It turns out to be ineffective, then prostate artery embolization (PEA) becomes a more effective treatment option.

Despite the widespread use of such treatment in foreign countries, in Russia the technique belongs to the category of new ones. This article will discuss what prostate embolization is, what are its advantages and disadvantages.

X-ray endovascular embolization is a manipulation to limit blood flow to the affected organ. This effect is achieved by blocking the blood vessel.

It should be noted that in addition to, the technique is often used in the treatment of various ailments of both male and female genital organs.

Embolization of the prostatic arteries

The operation itself is minimally invasive, characterized by insignificant, as well as minimal risks of any complication. At the end of the procedure, it is reduced in size by 1/3, which is reflected in the positive well-being of the patient.

The effectiveness of the procedure reaches 90% in men suffering from prostate adenoma. EAP is distinguished by the presence of a number of advantages, one of which is.

The advantages of the doctor's procedure also include:

• complete absence of danger of carrying out;
• significant performance;
• low percentage of trauma;
• no side effects.

But the main difficulty lies in the problem of choosing a clinic where you can perform the procedure.

Since embolization is a minimally invasive technique, the risk of developing serious complications after it is almost completely eliminated.

Prostate adenoma and other indications for the procedure

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

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

• the presence of a ban on endoscopic;
• 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.

Contraindications

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;

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;
• urinary dysfunction.

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

How is prostate surgery performed?

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 crease of the inguinal. During the entire operation, the patient may feel warmth in the abdomen, groin, buttocks.

Embolization of the arteries of the prostate

The appearance of such a sensation is facilitated by a contrast solution injected by an X-ray endovascular specialist through a catheter. During such an intervention, the doctor must establish the source of blood supply to the prostate gland.

After that, under the control of equipment that emits x-rays, introduce a microcatheter into them. As soon as the correct position of the microcatheter is confirmed, special particles of the embolization preparation, a non-hazardous substance consisting of acrylic resin, are injected through it.

This allows you to stop the blood supply by blocking the arterial vessels that provide blood flow to the enlarged prostate.

As soon as the particles are completely introduced, the final contrast is carried out, confirming the reliability of the blockage of the prostate arteries.

Catheterization of prostatic branches is performed from 2 sides through 1 puncture. As a result, the prostate shrinks over time, resulting in narrowing of the urethra. All this leads to the restoration of a normal outflow of urine, as well.

Possible complications after surgery

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.

Doctors are prescribed ordinary ones. It happens that the arteries are damaged during the operation, which may result in the formation of atrophy of the testicles. Dropsy of the testicles occurs as a result of ligation of the lymphatic vessels.

Some patients notice the occurrence for 2 weeks, which then disappear. Very often, the signs of the disease do not disappear with subsequent recurrence of the varicocele, which happens with insufficient intravascular obstruction.

The result of varicocele is sometimes impotence, infertility. For this reason, a man should not ignore the symptoms of the disease. Moreover, the signs themselves are not pronounced, but appear already at an advanced stage of the disease.

Price

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. urge to go to the toilet is frequent, does 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.

• Painless
  The operation is performed by a cardiovascular surgeon under local anesthesia. The patient is conscious throughout the operation.
• Safely
  After puncture of the femoral or radial artery, under X-ray control, a special embolizing substance is introduced through the catheter into the artery of the prostate, resulting in a stoppage of blood flow to the prostate gland.
• Effective
  The blood flow to the tissue of prostate adenoma is selectively blocked, its size gradually decreases, and the function of urination is normalized.

The operation is performed in an X-ray operating room with a full range of modern equipment. The patient lies on a sterile operating table, after which the artery puncture area is cleaned with a sterile composition. Next, a dropper is installed in order to avoid complications during surgery. Painkillers and sedatives are used to relieve nervous tension. Then a pulse oximeter is connected to the index finger, thanks to which the surgeon monitors the amount of oxygen in the blood and the pulse.

A person may experience discomfort and fever due to the entry of a contrast agent into the blood. In this case, the introduction of the catheter is absolutely painless. Before the puncture, the surgeon uses novocaine to eliminate pain. Next, a needle with the optimal thickness and length is inserted into the artery. This is necessary for the introduction of a metal string with a thin tip (after the introduction, the needle is removed). After that, an introducer is inserted into the string, which allows preserving the integrity of the artery and preventing extensive blood loss. Next, the catheter is smoothly introduced into the introducer (the process is controlled by radiography). This allows the surgeon to clearly see the arteries that supply blood to the BPH. A contrast agent is used to enhance the image.

The next step is the introduction of embolizing particles into the enlarged intranodal arteries through a syringe (particle size is not more than 0.5 mm). After that, the specialist presses on the area of ​​​​the operation for about 15 minutes, which allows you to prevent the accumulation of blood. Next, a heavy bandage is applied to the operated area, which is removed after 24 hours. During the day after surgery, you need to keep calm and not get out of bed.

Why do they trust us and choose the CELT clinic?

• Embolization of the prostate artery is technically more difficult than many other endovascular operations. Therefore, the qualification of doctors is the most important factor that a patient should pay attention to when choosing a doctor and clinic. Our doctors have more than 20 years of experience in performing endovascular operations of varying severity
• We were one of the first to start embolization of prostate adenoma in Europe and the world (!). Since 2008, more than 300 such operations have been performed.
• Extensive experience of urologists, endovascular surgeons and the latest equipment guarantee the effect and minimal risk of complications.

• We do not have queues for treatment, which allows us to hospitalize the patient as quickly as possible (in 1-2 days) and perform the operation.

One of the newest ways to treat prostate adenoma is arterial embolization. The decision on the necessity and expediency of using this method is made after a joint discussion between the urologist and the endovascular surgeon. Embolization is carried out according to special indications, these are:

• prostate adenoma, the volume of which is more than 80 cubic meters. cm;
• lack or insufficiency of the effect of ongoing conservative drug treatment;
• obstructive urination.

An increase in the size of the prostate and adenoma can be detected using conventional and transrectal ultrasound. Through them, important indicators are evaluated, according to which the need for embolization is determined, these are the exact dimensions of the prostate, its structure, the presence of calcifications and the orientation of the nodes, the determination of residual urine.

Obstructive type of urination, which is an indication for embolization, is characterized by the following symptoms:

• sluggish stream;
• urinary retention;
• tension of the abdominal muscles to start the act of urination;
• jet discontinuity;
• after urination, it is felt that the bladder does not empty completely;
• urine comes out drop by drop.

Urinary obstruction is determined using uroflowmetry. This procedure is carried out using a special apparatus in which you need to urinate. He analyzes the process of urination by changing its speed.

Features of embolization of prostate arteries

Artery embolization as one of the options for the treatment of adenoma is highly effective. The essence of this procedure is to limit the flow of blood to the gland. Blockage of blood vessels leads to the cessation of blood flow and, accordingly, a decrease in the size of the prostate by about 30-50%. As a result of this operation, urination is also facilitated.

This surgical manipulation is performed by the surgeon under the control of the angiographic apparatus. To search for the artery supplying the adenoma, it is necessary to selective angiography. This procedure is performed using X-rays so that after the injection of a contrast agent, the surgeon can clearly see the real picture and carry out embolization. It is carried out in several stages:

1. First, the puncture site in the thigh area is anesthetized. The procedure itself does not cause pain to the patient, but before the puncture of the femoral artery, this place is anesthetized.
2. A thin catheter is inserted through the puncture.
3. After a blood supplying artery is found, an embolization preparation is injected into it through a catheter, usually a special medical plastic is used.

Any special preparation for the embolization procedure is not required, there is only a restriction in food intake (it is desirable to have the last meal before 20-00 in the evening before the day of the operation). Before the procedure, the patient is given an ECG, chest x-ray, CT scan of the urinary system.

After embolization of prostate arteries the likelihood of side effects or complications is minimal. Rarely, minor bleeding, temporary urinary retention, or inflammation from the inserted catheter may develop. After the intervention, the patient must limit physical activity, follow a special diet and refrain from sexual activity for at least 1 month.

Embolization of varicocele

Experts identify a number of factors that can cause the development of such a pathology. These include an inflammatory process in the sex glands, hormonal disorders, vascular injuries, and a sedentary lifestyle. The disease can also be congenital.

Signs of varicocele are:

• asymmetry of the testicles, the affected side becomes smaller in size;
• sagging and enlargement of the scrotum due to dilated veins;
• pain in the scrotum;
• sexual dysfunction;
• violation of spermatogenesis.

Diagnosis of varicocele is carried out by palpation, ultrasound and dopplerography. Signs of this pathology on ultrasound will be an expansion of the vein inflow by more than 3 mm and a violation of blood flow.

Hyperplasia refers to the processes of increasing tissue or organ by quantitative multiplication of cells. Their accumulation in certain places causes a narrowing of the path for the urinary outflow. BPH does not belong to oncological diseases and is not associated with the development of cancer.

REFERENCE! It is believed that BPH occurs in more than 50% of men over 60 years of age. The increase in age leads to an increase in the risk of this disease. According to statistics, BPH is becoming one of the most common urological diseases in older men.

Traditional methods of treatment. Briefly tell us about the treatment options, on which they can be used, folk, drug options, operations - what are there, what complications are possible.

Treatment of BPH involves the use of funds to increase urinary outflow.

To achieve this goal, apply:

• invasive and laser procedures;
• with partial removal of the prostate.

IMPORTANT! However, all these methods of treating BPH have limitations associated with the age of the patient, the presence of other diseases (cardiovascular), and the size of the adenoma. The need to find a modern technique (the least traumatic and the most effective) led to the introduction of embolization.

Embolization of vessels in prostate adenoma

Embolization involves the selective occlusion of blood vessels with the deliberate introduction of emboli into the artery of the prostate. In other words, a blood vessel is intentionally blocked. This leads to the effectiveness of treatment and a minimally invasive effect on the organs of the human body.

The method of vascular embolization for BPH is recognized as the most modern method of treatment. It has been intensively used in technologically advanced countries since 2009.

The procedure is performed using special angiographic equipment. The operation is not performed by a urologist. She is trusted by an endovascular surgeon.

He has manipulative experience in dealing with vessels of the smallest diameter (less than 1 mm) and skills in working with X-ray television (angiographic apparatus).

The essence of the treatment is the actual blockage of the arterial vessels that supply blood to the enlarged prostate gland. Restriction of the blood supply leads to a decrease in the size of the prostate gland.

Embolization of the arteries of the prostate in BPH is effective when the volume of the adenoma exceeds 80 cm3.

This operation is applied when:

• blood clotting disorders;
• severe course of diabetes;
• diseases of the cardiovascular system;
• concomitant kidney disease;
• desire to get rid of the cystostomy.

Contraindications for embolization are:

• the presence of floating thrombi in the venous basin of the lower extremities;
• anomaly and lesion of the iliac vessels.

How is it going?

1. The decision on the need for embolization is made by a council of doctors (urologist, endovascular surgeon), taking into account the wishes of the patient. The operation is performed in an office equipped with X-ray television.
2. Usually embolization for BPH is carried out on the day of hospitalization. On the eve of the groin and thigh area (10 cm below/above the inguinal fold) shaved. It is recommended not to eat for 4 hours before the operation.
3. Immediately before the operation, premedication is done (sedative and analgesic drugs are administered intramuscularly) and a urinary catheter is installed. Local anesthesia is used during the operation. A contrast agent is injected through the catheter.

   REFERENCE! The main task is to find the endings of the blood supply to the prostate. A microcatheter (0.6–0.8 mm in diameter) is inserted into these sources, and an embolus (intravascular substrate) is inserted through it. Then it is checked whether all the selected vessels of the prostate are securely blocked.

4. The operation lasts within 40 minutes - 5 hours. Much depends on the individual anatomical features of the patient. After the end of the procedure, the doctor presses the puncture site with his fingers (10-15 minutes). This prevents the formation of a hematoma.

It is common practice to discharge a patient 6 hours after vascular embolization in BPH. But for greater safety, it is better to stay in the hospital until the next day.

What is the effectiveness of the procedure?

International research programs have confirmed the high level of effectiveness of embolization in BPH. Most patients experience an improvement in urination due to prostate reduction within 1 to 4 weeks after surgery. Complete normalization of urination and regression of the symptoms of the disease occur by the end of the year.

After a successful operation:

• the physiological frequency of urination is restored;
• false urge to urinate disappear;
• adenoma decreases by 40–80%;
• the total size of the prostate gland is reduced by 30-50%.

With prostate adenoma, embolization does not lead to inhibition of sexual function. In some cases, even contributes to its restoration.

Possible Complications

Embolization is a painless intervention. Complications after embolization of the arteries of the prostate, in some patients (approximately 5%) appear in the form of a hematoma. Its formation is possible at the site of arterial puncture. No special treatment is required.

In rare cases, there is a short violation of urination (dysuria). Eliminated by catheterization of the bladder (within 1-2 days).

Conclusion

The success of embolization is not affected by the increased size of the prostate gland. If the patient later requires conventional surgery, the earlier embolization will facilitate the operation and reduce the risk of bleeding. The new technique often prevents further intervention.