What Happens During a PAE Procedure — Step-by-Step, From Catheter to Recovery

Medicine Made Simple Summary

Prostate Artery Embolization (PAE) is a minimally invasive procedure that shrinks the prostate by reducing its blood supply. A small catheter is inserted through the wrist or groin. Using X-ray guidance, the doctor reaches the arteries supplying the prostate and injects tiny particles that gently block blood flow. This causes the prostate to shrink over time, improving urinary symptoms. The procedure is performed under local anesthesia, has no surgical cuts, and allows a quick return to routine activities.

Understanding the Purpose of the PAE Procedure

Prostate Artery Embolization treats benign prostatic hyperplasia, a common condition in which the prostate grows large enough to press against the urethra. This pressure blocks the flow of urine and causes symptoms such as weak stream, difficulty starting urination, urgency, and waking several times at night. Unlike surgery, which removes part of the prostate, PAE works by reducing the blood supply to the prostate so that it naturally shrinks. This makes the procedure less invasive and easier to recover from.

Before going through any medical procedure, it helps to understand exactly what will happen. Knowing what to expect reduces fear and allows patients to feel more confident and prepared. The following sections explain the PAE process in simple steps, from the moment you enter the treatment room to the moment you walk out after recovery.

Before the Procedure: How Patients Are Prepared

Your first appointment includes a detailed evaluation. The doctor reviews your symptoms and medical history, performs a physical examination if needed, and orders imaging studies such as an MRI or CT scan. A complete evaluation helps determine whether your prostate’s blood supply and anatomy are suitable for PAE.

Pre-Procedure Instructions

Most men do not need to fast. You may take your regular medications unless the doctor instructs otherwise. It is important to drink water and stay hydrated. You should wear comfortable clothing on the day of the procedure. A friend or family member may be asked to drive you home because mild sedatives are sometimes used.

Arrival on Procedure Day

You will be taken to a preparation area where the staff reviews your details. Your wrist or groin area is cleaned. This is where the catheter will be inserted. A small IV line may be placed in your arm. You remain awake throughout the procedure, but some patients receive mild sedation to stay relaxed.

The PAE Procedure: Step-by-Step Explanation

The procedure is performed by an interventional radiologist using specialized imaging tools. These tools help guide the catheter through blood vessels safely and precisely.

Step 1: Local Anesthesia

Local anesthesia is applied to the skin. You will feel a slight pinch, similar to a small injection at the dentist. After a few seconds, the area becomes numb. This ensures the catheter insertion is comfortable.

Step 2: Introducing the Catheter

A tiny puncture is made in the wrist or groin. Through this opening, a thin tube called a catheter is inserted into an artery. The catheter is flexible and smooth. You do not feel it moving inside your blood vessels. Most patients feel only gentle pressure at the insertion site.

Step 3: Navigating to the Prostate Arteries

Using real-time X-ray images, the interventional radiologist guides the catheter from the main artery to the smaller arteries supplying blood to the prostate. These arteries can be small and twisted, but trained specialists navigate them safely.

Step 4: Injecting Contrast Dye

A contrast dye is injected to highlight the blood vessels on the screen. This helps the doctor identify exactly where the prostate arteries are and ensures that the particles reach the correct place.

Step 5: Delivering the Embolic Particles

Once the catheter is in the right position, tiny particles are injected. These particles block blood flow in a controlled way. The blockage reduces the prostate’s blood supply and leads to gradual shrinking. The particles stay in place permanently.

Step 6: Treating Both Sides

The prostate receives blood from arteries on both sides. The doctor repeats the same process for each side to ensure complete treatment. The time needed depends on the complexity of the blood vessels.

Step 7: Removing the Catheter

After both sides are treated, the catheter is gently removed. A small bandage is applied to the puncture site. No stitches are necessary because the opening is very small.

What You Feel During the Procedure

Most men are surprised by how comfortable the PAE experience is. You remain awake and can speak with the doctor and staff. You may feel some pressure at the wrist or groin when the catheter is inserted. You may also feel warmth when the contrast dye flows through the arteries. There is no sharp pain. If any discomfort appears, the doctor can adjust the catheter or medication to help you relax.

After the Procedure: What Happens in Recovery

Once the procedure is finished, you are moved to a recovery area. Nurses check your blood pressure, heart rate, and the puncture site to ensure everything is stable.

Recovery Time

Most patients rest for one to three hours. During this time, the staff may ask you to keep your wrist or leg still to prevent bleeding at the catheter site. Once stable, you can go home on the same day. You should avoid heavy lifting for a few days.

Normal Symptoms After PAE

Some men feel slight pelvic discomfort, mild burning during urination, or increased frequency for a few days. These are normal and temporary. They occur because the prostate begins responding to reduced blood flow. Drinking water helps reduce discomfort.

How the Prostate Shrinks After PAE

The prostate does not shrink instantly. Because PAE relies on natural processes, the gland gradually becomes smaller over weeks to months. As it shrinks, pressure on the urethra decreases. Many men begin noticing improvement within two to four weeks. Full benefits may continue to develop for three to six months.

Shrinking occurs because the reduced blood supply limits the prostate’s ability to maintain its enlarged size. As cells receive less blood, they slowly reduce in volume. The tissue becomes softer, allowing the urethra more room.

Benefits of PAE: What Patients Typically Notice

PAE improves a wide range of urinary symptoms. Men often notice stronger urine flow, reduced urgency, fewer nighttime trips, improved bladder emptying, reduced dribbling, and overall comfort during the day. Because the bladder no longer works as hard, urgency gradually decreases.

Many patients report improved sleep and more energy during the day. Because PAE rarely affects sexual function, men feel more confident and relaxed about their treatment choice.

Why PAE Is Considered Safe

PAE has been performed worldwide for more than a decade with strong safety records. It avoids general anesthesia, avoids surgical cuts, reduces bleeding risks, and preserves sexual function better than many traditional surgeries. The complication rate is low. Any risks are thoroughly discussed before treatment.

How PAE Compares to Other Treatments

Unlike medications, which manage symptoms but do not reverse prostate growth, PAE shrinks the prostate directly. Unlike surgery, PAE does not remove tissue or require a hospital stay. For men with very large prostates, PAE provides an alternative to more invasive surgeries. For moderate symptoms, PAE offers long-term improvements while preserving recovery time.

Common Questions Patients Ask Before Undergoing PAE

Many patients want to know how long the procedure lasts. Most take one to two hours. They ask whether it hurts. The procedure is designed to be comfortable under local anesthesia. They ask when they can return to work. Many return within a few days. They ask about long-term results. Studies show durable symptom relief.

Conclusion

If you experience urinary symptoms due to an enlarged prostate and want a treatment that avoids surgery, consider scheduling a consultation with an interventional radiologist. Understanding the PAE procedure step-by-step helps you make an informed decision about your care and long-term comfort.