PAE: Alternative to Surgery for an Enlarged Prostate

02 September, 2019

What is Enlarged Prostate, Benign Prostatic Hyperplasia( B.P.H.)

Mr CM (name hidden), a retired embassy officer & an American citizen settled in Thailand who is just 65, does not want his age or to be more specific his enlarged prostate limit his physical activities and desire to travel. Everyday he walks the streets of his darling city for about 5 km a day, however unfortunately he has to run to bathroom every one to three hours throught the day and night. “The urgency to pass urine, when it hits, can be very creepy,” according to Mr.CM.

Mr. CM, like up to 80 percent of men in their 60s, has benign prostatic hyperplasia, or B.P.H., a nonmalignant enlargement of the prostate gland. As the prostate enlarges with age, it squeezes the urethra (urine pipe) that passes throughout it and can obstruct normal urinary flow.

Symptoms & Risk Factors

The prostate gland typically starts to enlarge in men’s 40s. As the gland gradually increases in size, nearly half of men develop moderate to severe symptoms of the lower urinary tract. These symptoms can include

  • hesitancy starting to urinate;
  • weak flow;
  • incomplete emptying of the bladder resulting in urinary retention;
  • a frequent urge to urinate, and for some, an urgency that can cause incontinence, leading to awkward situation such as wetting trousers.
    • The result is often a poor quality of life.

      Mr. CM said he uses the bathroom every one to three hours, adding that “it’s very unusual for him to sleep for more than four hours at a time.” He consulted a local urologist in his country. After undergoing thorough evaluation, it was found out that his prostate was enlarged more than 3 times the normal size & weighing > 120 gms. He was started on medications, which were not effective and caused lots of side effects. As TURP surgery is usualy advisable for prostate gland size up to 80 gms, he was offered the only option of open surgical removal of prostate gland with associated risks.

      Treatment Options

      Coming to treatment options, there are now many different ways to improve the symptoms of B.P.H. Right from life style modifications to medications and finally Surgery to remove part or all of the prostate, which can however cause complications, including erectile dysfunction.

      Still, the first approach to relieving the symptoms of B.P.H., and perhaps even preventing or slowing the progression of prostatic enlargement, are focused on lifestyle changes. They include :

      • reducing overweight;
      • minimizing liquid intake late in the day;
      • getting regular physical activity;
      • avoiding smoking and consumption of alcohol, caffeine and highly seasoned foods;
      • and treating constipation.

      Among currently preferred treatments are several categories of drugs, including alpha-blockers like Urimax, 5ARIs like finesteride, and PDE5 inhibitors like tadalafil.

      The most commonly performed surgery for B.P.H. is transurethral resection of the prostate (TURP). It involves anesthesia and then inserting a scope through the penis and cutting away excess prostate tissue to relieve pressure on the urethra. Though TURP is an effective remedy for troublesome B.P.H., it can sometimes cause serious sexual complications, or have risk of bleeding.

      Experts say that aggressive surgical treatment like TURP should now be necessary to treat an enlarged prostate only in certain circumstances. These might include inadequate kidney function, recurrent urinary tract infections, bladder stones, blood in the urine, or the patient’s unwillingness to take a daily medication or failure to get relief through drugs.

      There are also now minimally invasive techniques to reduce the pressure exerted on the urethra by an enlarged prostate such as UroLift System & “Rezum” Water Vapor Therapy. The risk of side effects, including those associated with sexual performance, is reported to be low.

      PAE: Alternative to Surgery for an Enlarged Prostate

      As PAE was not an option in his country of residance; Mr CM, finally decided to fly to India. He underwent PAE procedure on Day Care basis and was discharged same evening. The entire procedure and post procedure period was uneventful. He flew back to his country on 3rd day. His symptoms started to improve within couple weeks.
      Dr. Virender Sheorain and his team at Medanta Gurgaon, use specialized techniques to perform prostate artery embolization (PAE), a procedure being increasingly used in other parts of the world to treat prostate gland enlargement and its associated urinary symptoms.

      Benefits of PAE

      • Minimally invasive
      • No tissue removed
      • Shorter recovery
      • Not performed through the urethra

      PAE may be an option for patients who have severe symptoms from BPH and:

      • Are eligible for TURP or similar procedure but prefer a minimally invasive option.
      • Have prostate enlargement too great for surgery.
      • Have had previous surgery without improvement in symptoms.

      All the patients with B.P.H. should be told about all the various treatment options available and their benefits and risks, enabling them to make an informed decision about how to treat their problem.

      For further information of PAE please visit or call 9868887666 to schedule an appointment with Dr. Virender Sheorain, best doctor for enlarged prostate treatment without surgery at Medanta Hospital Gurgaon.


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