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Prostate Artery Embolization Side Effects
Bryant Schmitz • Jun 23, 2018 • 4k hits
Prostate artery embolization side effects are uncommon and generally mild, but interventional radiologists should be prepared to navigate exceptional cases of complications. Prostate artery embolization (PAE) expert Dr. Ari Isaacson discusses his experiences with acute urinary retention and what side effects interventional radiologists should expect after a successful prostate artery embolization.
We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable Brief
• Acute urinary retention is frequently cited as the most common prostate artery embolization side effect, 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 PAE prostate complication. 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 PAE side effects include hematuria, hematochezia, and hematospermia.
Table of Contents
(1) Acute Urinary Retention: Less Common
(2) Post-PAE Syndrome: More Common
Acute Urinary Retention: Less Common
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.
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Post-PAE Syndrome: More Common
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. Ari Isaacson
Dr. Ari Isaacson is a practicing interventional radiologist with the UNC Department of Radiology in North Carolina.
Dr. Sandeep Bagla
Dr. Sandeep Bagla is a practicing interventional radiologist with the Vascular Institute of Virginia and the president of Prostate Centers USA.
Dr. Michael Barraza
Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.
Cite This Podcast
BackTable, LLC (Producer). (2017, November 18). Ep. 17 – Prostate Artery Embolization [Audio podcast]. Retrieved from https://www.backtable.com
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