Prostatic Artery Embolization for Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a common condition in men in which the prostate is enlarged, causing a variety of unpleasant urinary tract symptoms.

It typically affects men as they age. About 50% of men ages 51 to 60 and up, 70% of men ages 70 to 79, and 80% of men over age 80 experience BPH.

“Over time, the prostate grows. A lot of men, starting in their 50s and up, will start to experience symptoms related to prostate enlargement,” says Fabian Max Laage Gaupp, MD, a Yale Medicine specialist in radiology and biomedical imaging. “And because it is enlarging, it compresses on the urethra, meaning the urine has a hard time passing through it and out through the penis.”

Due to this compression, men may need to go to the bathroom as often as every half hour and with a feeling of urgency. “Patients will get up at night, and that's probably one of the worst symptoms of this disease. When your sleep is interrupted, it affects everything," Dr. Gaupp says.

Usually, medications are the first line of treatment. These include alpha-blockers, which relax the muscles of the bladder and urethra to create better urine flow. On the other end of the spectrum is the surgical removal of the prostate, which is challenging because there isn’t much space around the prostate, Dr. Gaupp says.

But endovascular treatment is another option. One called prostatic artery embolization is a minimally invasive procedure in which doctors use a catheter (a long, thin, flexible tube) to access arteries and veins.

“Prostatic artery embolization can be done under moderate sedation with a combination of a pain medicine and a relaxation medicine through an IV,” explains Jessica Lee, MD, a Yale Medicine specialist in radiology and biomedical imaging. “It doesn’t require a patient to be asleep or under general anesthesia. We access an artery either in the wrist or over the hip with a very small needle and catheter, leaving just a pinpoint hole in the artery.”

Using special mapping technologies, the surgeon identifies the prostatic artery and constructs 3-D images to ensure they target the right area. The surgeon injects microspheres, which are tiny particles, into the artery, where they travel through the bloodstream to the prostate. The microspheres cut off blood flow to the prostate, causing it to shrink—a process that takes a few weeks.

“When I see patients four weeks after the procedure, they often have a significant improvement in their symptoms,” Dr. Lee says. “It's incredible to see a patient who comes to you with issues of getting up four or five times every night, and now I can see they are finally getting a good night’s sleep.”

In the video above, Drs. Gaupp and Lee talk more about prostatic artery embolization for BPH.