PAE vs. Urolift: A Treatment Comparison for BPH

Prostatic artery embolization (PAE) and the UroLift procedure offer two very different methods of treating the symptoms caused by enlarged prostates.

PAE vs UroLift - Treatment Comparison

This condition, also known as benign prostatic hyperplasia (BPH) causes lower urinary tract symptoms (LUTS) like increased urinary frequency and urgency in older men.

While both procedures are minimally-invasive and effective, there are a few key differences that make prostate embolization the preferred option in most cases by our southern California radiologists!

What is the UroLift procedure?

The UroLift procedure is an endoscopic one that involves the insertion of tiny implants into the prostate to open the urethra and allow for improved urinary flow. The implants hold enlarged prostatic tissue away from the urethra, thereby reducing the pressure there.

While UroLift is generally very effective at improving urinary flow, its advantages and limitations should be considered when deciding on your wellness plan.

Advantages of UroLift

The UroLift procedure is minimally-invasive, and is effective at reducing the symptoms associated with BPH. It is performed under local anesthesia in an outpatient setting, and patients can usually return home that same day.

UroLift also does not inhibit sexual function in men. Men who have gone through the UroLift procedure may also try other future treatment options should they be interested in a more permanent solution.

Limitations of UroLift

The first limitation is that UroLift does not address the underlying cause of BPH, which is that a patient is experiencing an enlarged prostate. As such, it is not uncommon for the condition to recur over time.

Additionally, the procedure can be associated with a number of side effects, including:

  • Bleeding
  • Infection
  • Pain

This can be especially concerning for older men or those with underlying health conditions.

Another limitation of UroLift is that it is not suitable for all men! In general, it is only recommended for prostates that are less than 80 grams in size. Thus, men with very large prostates over 80 grams in size are not good candidates for the UroLift procedure.

Lastly, the effectiveness of the UroLift procedure has been shown to last for only for a short duration. Up to 12% of patients who underwent UroLift needed subsequent re-treatment after only 2 years.

What is prostatic artery embolization?

Prostatic artery embolization (PAE) is an image-guided procedure that involves the injection of tiny particles into the prostate arteries, which blocks the blood supply to the prostate and causes it to shrink.

This procedure is done under local anesthesia and usually takes about an hour to complete!

Advantages of PAE

PAE offers several advantages over the UroLift procedure.

Embolization is the less invasive option of the two BPH treatment options. While the UroLift procedure requires the insertion of tiny implants into the prostate, prostate embolization involves only the injection of tiny particles, which flow to the prostate arteries.

Additionally, prostate embolization is better suited for treatment of larger prostates and may offer better long-term relief. It is a safer and more effective treatment option for BPH this way, and offers faster recovery, reduced recurrence risk, and fewer potential complications than does the UroLift.

Next, while UroLift has been shown to have little effect on sexual function, PAE offers not just improvement in the patient's urinary symptoms, but also shows improvement in sexual function for those who've been inhibited due to their enlarged prostates.

In terms of its universal applicability, prostate arterial embolization is better suited for patients with prostates of all sizes.

Limitations of PAE

There are few objective disadvantages to prostatic artery embolization that are specific to the procedure.

In both procedures, some patients have expressed disappointment that the bladder relief experienced post procedure is not large enough. In those cases, they may require a follow up treatment that relies on a more invasive solution.

Some patients have expressed experiencing "post-PAE syndrome" in the immediate days following their procedure. These may include, but are not limited to:

  • Nausea
  • Vomiting
  • Fever
  • Pelvic pain
  • Frequent urination

These effects usually subside within days. If they are experienced for longer periods, then patients are encouraged to schedule a follow up consultation with their healthcare provider.

In conclusion

Given the advantages and disadvantages of PAE and UroLift described above, many men prefer undergoing the embolization procedure. It addresses the root condition causing the enlarged prostate, is the less invasive option of the two, and offers more comprehensive relief.

Anecdotally, the LAIIC team recently performed PAE for a patient with an enlarged prostate who previously underwent a UroLift procedure. Shortly after UroLift was performed, he developed bloody urine and did not have any improvement in his urination frequency or the urgency.

The PAE procedure was performed easily in about 1 hour through a pinhole access in the wrist artery. His urinary bleeding resolved shortly thereafter, and his urinary symptoms improved completely without any adverse side effects.

He will have a long lasting response as his prostate shrunk by 43% after receiving the PAE procedure!

If you have questions about treating an enlarged prostate in Southern California, please feel free to give us a call or contact us to schedule an appointment.