Many of my patients have asked "Does it work?" or "How is it done?" So in this post I thought I would explain more about how this magic happens, with case examples. I'll also try to relate to you, dear reader, what the CiC experience is and how our patients have fared. Purely anecdotal, I know, but I've already outlined the scientific data defining the benefits and outcomes in a previous post.
So let's dive right in shall we?
This patient is a 68-year-old who has been dealing with his lower urinary tract symptoms (LUTS for short) for about 10 years, and it has been getting worse over the last several years. His day may sound familiar. He described frequency of urination, almost hourly. This, of course, significantly interfered with his ability to go about his daily business without a restroom close by. Travel, of course, was unthinkable. At night, he had significant nocturia. That's a fancy latin word for urination at night. Upwards of 10-12 times per night. There was simply no way he could get a good nights rest with having to get up so frequently. As a result, he suffered from daytime somnolence and fatigue. He wasn't able to enjoy his retirement because he was simply too tired during the day. He couldn't go golfing with buddies. He couldn't hang out with his grandkids. He couldn't enjoy his hobbies and had to give many of them up. He did see his primary care physician about this and eventually a urologist. They prescribed a 5-alpha-Reductase inhibitor (Finasteride) and an Alpha-Adrenergic Antagonist (Flowmax) but despite maximum dosage, these did not help (see post entitled Back to Basics for more information about BPH medications or check out this page). Finally, he ended up in the emergency department with an inability to urinate. He was treated for a urinary tract infection and had an indwelling (Foley) catheter placed.
So this was his life when he came to my office. I gave him the I-PSS survey (International Prostate Symptoms Score) and he scored a 34 out of 35 placing him in the severe category.
(Click here to read more about BPH and take the I-PSS for yourself)
I talked to him about his options. These included surgery such as prostatectomy or Trans-urethral resection of the Prostate (TURP). He wasn't interested in this approach given the side-effects, recovery time, and potential complications. We then discussed Prostate Artery Embolization, a minimally invasive procedure that has been around for decades for prostate bleeding, researched and applied specifically for prostate enlargement over the last decade, and FDA approved for BPH in 2017. This approach does not burn any bridges for other therapies, should they be needed, at a future date. At CiC this is an outpatient procedure performed with sedation. Patients recover in an hour and are discharged home. The following are images from his procedure:
In these images you can just see the tip of the catheter in the artery. I have injected contrast dye and we see the arteries feeding the prostate. The prostate is circled in each image. At this point in the procedure the patient is sedated (snoring, in fact, and listening to Dire Straights as requested). In this position, I will inject the little particles. At CiC we can watch the particles travel downstream in real time, so we know exactly where they are going.
This is an illustration of what this might look like. The spheres used are 300-500 micrometers in size. A micrometer is one millionth of a meter. To give you some perspective on this, a human hair is about 70 microns. A red blood cell is approximately 10 microns in size. Some patients ask me if these spheres can migrate once injected. The answer is depicted in the illustration above. The vessels taper down so that, at the capillary level, red blood cells, at 10 microns, must pass single file through the vessel. At 300-500 microns, the spheres become wedged upstream and cannot pass any further. This decreases the blood flow causing the prostate to shrink, but it is not enough to cause the prostate to infarct and die. The spheres are stuck and can travel no further.
So back to our patient. After the procedure we close the hole in the
artery with a small (2mm) paperclip-like device (see picture). The patient is recovered for about an hour and is discharged home. No hospital stay, no catheter in the bladder. No need for general anesthesia. No need for surgical incisions! Our patient, who we treated on Friday, reported 100% improvement in his urine flow on Sunday, and was playing tennis on Monday!
If you suffer from symptoms of BPH, there is no need to suffer any longer. Call CiC today to schedule an appointment to talk with Dr. O'Hara. PAE will help you get your life back!