Immediately after prostate artery embolization, the vast majority of men don’t feel any pain or discomfort in their prostate gland. While we block off most of the blood flow to the prostate gland through the prostatic arteries, it always gets some blood supply via collateral arteries from its neighboring structures in the pelvis, namely the bladder, the rectum, the pelvic floor muscles, and the male sex organs. This makes embolization of the prostate gland far less bothersome than embolization of other organs, such as the liver, spleen, or uterus. This is also likely why infection of the prostate gland is virtually unheard of after having a PAE.
For several days
For several days after prostate artery embolization, some men may begin to experience some mild pain in the region of their prostate gland. It should be easily controlled with over-the-counter medicine. We prescribe extra strength anti-inflammatory medicine, like ibuprofen, to be taken if necessary. It never requires narcotics. About a quarter of men will experience some combination of urinary symptoms beginning the evening of their embolization. This can include frequent urination, burning during urination, and a small amount of blood in the urine or semen. This is sometimes called post-prostate embolization syndrome. We prescribe a urinary tract pain relief medication to reduce any discomfort. During this period, some men may also find that their lower urinary tract symptoms caused by prostate enlargement slightly worsen. This is potentially due to prostate gland swelling in the days following PAE. We prescribe a short steroid taper to reduce swelling of the gland and keep patients on any medications they are taking for their enlarged prostate symptoms, like tamsulosin. The important thing to remember is that these symptoms are transient, and patients should return to normal after several days.
After around 10 days, urinary symptoms related to prostate enlargement should begin to improve. The process is gradual, and improvement can incrementally continue out to 3 months or so. We follow up with patients at 1 month, and by that time, there should be noticeable improvement of the strength of the urinary stream. That will tell us that the embolization has been effective in reducing the size of the prostate gland. At this time, we usually stop any medicines for an enlarged prostate. The urinary symptoms related to incompletely emptying the bladder should also have improved, such as needing to go often and waking up multiple times at night to urinate. Some men will have developed an overactive bladder in response to an enlarged prostate. These symptoms can take several months to improve after a successful embolization as the bladder adjusts to an easier job evacuating urine. In some cases, the overactive bladder symptoms persist, and these can be treated with medicine or other procedures. At three months, when we see patients in the clinic for a follow up appointment, we will evaluate urinary symptoms again and make any recommendations if necessary.
Long term follow up has demonstrated that improvement after prostate embolization lasts between 5-10 years.