Also on our site:
Genicular Artery Embolization (GAE)
Prostate Artery Embolization (PAE)
Uterine Artery Embolization (UAE)

Interventional Radiology · Reference Sheet

Prostate Artery Embolization (PAE) for benign prostatic hyperplasia (BPH)

A minimally invasive procedure that helps improve urinary symptoms caused by an enlarged prostate — a nonsurgical alternative that does not affect sexual performance, performed on an outpatient basis.

Procedure time

Up to 1 hour

Anesthesia

Local + light sedation

Outpatient

Same-Day, Outpatient Procedure

Access site

Pinhole needle access in upper thigh

What is PAE?

Prostate artery embolization treats the vascular contribution to an enlarged prostate rather than removing or resecting tissue surgically.

How it works

PAE is a minimally invasive procedure designed to alleviate urinary symptoms resulting from an enlarged prostate — a nonsurgical alternative for men experiencing urinary tract symptoms due to prostate enlargement. By reducing blood flow to the prostate, PAE results in both shrinkage and softening of prostate tissue, relieving lower urinary tract symptoms. If the prostate is causing bleeding into the urine, embolization can also help prevent future bleeding into the urinary tract.

Following PAE, urinary symptoms gradually improve over the following weeks leading to gradual shrinkage of the prostate over 3 months. PAE boasts a high success rate, with over 90% of men finding relief within the first year — and unlike some other BPH treatments, it does not impact sexual performance.

Who performs it

An interventional radiologist, a physician trained in image-guided, catheter-based procedures
Performed in an angiography suite with fluoroscopic (real-time x-ray) imaging
Often done in coordination with a referring urologist

Where it fits: PAE is generally considered for men with BPH-related lower urinary tract symptoms who want a nonsurgical option, or who are poor candidates for prostate surgery.

Benefits of PAE

PAE offers meaningful symptom relief with a different risk and recovery profile than surgical options for BPH.

Minimally Invasive, Nonsurgical

Over 90% Symptom Relief in Year One

Outpatient, Same-Day Recovery

No Impact on Sexual Performance

Unlike surgical options for BPH that can carry undesirable sexual side effects, PAE does not impact sexual performance. It’s performed through a tiny needle puncture in the upper thigh, avoids general anesthesia, and allows most patients to return home the same day.

Candidacy

Candidacy is determined individually after imaging review and clinical evaluation. The list below outlines general criteria discussed in consultation.

Appropriate for

Bothersome lower urinary tract symptoms from an enlarged prostate (BPH)
Symptoms not adequately controlled with medication
Men who want to avoid or delay surgical options such as TURP
Men who are poor surgical candidates for other medical reasons
Recurrent bleeding into the urine related to prostate enlargement
Men who are interested in maintaining future sexual function
Intolerance to BPH treatment medications
Patients on blood thinners
Patients who have been told that their prostate is too large for other therapies

The day of the procedure

Most procedures are completed within 1 hour.

Preparation

Tell your provider about all allergies, including any reaction to contrast dye, sedatives, or antibiotics. You may be asked not to eat or drink after midnight and to arrange a driver. Bring a full list of medicines and supplements.

Sedation and numbing

Sedation and/or local anesthesia keeps you comfortable and pain-free while you remain awake. Numbing medicine is applied to the needle puncture site in the upper thigh.

Catheter navigation

A thin catheter is guided into the artery, with contrast dye and live x-ray imaging helping the interventional radiologist reach the prostate arteries.

Embolization

Inert particles are injected into the prostate arteries to reduce their blood flow, “starving” the tissue and leading to gradual shrinkage and reduced inflammation over the following weeks.

Closure and recovery

The catheter is removed and pressure stops any bleeding — no stitches are needed. PAE is outpatient, so patients go home the same day after being monitored by the healthcare team.

Recovery & discharge instructions

Most patients resume normal activities within three days. A period of expected “post-embolization syndrome” is common as the prostate responds to treatment.

Immediately after the procedure

Rest quietly at home; avoid over-exertion for the next week, and light duty at work is recommended for one week
Mild tenderness, hardness, and bruising at the puncture site are expected
Do not drive or operate mechanical or electrical equipment
Do not consume alcohol, tranquilizers, sedatives, sleeping medication, or any non-prescribed medication
Drink plenty of liquids, eat light meals, and avoid important decisions the day of your procedure
No submersible water activities for 2 days; climbing household stairs is fine

Up to 48 hours, and general guidelines

Remove the groin bandage 24 hours after the procedure — do not replace it, and avoid lotion, powder, or creams on the area
Resume your regular diet, increase fluids, and restart blood thinners the next day as directed; continue other medications as prescribed
Do not lift more than 5 lbs. for one week
For fever, over-the-counter Tylenol or Motrin can be used; complete any prescribed antibiotic or steroid course as directed
If you arrived with an indwelling urinary catheter, follow up with your urologist about removal timing
Medications for bladder spasms may cause orange-colored urine
Most patients resume normal activities three days after the procedure

Expected post-embolization syndrome (7–10 days): A stinging or burning sensation in the urethra/penis, fever up to 101.5°F, pelvic pain or spasms, fatigue, nausea, painful or frequent urination, and blood in the urine or semen are all common and expected. Bruising at the puncture site typically resolves within 1–2 weeks. Rarely, temporary discoloration or a painful ulceration of the head of the penis can occur, usually resolving within 4–8 weeks — contact the office if this happens so it can be evaluated.

Risks and considerations

PAE is a low-risk procedure that is well tolerated without complication in the vast majority of patients. Your interventional radiologist will review all risks with you before you provide consent.

Common

Post-PAE syndrome

Nausea, vomiting, diarrhea, fever, pelvic pain, painful or frequent urination, small amounts of blood in urine, stool, or semen — an expected reaction lasting several days up to two weeks.

Common

Access-site bruising

Bleeding or bruising at the arterial puncture site in the upper thigh, usually resolving within 1–2 weeks.

Uncommon

Non-target embolization

Unintended blockage of blood flow to nearby areas (bladder, penis, rectum), which could result in painful ulcerations.

Uncommon

Contrast reaction

Allergic reaction to contrast dye, or contrast-related kidney damage.

Uncommon

Urinary tract infection

Infection can occur following the procedure and is typically treatable with antibiotics.

Rare

Urinary retention

Inability to adequately void, resulting in a temporary need for a urethral (Foley) catheter.

A formal written consent, reviewing these risks and alternatives in full, is completed with your care team prior to treatment.

Meet your interventional radiologist

PAE at Florida Radiology Consultants is offered by board-certified interventional radiologists with focused training and experience in embolization procedures.

David Johnson, MD

Board Certified Interventional Radiologist

Dr. Johnson is a graduate of Vanderbilt University School of Medicine in Nashville, TN. He completed his residency in Diagnostic Radiology in 2016 and his fellowship in Vascular and Interventional Radiology in 2017, both at Vanderbilt University Medical Center. He is board-certified in Interventional Radiology and Diagnostic Radiology by the American Board of Radiology, and has been practicing interventional radiology in Southwest Florida since 2017.

Dr. Johnson is a renowned and passionate expert in prostate artery embolization (PAE) for BPH; he has personally performed over 2,000 PAE procedures, successfully treating men suffering from BPH-related lower urinary tract symptoms.

Aaron Heligman, MD

Board Certified Interventional Radiologist

Dr. Heligman was raised in Fort Myers, Florida, and earned his medical degree at Rush University in Chicago, where he was inducted into the Alpha Omega Alpha Honor Medical Society. He completed his Vascular and Interventional Radiology fellowship at Jackson Memorial Hospital and University of Miami Health System.

Dr. Heligman specializes in interventional oncology, venous disease, prostate artery embolization (PAE), uterine artery embolization (UAE), and minimally invasive spine interventions. He is board-certified with the American Board of Radiology in diagnostic and interventional radiology.

About Florida Radiology Consultants

Florida Radiology Consultants is a premier embolization center in the Bonita Springs area, offering the latest equipment and imaging technology available for optimal patient care and outcomes across a full spectrum of diagnostic and interventional radiology services.

Florida Radiology Consultants
24301 Walden Center, Suite 102
Bonita Springs, FL 34134

T: 239.331.5566 | F: 239.494.4501
floridaradiologyconsultants.com

Frequently asked questions

Will PAE affect my sexual performance?

No. Unlike some surgical treatments for BPH, PAE does not impact sexual performance.

How soon will I notice symptom relief?

Following PAE, urinary symptoms gradually improve over the ensuing weeks with urinary improvements expected within 2–4 weeks and with maximum symptom relief achieved by 3 months.

How long will the improvement from this procedure last?

For patients who respond well to PAE, symptom relief can last for many years and is often permanent, although this can vary patient to patient. Around 20% of patients can develop recurrent prostate enlargement 5 years following the procedure. If the symptoms gradually return over time, repeat embolization treatment or other therapies may be considered.

Will I need a catheter?

No urethral (Foley) catheter will be placed during or after the procedure. A major advantage of PAE is that no device or instrument will be placed in your urethra.

Will insurance cover PAE?

PAE is covered by most medical insurers including traditional Medicare. Certain commercial and Medicare Advantage plans can have variable coverage, however. Confirm coverage and any prior authorization requirements with your insurance provider. Our office accepts most major insurers.

What workup is needed beforehand?

Depending on your history, imaging scans such as ultrasound, MRI, or CT may be used to evaluate the prostate. We will review your medical records and medical history and assess if any additional imaging or laboratory testing is necessary.