Updated: Mar 11, 2019
Side effects of prostatic artery embolization (PAE) are uncommon and generally mild, but interventional radiologists should be prepared to navigate exceptional cases. PAE expert Dr. Ari Isaacson discusses his experiences with acute urinary retention and what side effects interventional radiologists should expect after a successful prostatic artery embolization.
The BackTable Brief
Acute urinary retention is frequently cited as the most common complication of prostatic artery embolization (PAE), but this finding might be overrepresented by studies in China. Acute urinary retention seems to be a less common complication in the US, Europe, and South America. Dr. Isaacson only sees acute urinary retention when a patient is high risk prior to treatment.
Dr. Isaacson cites ‘post-PAE syndrome’ as the most common complication of prostatic artery embolization. Post-PAE syndrome can collectively describe symptoms of urinary urgency, urinary frequency, dysuria, pressure in the pelvis, and/or pain in the pelvis.
Other less common side effects of PAE include hematuria, hematochezia, and hematospermia.
Disclaimer: The opinions expressed by the participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Less Common: Acute Urinary Retention
Of course we don't have time to get into all the complications, but focusing on acute urinary retention, which appears to be the most common, when do you see this, and how do you manage it?
I would say that I don't see acute urinary retention ... Are you talking about post-PAE?
Okay. I would say that I don't see it quite that often. All of the Chinese studies tend to report acute urinary retention at a higher rate than the studies out of Europe and US and South America. I think it's because they tend to use smaller particles, and they also tend to hospitalize their patients for several days, or a week, after the procedure. I'm not sure what the hospitalization has to do with it. It may just be the smaller particles.
I only see acute urinary retention when patients are already kind of on the brink of it. For example, if they've already had two or three episodes of needing a catheter to urinate. I'm very concerned about that patient, and I'll usually catheterize that patient ahead of time. The rest of the patients I don't catheterize.
If we have a patient like that, that is either in acute urinary retention, or has had several episodes of it previously, we'll place a Foley ahead of time. Then, we have the patient follow up, probably two weeks after the procedure, if that's acceptable to them. Sometimes they want to come back a week afterward, which I think they're probably less likely to pass a Trial of Void at that point, but I try to accommodate their needs as best I can.
So either a week, or two weeks after the procedure, we do a Trial of Void. If it doesn't come out, then they come back two weeks later, and we try again. That's kind of how we go until we get the catheter out.
More Common: Post-PAE Syndrome
What do you tend to see more frequently?
I would say the most common thing you're going to see, is what I would consider post-PAE syndrome, which would include urinary urgency, frequency, some degree of dysuria, some patients will have some degree of pressure or pain in the pelvis. Those are probably the most frequent things. The other things that you will see sometimes, rarely, or not as frequently as those others, is hematuria, hematochezia, hematospermia, and that's pretty much it. That's the great thing about this procedure, is that the side effects are pretty mild, and rare.
Dr. Sandeep Bagla is a practicing interventional radiologist with the Vascular Institute of Virginia.
Dr. Ari Isaacson is a practicing interventional radiologist with the UNC Department of Radiology in North Carolina.
Dr. Michael Barraza is a practicing interventional radiologist with Radiology Alliance in Nashville.
Cite this podcast:
BackTable, LLC (Producer). (2017, November 27). Ep 17 – Prostate Artery Embolizations [Audio podcast]. Retrieved from https://www.backtable.com/podcasts
The Materials available on the BackTable Blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.