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 MRI of your prostate if you want to proceed with PAE and that will tell me much more about your prostate then I could possibly 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 MRI of your prostate if you want to proceed with PAE and that will tell me much more about your prostate then I could possibly learn from a physical exam or your prostate.
Will insurance pay for PAE?
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.
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 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 a few 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 this stops after a few days but can continue for a week to 10 days. It is rare to last more that 2 weeks. This is the reason I recommend you take a week off after PAE.
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
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 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 a few 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 this stops after a few days but can continue for a week to 10 days. It is rare to last more that 2 weeks. This is the reason I recommend you take a week off after PAE.
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
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.
No.
Once again you are confusing PAE with TURP. PAE does not cause incontinence. TURP can cause incontinence. If you don't want to be stuck wearing Depends, try PAE!
Once again you are confusing PAE with TURP. PAE does not cause incontinence. TURP can cause incontinence. If you don't want to be stuck wearing Depends, try PAE!
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 and all of the other surgical methods to ream it out from inside your penis tend to fail, so the surgical option becomes prostatectomy.
Unfortunately, all of those things that a TURP can cause are much more likely with an actual prostatectomy: impotence, incontinence, sterilization.
Oh, all of those things except for retrograde ejaculation, because after a prostatectomy there is a ZERO % chance of you every ejaculating again...ZERO. The tubes are destroyed and removed. You will never experience ejaculation again.
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.
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 and all of the other surgical methods to ream it out from inside your penis tend to fail, so the surgical option becomes prostatectomy.
Unfortunately, all of those things that a TURP can cause are much more likely with an actual prostatectomy: impotence, incontinence, sterilization.
Oh, all of those things except for retrograde ejaculation, because after a prostatectomy there is a ZERO % chance of you every ejaculating again...ZERO. The tubes are destroyed and removed. You will never experience ejaculation again.
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.
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 does not work for you, you can still have TURP or prostatectomy.
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.
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.
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.