ESG Virtual Series - BPH and PAE Treatments
Men’s Health (Part : 2 of 3)
Wed 30 March 2021 | 12pm - 1:30pm
“As a vascular and interventional radiology specialist, Dr. Manish Taneja looks after peripheral vascular disease, aneurysms, dialysis interventions, venous diseases like deep vein thrombosis, and varicose veins/spider veins/reticular veins.
He is also competent in performing newer endovascular procedures such as uterine artery embolization, prostate artery embolization, genicular artery embolization, and erectile dysfunction interventions.
Dr. Manish Taneja
Director Neuro-Interventional & Interventional Radiology, Consultant NeuroInterventionist
Vascular and Interventional Centre
Dr. Manesh Taneja gives the rundown of a new, minimally invasive technique to treat Benign Prostate Hyperplasia – Prostate Artery Embolisation. Then, Dr. Manesh goes through the procedure, its effects, and who is eligible to consider this form of treatment.
Dr. Manish Taneja: Good afternoon. Thank you everyone for joining us. Today I will be talking after Dr. Lim. I will now talk to you about this new technique for treating prostate issues called prostate artery embolization. Now, what is prostate artery embolization? This is one of the latest, minimally invasive techniques to treat patients with symptoms related to large prostate. As we know, prostate disease is something which is usually a benign condition, but it can be a big problem. And Dr. Lim discussed earlier in the previous talk, the major symptoms are urinary problems and it’s a very, very common, benign condition affecting men. Traditional treatment used to be TURP that has already been discussed.
Of course, it is an invasive treatment, and whenever there is something invasive, we are always looking at alternative treatment options. Try to be less invasive if possible. Prostate artery embolization is a technique which came as an offshoot to look at alternative treatment options for BPH, the prostatic hyperplasia. This has been something which has been going on for a number of years, been involved in doing this since almost 25 years back in 1996, we did the first prostate artery embolization for a patient who came in with bleeding after prostate surgery and we managed to stop the bleeding to save the patient’s life. Based on that, then we started thinking, what are the other techniques? Can this be used as a primary technique to shrink the prostate gland? So this is an offshoot of this old technique. The newer technology came about and in 2010 in Europe and for the first time, prostate artery embolization was done as a primary technique to shrink the prostate.
So what does the technique really involve? It basically involves shrinking the prostate gland by cutting down the blood supply very, very selectively to the prostate by getting into the arteries, blocking the blood supply only in the affected part, which is causing the symptoms, shrinking the prostate gland. So that’s how the technique came about. Since 2010 people realized that it really, really works. And now there’ve been multiple (inaudible) series, which have been published for the last one decade, showing that it is highly effective in shrinking the prostate and thereby reducing the symptoms of enlarged prostate, mainly the urinary symptoms in males. What does the technique do? Basically, it’s a technique which involves getting into a blood vessel with a four millimeter, like a less than a half centimeter, catheter into the groin or the artery in the arm, right at the wrist, just like we do a heart angiogram or a brain angiogram.
Something exactly similar is done in very light sedation. You don’t need any general anesthesia, a smart tube is then introduced selectively under that imaging guidance. Most commonly, we use a fluoroscopy machine, which I will show you later in the room. We get access through these very, very small catheters, which are barely visible to the eye. They’re advanced into the blood vessels and into the prostate gland very, very selectively. We reach the area, which is enlarged and very, very selectively we inject some particles which are permanent particles, but they are only lodged in the abnormal part of the prostate gland, thereby causing shrinkage, which takes place over the period of next three to six months after the blood supply to that area is cut out. And over a period of time, the area becomes smaller and smaller causes, less pressure, and the symptoms get better. It could take almost up to three to six months before the actual outcome is more apparent to the patient and but the effects are usually lasting
and last for a long time in patients. Very few people will need to repeat the procedure, but that is very, very uncommon. Usually most patients do very well after a single procedure with the effect coming in about a three to six months period of time. What do we expect? What are the effects? So, you know, we would want to know what the procedure is about. So we talked about the background history, then we just now, I talked about how we do the technique. So what do we expect as a patient? What do I want to know? You know, we will talk about something new. What do we want to know? We say, what do you need to know is that it’s performed with light sedation. It’s done as a day surgery procedure that takes about one hour to do with no cutting board. There’s a small five millimeter, less than one centimeter incision, either in the groin or in the artery, the hand no stitches needed.
And if the area just becomes normal within one to two days, you come into the hospital or in our day surgery center and you go back home within six hours after the procedure is done, light sedation, and then you’re back to normal activity. Within a couple of days, there is hardly any discomfort during the procedure because it’s done under light sedation. As you’re not really aware of what’s going on, there is no general anesthesia involved. So the moment a sedation wears off you’re back to normal. And then you walk home the same day with no surgical scar.
So who is eligible? Am I the right person for prostate artery embolization? Am I the person who falls in this category? Should I be considered for prostate artery embolization? So who is eligible? Patients who have oral medication still have symptoms. You know, there are different types of medication available. Some of them have significant side effects. Some of them are not so significant. So patients who are having oral medication or still have symptoms of BPH, patients who have undergone other procedures and, you know, still have symptoms, still cannot get rid of their urinary symptoms. Patients who are not suitable for a TURP because of bleeding risk patients who want to maintain their urine continence sexual potency, which is a side effect for TURP and patients who want to avoid invasive surgery. Now I will be taking you for a walk around to see our facility, how we do the procedure and what does it involve? And what’s done over there followed by Dr. Ben, will be talking about the next topic. Thank you.
Benign Prostate hyperplasia or also called BPH in common terms is a condition which involves males usually in the age group of 50 plus. This condition involves a benign enlargement of a benign nodule which forms on the prostate gland, which causes symptoms. For example, increased urinary frequency. You have a more urge to pass urine, but cannot complete the process and have inability to completely pass the urine or with poor stream. So it’s a common condition, which is something which is very debilitating for a number of males in their age group. After 50 years of age, BPH is commonly diagnosed by clinical examination based on history when a patient visits with a history of difficulty in passing urine, multiple urges to pass urine or incomplete bladder emptying. And then after that, we do an examination of the patient.
And one of the gold standard tests is to use this machine to diagnose BPH, which is an ultrasound machine. All it involves is a probe, which I will show you that are different types of probes. This is the commonest probe that they use. This is put on the patient. And we do an ultrasound of the prostate gland in the lower part of the abdomen, through the abdominal wall and we look at the size of the prostate and we look at what’s the volume of the prostate and how it’s affecting the bladder. That’s the commonest way we diagnose BPH. Of course, there are other things that we do for example, flow measurements and all. But of the time, this is one of the most common ways we diagnose a prosthetic condition and BPH patients. So this is the room where we performed a minimally invasive treatment called prostate artery embolization.
As I discussed in the slides earlier, if the patient comes here, lies down with the head on that side. Then we stand on the patient’s side. So minimally invasive procedures. So we use either a groin artery, or an artery in the wrist. We go past very small catheters, about two or three millimeters. As you can see on the screen here we can. We advanced the catheter right into the blood supply to the prostate. You can see this is a real life example of a patient that we did two weeks ago. So we go into the blood vessel to the prostate. This is where a small catheter is placed. You can see the x-ray of the patient. You can see the catheter going in. It’s a very, very small incision. It’s like a two millimeter catheter going inside. We go to the prostate. You can see the arrow.
There’s an embolic agent injected. You can see the right side. This is before the blood supply to the prostate. This is after the embolization is done, done under sedation. Patient does not feel anything that’s going on. They wake up. It’s like nothing has ever been done. No catheter, no nothing. They bedrest for sometime. And they go home within four hours after the procedure. But this is a recovery room at our vascular interventional center. This is where the patient rests, they rest here for about four hours. As you can see, it’s a very well equipped theater area with very good monitoring equipment. You switched it off just for this part for patient confidentiality. And there’s a one-to-one nursing, which takes place. There’s one nurse looking after one particular person, and we make sure that we keep it as comfortable for you as possible at the centre, making sure that you’re fully safe and the procedure is done with full privacy and with full, complete safety concerns. And then for your comfort, we make sure you go home within four hours after the procedure.
Prostate Artery Embolisation is relatively new in being the primary treatment for Benign Prostate Hyperplasia. This is a minimally invasive technique used to shrink the prostate glands, decreasing the swelling in order to relieve the patient of their urinary tract symptoms.
During the procedure, a small catheter, only about 2-3mm wide, is inserted into the prostate gland through an artery. Once it reaches the affected area, an embolic agent is injected to decrease the blood supply to the area, thereby decreasing the swelling. This is a day surgery which means a patient is not placed under General Anesthesia but rather under light sedation and is able to leave the facility after about 6 hours after the procedure begins. While the effects of this procedure is not immediate, taking about 3-6 months to fully set in, it has a very high success rate as well as long lasting effects.
This minimally invasive treatment does not leave scars and there is less swelling around the area than if traditional surgery was performed.
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