A non-surgical embolization treatment for enlarged prostate (BPH) that shrinks the gland gradually — with a much lower risk of sexual side effects than surgery.
Benign prostatic hyperplasia (BPH) is a very common, non-cancerous enlargement of the prostate gland that develops with age, which can press on and narrow the urethra as it grows — causing symptoms such as a weak or interrupted urine stream, frequent urination, getting up repeatedly at night, or a sense of incomplete bladder emptying. The prostate receives its blood supply through a pair of prostatic arteries, one on each side, which is what makes an embolization approach possible.
In PAE, a catheter is guided into each prostatic artery in turn, and tiny embolic particles are injected to block blood flow to the enlarged prostate tissue specifically, while sparing surrounding structures such as the bladder and rectum. Deprived of its blood supply, the treated prostate tissue gradually shrinks over the following weeks to months, reducing the pressure on the urethra and, for most men, meaningfully improving urinary symptoms — without any tissue being surgically cut away or removed.
Moderate to severe urinary symptoms from BPH not controlled with medication.
Retrograde ejaculation is common after surgery but substantially less frequent after PAE.
Including men on blood-thinning medication or with other significant medical conditions.
Where the gland's size makes conventional surgical approaches more difficult.
A CT angiogram maps the prostatic artery anatomy on both sides.
A single needle puncture is made at the wrist or groin under local anaesthesia.
Tiny particles block blood flow to the enlarged tissue on each side.
Most go home the same day or after a short overnight stay.
Men with moderate to severe urinary symptoms from BPH that haven't responded well enough to medication, or who can't tolerate the medications commonly used for it.
Men who want to avoid the sexual side effects associated with surgical treatment, since retrograde ejaculation — semen entering the bladder instead of being expelled during orgasm — is common after TURP and other surgical options, but substantially less frequent after PAE.
Men at higher risk from surgery or anaesthesia, including those on blood-thinning medication (where a needle puncture carries much less bleeding risk than a surgical resection) or with other significant medical conditions.
Men with a very large prostate, where the gland's size makes conventional surgical approaches more difficult or would require a more invasive open procedure.
Men wanting to avoid an extended hospital stay or a general anaesthetic, given PAE's typical day-case or short-stay nature under local anaesthesia and sedation.
PAE isn't the right choice for every man with an enlarged prostate — unfavourable artery anatomy (which becomes more likely with significant atherosclerosis), a co-existing condition needing direct surgical treatment such as large bladder stones, or any suspicion of prostate cancer that hasn't yet been properly evaluated, generally shift the discussion toward surgery or a different work-up first. Suitability is best judged jointly with the treating urologist.
Planning: a CT angiogram beforehand maps the prostatic artery anatomy on both sides, which varies considerably between individuals and is essential to plan safe, selective catheter access.
Access: under local anaesthesia with sedation, a single needle puncture is made in the wrist (radial) or groin (femoral) artery.
Catheterisation: a fine catheter is guided under X-ray guidance into the prostatic artery on one side, then the other — technically demanding, since these arteries are small, often tortuous, and can be affected by age-related narrowing of nearby vessels.
Embolization: tiny embolic particles are injected through the catheter into each prostatic artery, selectively blocking blood flow to the enlarged prostate tissue while sparing nearby structures.
Confirmation and recovery: imaging confirms the embolization is complete on both sides, and most patients are observed for a period afterward before going home the same day or after a short overnight stay.
Unlike surgery, where the prostate tissue causing obstruction is removed immediately, PAE works by cutting off blood supply and letting the prostate shrink gradually over time — most men notice a steady improvement in urinary symptoms over the following weeks to a few months as the tissue responds, rather than an immediate change on the day of the procedure. Men who go into the procedure with a urinary catheter in place because of retention are typically able to have it removed once the prostate has shrunk enough to relieve the obstruction, assessed at follow-up.
Most men experience a short period of post-embolization syndrome — pelvic discomfort, urinary frequency or a burning sensation, and sometimes blood in the urine or semen — for several days to a couple of weeks after the procedure, which is an expected inflammatory response rather than a complication, and settles with simple pain relief. Because prostate artery anatomy sits close to the bladder and rectum, there is a small risk of embolic particles affecting nearby tissue instead of the intended target (non-target embolization), which is why careful, selective catheter technique and pre-procedure imaging planning matter so much. A urinary tract infection can occasionally develop afterward and is treated with antibiotics if it occurs.
Follow-up typically combines a symptom questionnaire (such as the International Prostate Symptom Score), a urine flow test, and sometimes repeat imaging to confirm the prostate has reduced in size, usually assessed a few months after the procedure once the shrinkage process has had time to take effect. This is used, together with the urology team, to judge how well symptoms have improved and whether any further treatment is needed.
The prostatic arteries are small, frequently tortuous, and vary considerably in their origin and course from one patient to the next, often further complicated by age-related narrowing of the pelvic arteries supplying them — making selective, safe catheterisation on both sides one of the more technically demanding embolization procedures performed in interventional radiology. Because the treatment margin between the prostate and adjacent structures like the bladder and rectum is small, achieving a good symptomatic result while avoiding non-target embolization depends on meticulous pre-procedure planning and hands-on experience specifically with this technique, working alongside the referring urology team.
PAE is used to treat urinary symptoms caused by an enlarged prostate (benign prostatic hyperplasia, or BPH) by shrinking the gland through blocking its blood supply, as a non-surgical alternative to procedures like TURP.
TURP and similar surgical procedures physically remove or reshape prostate tissue causing obstruction, giving a more immediate result but carrying a real risk of side effects such as retrograde ejaculation. PAE instead shrinks the prostate gradually by cutting off its blood supply through a needle puncture, with a substantially lower risk of affecting sexual function, though symptom improvement takes longer to develop.
PAE carries a much lower risk of retrograde ejaculation and erectile difficulty than surgical treatments for BPH, which is one of the main reasons many men choose it. It isn't entirely risk-free, so this is discussed individually as part of deciding whether PAE is the right option.
The procedure itself is done under local anaesthesia with sedation, so it isn't painful at the time. Afterward, most men experience some pelvic discomfort, urinary frequency, or blood in the urine or semen for a few days to a couple of weeks, which is expected and settles on its own, and most go home the same day or after a short overnight stay.
Men with moderate to severe urinary symptoms from BPH who want to avoid surgery, are on blood-thinning medication, have other medical conditions that make surgery riskier, or have a very large prostate are often good candidates — final suitability depends on the prostatic artery anatomy seen on imaging, assessed individually.
Book a consultation with Dr. Giragani to discuss whether PAE is right for you.