Innovation
Until now, surgery for enlargement of the prostate required general anaesthetic and a hospital stay of two to three nights.
But a new procedure, called prostate artery embolisation (PAE), is an effective alternative to surgery and is available in South Africa.
Dr John Cantrell, an interventional radiologist who specialises in image-guided procedures at the Wits Donald Gordon Medical Centre, is one of the leaders in performing these PAE procedures. He says that this new, minimally invasive technique can be an alternative to surgery for treating the condition – known as Benign Prostatic Hyperplasia (BPH) – with similar results and fewer complications.
‘The embolisation is done using fluoroscopy (an imaging technique that uses X-rays to obtain real-time moving images) under local anaesthetic or sedation in an angiography suite without the need for a general anaesthetic,’ he explains. The recovery time is also quicker, he adds. ‘Patients either go home on the same day or overnight in hospital.’
During the procedure, a small flexible catheter is inserted through a tiny puncture in the groin into the arteries that supply the prostate gland. Then, small beads, less than a millimetre in diameter, are injected through the catheter.
‘These tiny beads get wedged in the arteries and so block the blood supply to the prostate, shrinking it over time and alleviating the symptoms related to the prostate enlargement,’ says Dr Cantrell. ‘The procedure severely restricts blood flow to the tissue, but there is still a little bit of blood flow through collateral vessels that keeps the tissue alive while it shrinks over time.’ With the blood flow reduced, the prostate will shrink in size, thereby relieving the symptoms of BPH.
BPH is unrelated to cancer, but is nonetheless a fairly common condition, affecting about 210 million men worldwide. The symptoms can include frequent and painful urination, an urgent need to urinate, weak urine stream and incomplete emptying of the bladder. According to University of Virginia researchers, nine out of 10 men aged 80 will have an enlarged prostate, with half of them experiencing those symptoms.
PAE was first developed by doctors in Portugal and Brazil in 2011, and has since gained worldwide acceptance. New data from long-term studies show excellent results, with no urinary incontinence or sexual dysfunction reported.
‘The procedure is very much a team approach,’ Dr Catrell concludes, ‘with the radiologist working with the patient’s urologist for the best possible outcome.’