the procedure will fail due to an inability to embolise the arteries completely or a failure of response to the treatment.
Treatment is not always necessary for BPH, however, if you do need treatment there are several options. Your urologist will discuss with you any alternative options they think may be suitable, including medicines and surgery.
Before your appointment, imaging of the prostate is performed to fully check the size of the prostate and to assess the blood supply. This is usually with a Computed Tomography (CT) scan or a Magnetic Resonance Imaging (MRI) scan organised by your urologist. A blood test will also be needed before the procedure.
To prepare for the procedure you will need to make sure you do the following:
- Please let us know if you are taking any antiplatelet medicines (for example, aspirin, clopidogrel) or any medicines that thin the blood (for example, warfarin), as these may need to be withheld temporarily before the procedure. Call the X-ray Department for advice as soon as you receive your appointment letter.
- If you are taking medicines for diabetes (for example, metformin) or using insulin, then these may need to be altered around the time of the procedure. Again, contact the X-ray Department as soon as possible.
- You must stop eating six hours before your procedure. You may drink clear, non-milky fluids, such as black tea, coffee or water up to two hours before the procedure.
The staff caring for you will ask your permission to perform the procedure. You will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.
Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you have changed your mind. Your wishes will be respected at all times. If you would like to read our consent policy, please ask a member of staff.
You will be given a hospital gown to wear, before you are taken from your ward to the X-ray Department. You do not need to have a general anaesthetic (where you go to sleep) but will be given a sedative which relaxes you and makes you feel sleepy. A small, plastic tube (cannula) will be inserted into a vein in your hand or forearm, though which the sedation will be administered.
You will be positioned on the x-ray table. The groin area will then be sterilised and covered with a surgical drape. The radiologist will numb your right groin with a local anaesthetic injection. A fine, flexible, plastic tube approximately the thickness of one spaghetti strand (the catheter) is inserted into an artery in your groin. Using x-ray monitoring to check its position, the radiologist guides the catheter into both your prostate arteries (right and left). Only when the catheter is precisely positioned does the radiologist inject fluid, containing tiny particles, through the catheter.
This flows into the prostate arteries and blocks them off with embolisation particles or glue. The procedure itself can take up to 2 hours. Once the embolisation is completed, the catheter is taken out and the radiologist presses on the puncture site in your groin for about ten minutes to stop bleeding. You will not need any stitches or dressings and there will not be a scar.
The local anaesthetic will numb your groin area so you will not feel any pain during the procedure. You should expect some pain for several hours after the procedure, but you will be given painkillers for this. Sometimes you may also feel sick (nauseous), anti-sickness medication can be administered if this occurs
You will stay in the X-ray Department Recovery Room for a short while and will then be taken back to your ward. You will need to lie flat for about four hours. Your blood pressure and pulse will be checked at regular intervals and a clip on your finger will measure the oxygen level in your blood. The nurse will also check the pedal pulse of your foot. This is found around the base of your ankle – it is not painful.
Everyone gets some bruising where the artery (or vein) was punctured. The bruising will normally be sore and uncomfortable for a few days.
You will have minor pain and cramping in the first few hours and may feel sick or be sick.
The procedure is usually performed as a day case procedure and you will be discharged later the same day. You will need to have someone to collect you as you will not be able to drive yourself home.
- You may feel tired and we advise you to rest for one to two weeks depending on your recovery. You can then go back to work and resume your usual activities.
- Keep a regular check on the puncture site where you had the procedure. To give the puncture site time to heal, do not drive or do any form of strenuous exercise for 48 hours after the procedure.
- You can eat and drink as normal.
- Continue with your normal medication as usual unless told otherwise. For example, if you take any diabetes medicines containing metformin, you should not take them for the next two days after your procedure.
- You may have a burning feeling in your lower abdomen for a couple of days. We will give you painkillers when you leave hospital, which you can take as prescribed to treat this.
- You may notice a very small amount of blood mixed in your stool or urine. If the bleeding becomes excessive and you also have worsening pain and/or a temperature, you should contact the x-ray department or speak to your urologist as soon as possible.
- You may notice some bruising at the puncture site, as mentioned above. Bleeding or swelling is rare but if it does happen, lie down and apply pressure directly on the site for ten minutes. If the bleeding or swelling continues after ten minutes you should go to your nearest accident and emergency (A&E) department taking this leaflet with you.
- You may have a cramping feeling in your lower abdomen for a few weeks. We will give you painkillers when you leave hospital, which you can take as prescribed to treat this.