With age, each representative of the stronger sex greatly increases the risk of adenoma (benign hyperplasia) of the prostate. At the moment, there are a lot of methods and principles of therapy for this pathology.

While the disease has not yet developed strongly, drug treatment is useful. If the adenoma has reached a significant size, it is required to resort to surgical intervention.

Drug therapy, although it is the best method of getting rid of, but in about every tenth case it is powerless. Then an operation is performed - an adenomectomy is performed, as well as a transurethral resection of the prostate. These methods give excellent results, but there are also contraindications to them in the form of serious pathologies of some organs. For example, the heart and thyroid.

Thanks to the development and the beginning of the use of PEA (embolization of the arteries of the prostate), this circumstance was corrected. With EAP, substances are introduced into the vessels of the organ so that they block the gaps there.

With the help of EAP, arteries in the prostate are blocked if it begins to grow at least up to 60 cubic centimeters. Another technique is used if urination is very difficult.

The very first time EAP was used in Brazil in 2008. Then, with its help, success was achieved in 91 cases out of 100. In 2009, the Portuguese also used the technique. On the territory of the Russian Federation, it gained wide popularity only quite recently thanks to Georgy Kim and other authors, who together published a report on the effectiveness of the technique.

It is used for patients for whom drug therapy has not brought positive results, or for those people in whom the prostate has reached a volume of more than 60 cubic centimeters, and there are difficulties with urination.

This is usually a planned procedure. Thanks to this, it is possible to discuss everything that is necessary with the doctors without undue haste, additionally being examined and preparing for the operation.

Interesting! X-ray endovascular PEA is the latest technique for the treatment of BPH.

Traditional Therapy

Common surgery includes endoscopic TUR and open surgery with an incision in the bladder, which is done if the prostate has grown too much. Such methods have weaknesses. For example:

• severe trauma received during the operation;
• a greater likelihood of danger due to anesthesia;
• possible complications;
• drop in libido;
• many contraindications.

Important! Among the patients there are also those in whose treatment the medical technique is useless, and surgical intervention will harm even more.

Then you have to "get out" with an alternative technique - for the rest of your life, install a cystostomy in the patient's bladder to drain urine - a special drainage tube. There is no other way to cure this pathology. It is impossible to bring urination back to normal with it, as well as to make the quality of life higher.

Consequences

In most cases, the first symptom of BPH is a problem emptying the bladder. That is, the jet becomes weaker, which makes the process longer, sometimes reaching five minutes, and this happens a dozen to one and a half times a day. Also, more than 50 ml of urine rarely leaves the body at one time. The patient is forced to go to the toilet and at night 5-6 times. After some time, the adenoma progresses even more, the urge becomes even more frequent, and the man cannot leave the room where there is a toilet for a long time, normally watch the desired movie, go to rest for at least a day or two.

Against the background of an exacerbation, which is very common in actively living men, adenoma becomes a nightmare disease altogether. In this case, there are symptoms of not only adenoma, but also exacerbation of prostatitis.

Moreover, the adenoma spoils the erectile function. This makes the life of any member of the stronger sex hell. Family happiness may also be affected. All this creates great discomfort, demoralizing and psychologically oppressing the patient.

Purpose of the EAP

This technique treats only symptomatic prostate adenoma. It is the responsibility of physicians to ensure that the symptoms are due to PEA and not to any other prostate disease that is not treated with PEA before using PEA.

Indications

Here are the cases with prostate adenoma, when EAP helps the most:

• the prostate, which has reached a volume of more than 80 cubic centimeters;
• serious pathologies of the heart and blood vessels, which include, for example, myocardial infarction, severe diabetes mellitus, problems with blood clotting, as well as renal pathologies;
• varicose veins of the prostate, blood flows from them, and all this is not treated with traditional therapy;
• the patient really wants to get rid of the established cystostomy.

Contraindications

EAP also has contraindications. Here are the main ones:

• abnormal development of the iliac vessels;
• floating thrombi in the basin of the veins of the legs.

Who exactly decides whether an EAP should be done?

Whether it is worth resorting to EAP, the medical consultation decides. Before using this technique, two doctors cannot do without discussing it: a urologist and an endovascular surgeon, and these are representatives of different areas of medicine, are involved in the process of therapy. However, the final word remains with the patient. So he must find out from the doctors all the information he is interested in if he wants to make the right decision.

For this procedure, special X-ray operating rooms equipped with an angiography apparatus are designed. It is needed in order to control the EAP using X-ray television. It is under these conditions that every endovascular procedure is performed.

Preparation

PEA is usually done on the same day that the patient is admitted to the hospital. Abroad, it is in the order of things to discharge the patient six hours after the procedure. But it would be more correct for the patient to stay in the clinic for the night.

The last meal before PEA should be no earlier than 4 hours before it, and breakfast should be small in the morning. Drinking is allowed in the same way as usual. And before you go to the hospital, you need to shave the groin and thighs on both sides of the inguinal fold.

Before the procedure itself, the patient is given an injection with sedatives and anesthetics - premedication. He is also fitted with a Foley catheter. It is required both during the procedure and 4-6 hours after its completion. It is best when modern catheters are used - they are safer and have a very small diameter.

Important! In case of drug allergies, the patient should report them to the doctors.

How is an EAP performed?

This is a minimally invasive procedure. Its essence is the clogging of the vessels of the arteries in the prostate gland. This causes her to shrink in size.

EAP is performed by endovascular surgeons. This requires sufficient experience in manipulations on very thin, often less than a millimeter, vessels, as well as a high skill in using an X-ray angiographic device to control one's own actions.

Worth knowing! PEA is a minimally invasive procedure and does not require the patient to be put under general anesthesia. It is enough to use local anesthesia where the puncture of the artery will be performed.

The surgeon makes a puncture on the right thigh a centimeter or two below the inguinal fold. All that the patient will feel during the operation is sometimes a feeling of warmth in the groin and buttocks. This feeling appears due to the contrast agent injected by the surgeon through the catheter.

An endovascular surgeon must identify the sources of blood supply to the prostate, into which then insert a microcatheter with a diameter of 0.6-0.8 mm. After making sure that the catheter is stable and in the right place, the doctor injects an embolization preparation, particles of medical plastic, into the artery through it.

Then the result is checked by contrasting, which makes it possible to verify the reliability of blockage of all prostatic arteries.

Embolization is necessarily performed on the right and left, but there is usually no need to pierce the left leg: the current catheters are designed so that they can be used to catheterize both sides using a common access for them.

Video - Doctor about the PEA procedure

Efficiency

Now there are results of two serious researches. From these, it can be concluded that PEA is a very effective technique for blocking the prostatic arteries for the treatment of prostate adenoma. In almost all patients, during the first month, the prostate is greatly reduced and urination improves.

In almost every third patient who underwent PEA, improvements are noticeable in the first week after surgery. Further, the prostate decreases, and the state of the genitourinary system is completely restored in no more than a year.

The EAP requires:

• high tech;
• special operating room;
• very precise instruments;
• the highest professionalism of experienced doctors;
• the latest endovascular techniques.

Table. Results of treatment of 52 patients with BPH with PEA.

Indicators\timelines	After 3 months	After 6 months	After 12 months	After 24 months
Residual urine volume (ml)	158.2±0.028	143.0±0.0023	25.3±0.0020	26.3±0.0020
IPSS scores	6.2±0.051	4,0+0,014	3,6+0,011	3,9+0,011
PSA (total/free) (ng/ml)	1.3±/0.03± 0.0036	1.08± /0.027±0.0015	1.06± /0.022± 0.0015	1.09±/0.027±0.0017
Prostate volume (cm)	83.4±8.3	54.29±5.37	52,07+5,37	53,07+5,38
Knot volume (cm 3)	52.9±5.17	33.26±6.67	32.16±5.43	33.18±4.83

These indicators indicate that after 3-6 months the work of the prostate gland and the genitourinary system as a whole normalizes in patients, and after a year or two there is no trace of any pathologies associated with this area at all.

Does the PEA process cause pain?

There is no pain during this procedure. Of the discomfort, the patient may feel only the first injection of a local anesthetic. But after PEA, about 50% of patients notice a pulling pain or pain in the lower abdomen and in the urethra. This discomfort usually resolves within a few hours, and can be quickly removed with the help of non-steroidal anti-inflammatory drugs.

Probability of risks

This procedure is a relatively new technique. But we already know that it is very safe. Of all the possible complications of PEA, hematoma most often occurs where an arterial puncture was performed. And then this risk, in principle, can not be considered. Not only does this complication develop in only 5% of patients, it also goes away on its own in fifteen days.

At first, in the early days of the development of PEA, patients occasionally had a short interruption of urination, which was corrected in a day or two with the help of bladder catheterization.

Thanks to current technology, this technique reduces even such risks to a minimum. Therefore, patients are usually discharged the next morning.

The positive aspects of this technique:

• almost complete absence of pain during rehabilitation;
• rapid recovery of the ability to the previous way of life;
• almost complete absence of the risk of any complications;
• hospitalization, equal to just a day, and in other countries the procedure usually takes place at home;
• no need for dressings, anesthesia, intensive treatment, outside help.

Preliminary procedures

In order to go to the clinic for EAP, you need to pass certain tests, as well as undergo examinations. These include:

• complete blood count - not earlier than two weeks before the EAP;
• a biochemical blood test - while the levels of urea, ALT, AST, and bilirubin should be indicated - not earlier than two weeks before the operation;
• coagulogram indicating INR, PTI, APTT - not earlier than two weeks before surgery;
• tests for RW, HIV, tests for hepatitis B and C, not earlier than 90 days before surgery;
• ECG in 12 leads;
• fluorography - not earlier than a year before the operation;
• blood test for PSA. If the level is elevated, then also a consultation with an oncourologist and biopsy data;
• Ultrasound of the prostate.

Modern surgical methods for curing prostate adenoma are being improved every day. Embolization of prostate arteries has been widely used in Russia for about 10 years. This procedure is classified as a minimally invasive procedure and should be performed by a highly qualified physician experienced in intravascular surgery. The operation allows you to achieve remission of the adenoma, but for this you must strictly adhere to the rules during the rehabilitation period.

Prostate adenoma is a benign tumor in the prostate gland. The reasons for its appearance in most cases lie in a change in the balance of hormones. This process is typical for men aged 50-55.

It is at this age that the concentration of sex hormones begins to gradually fall, and estrogen and estradiol increase. These hormones contribute to the growth of adenoma.

Doctors distinguish 3 stages of the disease. Conservative treatment is indicated in the first stage, the next two require the intervention of a surgeon. In advanced cases, the prostate has to be removed.

Symptoms of prostate adenoma:

• Constant urge to urinate. Even immediately after going to the toilet, the patient again feels the urge. Sensation worse at night;
• Sluggish stream. In order to urinate, a man has to keep the abdominal muscles in a strong tension. Despite increased efforts, there is a feeling of a full bladder;
• Burning and itching in the urinary tract;
• Potency problems. Sexual desire is greatly reduced, up to complete impotence;
• Presence of blood in urine and semen. This sign indicates that the pathology is aggravated;
• Pain in the groin area that occur during intercourse and the process of urination.

If the treatment of adenoma is not started in time, the patient's condition will quickly begin to deteriorate. Urinary retention accumulates, the patient's sensations are characteristic of a state of severe poisoning.

Indications for embolization

Embolization of the arteries of the prostate gland is designed to restore the function of the prostate. Operation is indicated when the formation is benign, and the total size of the prostate and tumor does not exceed 80 cm 3 .

Embolization has also been successfully used in prostate cancer, dealing with the effects of mechanical gland injuries, with varicose veins.

The operation is shown rupture of blood vessels feeding the prostate.

Embolization is not a panacea and in some cases cannot be used. So, with anomalies of adenoma and in violation of vascular patency, it is strictly contraindicated. If there is a risk of thrombus separation, embolization is also strictly prohibited.

Preparation

Embolization of prostate adenoma is always preceded by a set of diagnostic measures. Tests to be done before the procedure:

• general urine and blood tests;
• blood sugar test;

The urologist must digital examination of the prostate and does blood test for tumor markers.

Having all the results of the examination in hand, the doctor decides whether it is advisable to do embolization or other methods of treatment are indicated to the patient.

Special preparation for the procedure is not required. It is enough to cleanly shave the hair in the groin and not eat 4 hours before the operation. Drinking water is allowed, but in small quantities.

Carrying out the procedure

If necessary, the patient before embolization takes prescribed antibiotics. Immediately prior to embolization, the surgeon injects a sedative intramuscularly for anesthesia and then inserts a catheter.

Embolization of the prostate is carried out as follows:

1. The patient is placed on the operating table. Sensors are attached to his chest to take ECG data. Wrist cuff helps track pressure fluctuations. A blood oxygen sensor is attached to the patient's finger.
2. A few centimeters from the groin on the right thigh, a puncture is made and the surgeon proceeds to arteriography.
3. The doctor then locates the arteries leading to the prostate gland and inserts a microcatheter less than 1 millimeter in diameter into them.
4. The surgeon localizes the location of the catheter in the artery, then delivers a special drug through it. It is a microscopic piece of medical plastic rounded shape.
5. After the introduction of the embolization preparation, a control study of the vessels is done. It confirms that the arteries supplying the prostate are well blocked.

After the operation, the doctor in a special way squeezes the puncture site in the thigh to avoid the formation of a hematoma. The whole procedure takes from half an hour to an hour, depending on its course.

X-ray endovascular embolization of the prostate arteries leads to a decrease in the size of the adenoma by 60-80%. The prostate gland itself is also reduced in size by 50% or more. Thanks to this effect, the process of urination returns to normal.

The positive effect of the procedure makes itself felt after 3-4 days. Frequent painful urge to urinate stops, a person gets rid of constant pain in the groin and other unpleasant sensations.

The vast majority of patients note the fact that the embolization procedure has significantly improved their quality of life. A person not only gets rid of constant discomfort, but also regains confidence in his own potency quickly enough.

You need to spend 2-3 days in the hospital for a full recovery.

Prevention

In order to exclude further recurrences of prostate adenoma, it is enough to follow simple rules:

• Go to the urologist regularly for checkups. Be sure to take all the tests prescribed by the doctor to control the prostate. Do not think that after the operation, the adenoma will not be able to return again;
• Eat properly. In addition to the basic rules of a healthy diet, patients after embolization should avoid foods high in fat and simple carbohydrates;
• Eliminate alcohol from your diet. This recommendation applies especially to beer containing phytoestrogens. These hormones can provoke the growth of adenoma;
• Quit smoking since this habit has a bad effect on the vascular system as a whole;
• Take drugs containing hormones only as prescribed by a doctor and very carefully. Any change in hormonal balance can cause re-adenoma;
• Exercise and try to maintain an active lifestyle. This is especially true for patients with sedentary work. They definitely need walks, which not only remove the stagnation of blood in the pelvic region, but also positively affect the emotional sphere.

Are any drugs needed after adenoma embolization to prevent its possible growth? Usually not needed unless there is a special indication. These medications have a negative effect on potency and sperm quality, so taking them for prevention is not justified.

In the postoperative period, the doctor may prescribe supplements for rapid healing and in order to avoid recurrence of adenoma in the future.

As a rule, general recommendations about changing your lifestyle to a healthier one are enough to ensure that prostate adenoma does not return.

2018 – 2019, . All rights reserved.

When drug therapy does not give a positive result, the patient undergoes prostate embolization. Although this method is effective and has long been practiced abroad, it is still considered innovative in the countries of the former USSR. What is such a treatment, and how is it carried out?

What is prostate adenoma

A benign tumor formed from the stroma and glandular tissues of the prostate is called adenoma or prostatic hyperplasia. This is the most common urological disease in men, which now occurs not only in the elderly, but also at a young age.

There are many drugs aimed at combating pathology, but their effectiveness is not at the highest level. Ultimately, specialists have to resort to surgical intervention.

What happens if the disease is not treated

The disease begins with minor difficulties with urination: the stream of excreted urine becomes thinner, the duration of the release of the bladder increases to five minutes. Urges become more frequent up to ten times a day, while no more than 50 ml of urine is excreted. There are frequent nocturnal urges, and the man has to wake up several times a night.

Over time, the adenoma grows, problems with going to the toilet increase. A person practically does not leave the house or office due to endless and practically ineffectual urges, which causes discomfort and makes bleak adjustments to everyday life.

The most unpleasant manifestation of prostate hyperplasia is the deterioration of potency, which can destroy sexual life and completely demoralize a man. Despite the fact that adenoma does not metastasize, if left untreated, it can degenerate into prostate cancer.

In addition, the following complications may develop:

• acute urinary retention, in which it is impossible to urinate when feeling a full bladder;
• hematuria, characterized by the appearance of blood in the urine;
• stones in the bladder, which form at that stage of the pathological process, when a large volume of urine begins to remain in the bladder;
• infectious complications (cystitis, pyelonephritis, urethritis, prostatitis);
• development of renal failure, leading to the death of the patient.

Treatment Methods

There are quite a lot of minimally invasive and radical interventions used for prostate hyperplasia. For example, in the presence of complications and adenoma mass of more than 40 g, adenomectomy is indicated. Such treatment is carried out by an open method. With hyperplasia weighing up to 60 g, transurethral resection is used, during which the glandular tissues are removed through the urethra.

These methods have many disadvantages, among which are:

• injury;
• increased anesthetic risk;
• high likelihood of complications;
• development of erectile dysfunction;
• the presence of serious contraindications.

Each procedure is prescribed, taking into account the age of the man, the size of the adenoma, concomitant diseases (diabetes mellitus, cardiovascular problems, blood clotting, etc.). All this prompted scientists to continue further searches for the most universal surgical treatment for benign prostatic hyperplasia.

As a result, the method of embolization of prostate arteries was introduced into clinical practice, which can be prescribed to patients who have contraindications to the above methods of surgical therapy.

What is Prostate Artery Embolization?

A minimally invasive X-ray surgical operation, which consists in blocking the arterial vessels that feed the enlarged gland with blood, is called prostate adenoma embolization (PEA). After it is carried out, the prostate gland decreases in size, and the swelling of the tissues is eliminated. The procedure is performed by an endovascular surgeon, since EAP requires tremendous experience in working with vessels of very small diameter, the ability to control the entire process using an angiographic system.

EAP is a complete replacement for radical open intervention. In many cases, it is used as an additional therapy in patients undergoing medical treatment.

Indications and contraindications for PEA

The procedure is widely practiced for uterine myoma, various tumor formations, bleeding, vascular malformations, aneurysms. In the urological field, this method is used to combat varicocele. Prostate embolization is performed when:

• the presence of contraindications for transurethral resection of the gland;
• detection of a benign formation exceeding 50 cm 3 in volume;
• lack of effectiveness of conservative therapy;
• diagnosing an obstructive form of urination based on the results of uroflowmetry;
• identified cardiovascular and nephrological diseases;
• increased concentration of sugar in the bloodstream;
• restoration of urinary function in people with cystoma;
• expansion of varicose veins of the prostate with bleeding.

Despite the extensive list of indications, this method is not suitable for people with:

• individual intolerance to drugs based on iodine;
• anomalies of the iliac artery;
• aggravated coagulopathy;
• increased content of creatinine in blood serum;
• malignant neoplasms in the prostate.

In addition, there are certain factors that affect the effectiveness of the procedure:

• age category of the patient;
• the severity of the clinical symptoms of the disease;
• the presence of concomitant pathologies;
• the presence of an infectious process;
• urinary dysfunction.

Important! Regardless of the presence of indications and contraindications, EAP is performed only on the recommendation of a qualified physician.

Where performed and cost

The procedure is performed in a clinic equipped with an X-ray operating room with an angiographic complex. Such an intervention is highly effective, painless and less traumatic. It should be carried out by an experienced specialist, using expensive drugs and the latest equipment.

Therefore, the total cost of treatment is quite high. In Moscow, the EAP will cost from 80 to 180 thousand rubles. This amount, in addition to the services of medical workers, includes the price of embolization drugs, which ranges from 15 to 30 thousand rubles per bottle (2 of them are needed), as well as a microcatheter. Its price varies from 70 to 100 thousand rubles.

Preparation for the procedure

EAP has positive feedback from patients. Often the procedure is carried out on the day of hospitalization. Within 6-12 hours after its completion, a man can return home.

On the eve of the manipulation, it is recommended to refrain from a rich breakfast and ensure a normal drinking regimen. The groin area and thighs need to be shaved. Immediately before the operation, the patient is given an intramuscular injection with sedatives and painkillers. Next, a urological catheter with a minimum diameter is installed, which is removed 4-6 hours after the intervention.

Important! If the patient has allergies to any medications, he must inform the clinic staff about this.

How is the procedure carried out

During embolization of the arteries of the prostate, the patient lies on his back in the operating room. ECG sensors are attached to his chest, a cuff is put on his arm that automatically measures blood pressure, and a pulse oximeter is placed on his finger to record the oxygen content in the bloodstream. If necessary, oxygen is supplied through tubes inserted into the nostrils.

EAP is not a painful procedure, so general anesthesia is not needed to perform it. Only local anesthesia is used in the puncture zone of the artery. The puncture is performed on the right thigh just below the inguinal groove. During the intervention, the patient may feel warmth in the groin, abdomen and buttocks. This is due to the action of the contrast agent, which the surgeon uses, introducing through the catheter.

The specialist performs arteriography of the vessels of the internal iliac arteries, establishes the sources of blood supply to the gland and inserts a microscopic catheter into them. As soon as it takes the right place, a special embolization preparation is injected through the microcatheter - a harmless substance consisting of acrylic resin.

After the administration of the drug, a control contrast is performed, confirming the complete blockage of the necessary arteries. Embolization is always performed bilaterally, but catheterization is performed only on the right leg through one puncture.

The manipulation lasts from 40 minutes to five hours, since the capillaries of the iliac artery are rather small in diameter and are difficult to access for catheterization. In addition, in most arteries located in this part of the body, atherosclerotic processes can occur, dramatically changing the anatomical structure of the vascular walls.

Upon completion of the intervention, the surgeon squeezes the puncture site with his fingers to avoid the formation of an extensive subcutaneous accumulation of blood. A hemostatic device is then applied to the leg, continuing to apply pressure to the puncture.

Possible risks and complications of the procedure

Already, embolization of prostate adenoma has numerous reviews from patients and doctors confirming its safety. One of the most possible and frequently encountered complications of the intervention is the formation of a hematoma at the puncture site. It does not require special medical attention and disappears without a trace in one to two weeks.

At the beginning of the use of this treatment technique, some patients recorded cases of short-term violation of the urination process, which was eliminated in one to two days with the help of a catheter. Modern technology for performing embolization of the arteries of prostate adenoma leads to a minimal development of complications.

Advantages and disadvantages of the method

Among the clear advantages of EAP are:

• absence of pain, sutures, incisions, scars;
• fast recovery;
• low probability of any complications in comparison with other surgical interventions;
• minimum hospitalization period - the patient returns home on the same day or the next morning;
• no need for dressings, intensive care and any specialized care of health workers.

Of the significant shortcomings of the EAP, it is worth noting the high cost and inaccessibility for most Russians.

Recovery after the procedure

The recovery period begins almost immediately after returning from the clinic. In patients, 2-5 days after embolization, the frequency of urination is reduced, and fake (false) urges to it are almost completely eliminated. This is due to a decrease in swelling of the seminal tubercle, which is often irritated, causing a desire to go a little.

After two weeks, the gland begins to decrease due to a decrease in swelling of the tissues around the hyperplasia. During this period, the formation itself decreases by 15-20%, which is noted during an instrumental ultrasound examination.

Result after EAP

Research activities on the effectiveness of PEA have shown that in most patients, after manipulation, there was a sharp decrease in the size of the gland, and the process of urination improved. At the same time, 30% of patients noted an improvement in the first week after the intervention. The final recovery and complete elimination of all unpleasant symptoms occurs within a year.

Important! Embolization of the arteries of the prostate, judging by the reviews of men, does not inhibit sexual function, but rather contributes to its restoration.

The main results of the EAP include:

• complete elimination of false urges to empty the bladder;
• restoration of normal urination;
• reduction of the gland by half;
• reduction of hyperplasia by 40-80%.

Do they make it in Russia

The EAP procedure is the most complicated, almost a jeweler's operation, which can only be handled by an experienced X-ray endovascular surgeon. Education and training of such a specialist lasts 10-15 years. As a result, about eighty surgeons are now working in Moscow, while there are more than ten thousand gynecologists. Sixty of the eighty doctors listed are involved in coronary stenting of the heart vessels.

You can find out where the embolization of the prostate arteries in Russia is performed from the attending urologist.

A distinctive feature of the operation is that the indications and the examination plan are carried out by the urologist, and the manipulation itself is carried out by vascular surgeons.

The standard prostate embolization procedure consists of several steps:

1. The man is brought to the operating room, the necessary medical equipment is connected and local or epidural anesthesia is administered.
2. At a distance of 2-3 cm from the inguinal fold, a small incision is made, an arterial catheter is inserted, after which the state and patency of the arteries are studied using angiography.
3. Equipment is installed for blood supply to the prostate during the operation and a device is launched that delivers emboli to the nearest artery.
4. After the introduction of the drug, angiography is repeated to monitor the effectiveness of the embolization of the prostate arteries.
5. All sensors and devices are removed, the incision is sewn up and processed, after which the patient is taken to the ward.

The duration of the operation rarely exceeds 2 hours and mainly depends on the experience of the surgeon. A man can go home the same day.

So, in what cases do surgeons use the prostate artery embolization method? The indication for use is benign prostatic hyperplasia, in which the size of the prostate with a tumor is more than 80 cubic centimeters.

By the way, embolization can be used not only for benign prostatic hyperplasia. Among the indications for use, prostate cancer, varicose veins of the prostate gland, and mechanical trauma to the prostate are also distinguished.

Surgeons also argue that the procedure is advisable to use if there is a rupture of the blood vessels through which the prostate gland receives blood.

Of course, the procedure may not be used in all cases. Recent studies have shown that embolization is extremely dangerous in cases where prostate adenoma is accompanied by an anomaly or occlusion of the iliac vessels.

Strict contraindications are conditions in which there are floating blood clots. What it is? Floating clots are clots that can break off at any moment.

Before surgeons begin embolization of the arteries of the prostate gland, the patient should undergo a comprehensive diagnosis. The patient will have to pass a general blood and urine test, a blood test for sugar, ultrasound of the veins of the lower extremities, and electrocardiography.

A rectal digital examination of the prostate is mandatory. Another patient is shown TRUS of the prostate gland and a blood test for PSA. If the patient has a tendency to allergic reactions, he needs to be tested to determine the sensitivity to anesthetics.

According to the results of the diagnosis, doctors decide whether it is effective in a particular case to resort to arterial embolization, or it is better to choose another procedure.

After arterial embolization, the size of prostate adenoma decreases by an average of 50-80%. The prostate also decreases in size by 30-50%. Thanks to this, it is possible to normalize the process of urination quickly.

Good results in urodynamics can be achieved in just a few days. The urge to urinate becomes much less, pain in the urethra and other symptoms characteristic of benign prostatic hyperplasia disappear.

What feedback do patients leave for embolization of the prostate arteries? In general, people respond positively to this procedure. Most patients note that within a few days after surgery, they feel much better.

In order to avoid relapse in the future, the patient must adhere to the following rules:

1. Monitor PSA levels in the blood and regularly visit a urologist for preventive examinations.
2. Eat a balanced diet. Foods that contain fats (saturated) and simple carbohydrates should be avoided.
3. Refrain from drinking alcoholic beverages. It is especially dangerous to drink beer, as it contains a large amount of phytoestrogens.
4. No smoking.
5. Do not use hormonal drugs unnecessarily. Any changes in the hormonal background are extremely dangerous, because with an imbalance of hormones, a relapse is quite possible.
6. To live an active lifestyle. This is especially true for men who have a sedentary job. Regular walking, swimming and jogging will be very beneficial for your health. In addition, exercise contributes to the stabilization of hormonal levels.

Is it necessary to use any drugs for prophylactic purposes? 5-alpha-reductase inhibitors and alpha-1-blockers are not recommended to be used unnecessarily, as they negatively affect sperm quality and potency.

For preventive purposes, it is best to use bioadditives. They are safe and may well be used after the body has undergone surgery. The best dietary supplement is the Chinese urological patch ZB Prostatic Navel Plasters.

This tool will be an excellent prevention of recurrence. Moreover, the Chinese urological patch can be used even in the treatment of compensated and subcompensated stages of adenoma. Among the indications for the use of bioadditives, prostatitis and other urological pathologies are also distinguished.

ASK A QUESTION TO THE DOCTOR

The operation is performed in a specialized X-ray operating room, which must be equipped with an angiographic complex, which makes it possible to obtain a high-quality picture during the entire procedure.

Embolization is performed not by urologists, but by X-ray endovascular surgeons.

This is explained by the fact that such a process involves precise action with vessels of small diameters using special equipment and tools. The described procedure belongs to the category of the least traumatic. There is no need for general anesthesia.

At the puncture point of the artery, only local anesthesia is used, so the patient does not hurt at all. The surgeon performs a puncture on the thigh just below the inguinal fold. During the entire operation, the patient may feel warmth in the abdomen, groin, buttocks.

The effectiveness of the procedure

Long preparation for the procedure is not required. However, the patient should shave the hair from the groin area and refrain from eating 4 hours before embolization. Liquids are allowed, but in moderation.

If necessary, the doctor prescribes a number of antibiotics to the patient before the procedure. Also, before the procedure, surgeons make an intramuscular injection with a sedative and anesthetic, after which a Foley catheter is installed.

Embolotherapy, like any other medical technique, has a number of indications and contraindications.

Indications

• impossible to carry out endoscopic transurethral resection of the prostate;
• benign prostatic hyperplasia (tumor volume over 80 cc);
• lack of positive dynamics in therapy with conservative methods;
• obstructive type of urination according to uroflowmetric study;
• the presence of pathological disorders of the cardiovascular system;
• nephrological diseases;
• elevated blood glucose levels;
• restoration of urinary function in patients with cystoma;
• expansion of varicose veins of the prostate, accompanied by bleeding;

Contraindications

• intolerance to medicines based on iodine;
• anomalies of the iliac artery;
• life history aggravated by coagulopathy;
• elevated levels of creatinine in the blood;
• malignant formations of the prostate;

Factors that directly affect the effectiveness of the procedure:

1. Age group of the patient.
2. Explication of the disease.
3. The presence of concomitant pathological processes in the body.
4. Infection of the urinary system.
5. urinary dysfunction.

Embolization of prostate arteries is a specific procedure that requires special skills and abilities. The procedure under consideration assumes significant experience of surgeons who perform manipulations on small-diameter vessels.

Thanks to narrowly focused specialists, as well as the availability of high-precision medical equipment and medical instruments, arterial embolization is not a problem.

• malignant neoplasms (prostate cancer);
• mechanical damage, trauma to the gland;
• varicose veins of the prostate, profuse bleeding;
• damage to the prostatic arteries;
• intolerance to general anesthesia;
• presence of a urinary catheter or cystostomy.

Embolization is prescribed in case of severe concomitant diseases in a man: diabetes mellitus, renal or hepatic insufficiency, impaired hematopoietic function, ischemia, myocardial infarction, stroke.

The procedure is performed when the patient refuses an open operation, or if the state of health does not allow an incision of the bladder, surgical intervention through the urethra.

Doctors insist on embolization when there is a rupture of the vessels through which blood enters the prostate.

The described type of treatment, like any other therapeutic technique, is distinguished by the presence of indications, contraindications for its implementation.

So, the main indications of the doctor's procedure include:

• the presence of a ban on endoscopic transurethral resection of the prostate;
• diagnosis of benign prostatic hyperplasia with a tumor size of more than 80 cm3;
• there is no positive dynamics in the treatment with standard methods;
• the presence of an obstructive type of urination according to the uroflowmetric study;
• diagnosing pathological disorders of the cardiovascular system;
• nephrological ailments;
• increased amount of sugar in the blood serum;
• regenerative process of urinary functions in patients with cystoma;
• the presence of expansion of varicose veins of the prostate gland with bleeding.

Despite such a significant list of indications for the described procedure, it also has contraindications, which it is desirable for every patient with prostate adenoma to know.

The main contraindications for embolization include the presence of:

• individual intolerance to drugs based on iodine;
• anomalies of the iliac artery;
• aggravated coagulopathy;
• increased levels of creatinine in the blood;
• malignant tumors of the prostate.

In addition to the contraindications listed above, there are some other factors that directly affect the effectiveness of the procedure. These include:

• patient's age;
• explication of the disease;
• diagnosing a concomitant process in the body;
• infection of the urinary system;
• urinary dysfunction.

Regardless of the available indications, contraindications, embolization can only be prescribed by a qualified doctor.

Contraindications

One of the undoubted advantages of the embolization method is the complete absence of mechanical impact on the prostate tissue. The operation affects only the local arteries that feed the gland, which expands the list of indications for the application of the technique.

Initially, the method of intravascular blockage of the arteries was used to treat prostate adenoma. Gradually, the range of effective use of the technique was expanded. Embolization of the prostate arteries is carried out in case of diagnosing the following diseases and pathologies:

• Prostate cancer. Restriction of food allows you to reduce the activity of cancer cells, stopping the growth of the tumor or slowing down its development.
• Prostate injury. Damage to the parenchymal tissue is usually accompanied by prolonged bleeding, which is difficult to stop. Using the modern method of arterial embolization, it is possible to eliminate blood loss and restore the organ's performance.
• The presence of concomitant heart diseases, diabetes mellitus, renal or hepatic insufficiency, diseases of the blood coagulation system are a contraindication for most surgical operations. Due to low trauma, embolization of prostate arteries becomes almost the only way out for such patients.

A good result is given by the technique in the presence of varicose veins in the pelvic area. The lack of effect of ongoing conservative therapy or surgical removal of the tumor with negative results is also an indication for intravascular embolization of the prostate arteries.

Limitations to the use of the method are associated with the presence of systemic diseases that interfere with the implementation of anesthesia or are accompanied by an increased risk of complications during surgery or during the rehabilitation period.

Embolization of the prostate arteries is contraindicated in patients who have a history of the following pathological conditions and disorders:

1. Individual intolerance to drugs that are used as a contrast agent to monitor the progress of the operation.
2. Acute infectious and inflammatory diseases that increase the risk of postoperative septic complications.
3. chronic diseases internal organs in the stage of decompensation.
4. Severe form of bronchial asthma.
5. Post-infarction or post-stroke condition.
6. Thrombosis of deep and superficial veins of the lower extremities.
7. Stenosis and blockage of arterial vessels.

Before embolization of the prostate arteries, the patient undergoes a full course of diagnostics to exclude the possibility of surgery in the presence of threatening conditions.

The decision on the advisability of embolization is made by the attending physician. In the case of additional diseases, a man needs to consult several specialized specialists. The procedure is not available to everyone, it has a number of contraindications:

• individual intolerance to iodine preparations;
• floating (capable of breaking off at any moment) blood clots;
• occlusion of the iliac vessels;
• pathological changes in the iliac vessels;
• coagulopathy (blood clotting disorder).

Possible Complications

The most common complication after embolization of the prostate arteries is the formation of a hematoma at the site of catheter insertion. It does not require treatment, but for a speedy disappearance, you can use ointments or apply cold to the bruise.

In addition to the hematoma, urination disorders develop:

• Urinary retention;
• Frequent, false urge to urinate;
• Painful urination.

The risk of developing infectious diseases is minimal due to the small area of ​​intervention and the use of sterile instruments. Prophylactic antibiotics also help prevent infection.

The use of local anesthesia can cause an allergic reaction at the injection site. It manifests itself immediately after using the medication, and 3-4 days after the operation.

There is also a risk of complications that are associated with the inexperience of surgeons.

Since embolization is one of the least traumatic procedures, it does not lead to any very serious complications. However, they are possible.

Since large hematomas are instantly emptied, such a consequence as suppuration is usually superficial and does not require an enhanced course of therapy.

Price

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Embolization of the prostate arteries in BPH can only be done on an outpatient basis without hospitalization. True, the patient may remain in the hospital until the next morning.

Since the procedure is quite effective and is performed by a highly qualified specialist, its cost for some can be very solid.

Thus, the cost of prostate artery embolization in Moscow reaches 60-100 thousand rubles. In general, the cost of the operation consists of several points. It includes the cost of embolization material, which ranges from 15-30 thousand rubles. for 1 bottle. And they need 1-2 pieces.

The whole process is not at all routine. Since it is problematic to perform manipulations with a single catheter, microcatheters are usually used to prevent the onset of various complications. The cost of the 1st microcatheter is about 70-100 thousand rubles.

This is a new technique, prescribed in the absence of the effect of standard therapy and carried out only by qualified specialists.

- a procedure aimed at reducing the volume of neoplasms in the prostate gland by 80%.

Embolization allows you to achieve a stable remission, but for this, in the postoperative period, you should follow all the doctor's recommendations and regularly undergo examinations.

Method features

The method of embolization is to artificially limit the blood supply to the prostate, which leads to a decrease in the gland by about 30%.

Using this method, it is possible to eliminate pathological processes not only in the male, but also in the female body, especially for oncological diseases.

For the first time the method was applied in Brazil, the overall effectiveness of the treatment was 90%. For prostate pathologies, the technique was tested in 2008, with excellent results.

Already 1.5 weeks after the blockage of blood flow, the patient shows signs of complete relief from the symptoms of the disease. Today, the technique is gradually being introduced in Russia, also showing good results.

Treatment is carried out in large urological centers and clinics. Currently, it is planned to introduce this method of therapy everywhere, because it allows you to eliminate adenoma without surgical intervention.

Indications and contraindications

Prostate embolization is carried out using modern technologies. A feature of the procedure is that the removal of tissues of the overgrown organ is carried out locally.

The blocking of blood vessels does not affect the tissues, all manipulations are as accurate as possible and gentle to the surrounding organs.

This type of treatment is indicated in the following cases:

1. with severe pain in the affected area;
2. if urination is accompanied by burning, severe pain, pain that radiates to the pubic area, lower back (conventional painkillers do not bring relief or help, but weakly);
3. frequent urge to go to the toilet, do not bring relief;
4. the volume of residual urine is quite large.

With timely prescribed and carried out therapy, at the stage when hyperplasia is just beginning to develop, the percentage of those who have recovered is quite high.

According to studies, in 95% of cases it is possible to completely stop the pathogenic process, i.e. achieve elimination of the disease.

If the pathology is in a more advanced stage, then the treatment prognosis will not be so favorable. Usually the probability of recovery is no more than 5%. In addition, the method may not be assigned in all cases.

The vascular blocking method is contraindicated in such situations:

• the patient has blood clots, which can lead to occlusion of blood vessels or serious consequences during separation;
• there are anomalies in the structure of blood vessels;
• the conduction of the iliac vessels is seriously reduced.

The result of treatment is mostly positive, but only with timely identification of the problem and the beginning of therapy. Increasingly, prostate embolization is prescribed for oncology, gland injuries, cystostomy, and bleeding.

Preparation for EAP

Therapy is carried out only as prescribed by a doctor. Before treatment, it is necessary to undergo diagnostics, which will confirm the diagnosis and show whether embolization can be used in a particular case.

In preparation for the procedure you need to do the following:

1. a couple of hours before the procedure, refuse high-calorie foods;
2. in the inguinal region, the entire hairline is removed;
3. the doctor should be notified of the presence of allergic reactions to any medications(if necessary, samples will be taken).

Features of the EAP

X-ray endovascular embolization of the prostate arteries is a special technique carried out under the control of an X-ray machine. During therapy, manipulations on the vessels are carried out.

All actions of the doctor must be as accurate as possible so as not to hurt the surrounding tissues. Also, the specialist additionally monitors the course of the procedure using angiography.

Embolization procedure for benign neoplasms of the prostate includes the following steps:

• preparation of the operating area (hairline is removed beforehand);
• the doctor injects a local anesthetic into the area of ​​the femoral artery (general anesthesia is not required, as well as long-term hospitalization of the patient);
• in the region of the lower inguinal fold, a small incision should be made through which the catheter is inserted;
• the contrast agent through the catheter goes directly to the affected area and blood vessels;
• blood flow is blocked using a special embolization preparation (it contains epoxy resins that do not pose a health hazard and do not cause adverse reactions);
• all manipulations are carried out under strict control, the doctor can choose a specific vessel to block, which greatly increases the effectiveness of treatment;
• if necessary, bleeding quickly stops, which protects the patient from the risk of surgical complications;
• the catheter is removed.

The procedure is carried out as soon as possible, its advantage is that normal urination is restored quickly, destructive processes stop, and the gland gradually decreases in volume to normal levels.

Possible complications and risks

Innovative therapy allows you to completely get rid of the disease if the treatment was prescribed in the early stages, but the effectiveness of manipulation depends entirely on the age of the patient, the qualifications of the doctor and the degree of development of the pathology.

That is why one of the main places is occupied by preliminary early diagnosis and the experience of a specialist who will carry out all the manipulations.

According to statistics, the use of the technique allows to achieve the effect of stable remission, which lasts for several years.

Today, the highest quality service and a positive result can be provided by therapy in foreign clinics, where there are doctors with the necessary high level of qualification and experience in performing such manipulations.

Also important is the availability of modern equipment used to block blood vessels and control all the actions of a doctor. In any case, you should contact only those specialists who have extensive experience in vascular urology.

Manipulations do not affect the surrounding tissues, they only affect specific vessels, blocking blood flow. There are practically no complications, but in some cases there are difficulties with the withdrawal of the contrast agent.

Therefore, all procedures are performed strictly under the supervision of a doctor, which ensures a quick withdrawal of the substance and no harm to the organs of the genitourinary system.

Recovery after surgery is quite fast, it does not require special medical manipulations. Dressings are not needed, in addition, the patient is not limited to physical activity.

The patient can maintain a normal daily routine, continue to work.

If the procedure went well, the patient is discharged home the very next day: there is no need to stay in the hospital. Usually, the duration of stay in the clinic, including examination and postoperative period, does not take more than three days.

Embolization of prostate adenoma is allowed in about 98% of cases, that is, there are almost no contraindications.

The technique is minimally invasive, it does not cause complications or deterioration in the health of the patient, allowing you to get rid of the disease.

There are almost no negative consequences after therapy, and a repeated blocking procedure is also not required.

• undergo regular preventive examinations with a doctor;
• monitor the indicators of a specific antigen of the prostate;
• exclude from the diet all foods saturated with fats and simple carbohydrates, do not eat junk food, fast food;
• monitor the normal level of saturation of the body with minerals and vitamins, exclude alcohol, especially beer containing phytoestrogens;
• complete cessation of smoking;
• all medications are taken only after consulting a doctor, so as not to provoke a deterioration in the condition;
• avoid stagnation due to low activity; It is recommended to go swimming, walk more.

Where can I get an EAP

To undergo the procedure, you should contact a specialized medical facility that deals with vascular urology and has equipment for such manipulations.

Today, the number of such medical centers is not too large, and the queues in them are very long.

The price of treatment is almost the same as laser therapy, but embolization has practically no side effects. Traditional surgery with this method is not needed, the recovery time is minimal, and the patient is sent home the next day.