Prostate Artery Embolization (PAE) is a minimally invasive technique used to treat Benign Prostatic Hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. The procedure involves an interventional radiologist inserting a catheter, usually through the groin or wrist, and guiding it to the arteries supplying the prostate. Microscopic particles are then injected to block the blood flow, which causes the prostate tissue to shrink over time. Understanding the difference between expected recovery symptoms and rare complications is important for anyone considering this treatment option.
Common and Temporary Post-Procedure Symptoms
The most common side effects following PAE are generally mild and are often grouped under “Post-Embolization Syndrome” (PES), which is a normal inflammatory response as the prostate tissue reacts to the reduced blood supply. Symptoms of PES typically appear within the first few days and resolve completely on their own within a week or two.
Pelvic discomfort is a frequent symptom, often described as a dull ache, cramping, or pressure in the lower abdomen or perineal area. This pain is usually manageable with prescribed or over-the-counter pain medication. Some men may also experience mild, flu-like symptoms such as a low-grade fever, fatigue, or nausea, which are part of the body’s reaction to the treated tissue.
Urinary changes are common. Patients may notice a temporary increase in urinary frequency or urgency, or a burning sensation during urination, known as dysuria. These symptoms usually start to improve as the inflammation subsides.
Changes in bodily fluids are also expected. Seeing blood in the urine, called hematuria, is common for a few days following the procedure. Similarly, some patients may temporarily observe blood in their semen, known as hematospermia, which can last for a couple of weeks.
Potential Rare and Serious Complications
One of the most serious but rare risks is Non-Target Embolization, which occurs when the microscopic particles inadvertently travel to arteries supplying organs other than the prostate. This complication is possible due to the complex and variable branching patterns of pelvic blood vessels. The risk of this is minimized by the skill of the interventional radiologist and the use of advanced imaging to confirm the correct vessel placement.
The particles can block blood flow to nearby structures like the bladder, rectum, or even the penis. This can cause localized tissue damage, such as bladder wall inflammation.
Infection is a potential risk, manifesting as a Urinary Tract Infection (UTI) or a prostate infection. The reported occurrence of UTIs after PAE is relatively low, typically ranging from 2% to 8%, and these infections are usually treated successfully with antibiotics. Acute urinary retention, a temporary inability to urinate, can also occur in a small number of cases due to significant post-procedure swelling.
Complications can also occur at the access site. While mild bruising is normal, more serious issues include excessive bleeding, the formation of a pseudoaneurysm (a localized collection of blood outside the artery wall), or damage to the blood vessel itself.
When to Seek Urgent Medical Attention
It is important to distinguish the expected post-procedure symptoms from signs that indicate a medical emergency. Patients should be aware of specific thresholds that warrant immediate contact with their healthcare provider or a visit to the emergency room.
A persistent or high fever is a warning sign, especially if the temperature exceeds 101.5°F (38.6°C), as this may suggest a serious infection. Severe pelvic or abdominal pain that does not improve or is not controlled by the prescribed pain medication requires urgent evaluation. Pain that increases in intensity over time rather than decreasing is a cause for concern.
Any inability to pass urine, known as acute urinary retention, is a medical emergency that needs immediate attention. This symptom suggests that the prostate swelling is severely obstructing the urethra, and a catheter may be needed to drain the bladder.
Concerns at the access site include a growing lump, a mass that pulses, or bleeding that cannot be stopped with firm, continuous pressure.
While minor discoloration is normal, any heavy or prolonged flow of blood is not. These severe symptoms are rare, but being able to recognize them and act quickly is paramount for a safe recovery.