My PAE Experience in May 2023- by Curtis M.
“I was 56 years old and returning from a China vacation in 2011. I was using a urinal at a gas station. In walked a 20-something and he didn’t use a urinal but instead went into a toilet stall and proceeded to micturate (pee) with the velocity of a high-pressure hose into the toilet. That is when I first realized my urinary flow was slowing down. LUTS are lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) which is lowered urine flow due to an enlarged prostate. I have known several people who used urinary catheters daily. And the subsequent UTI (urinary tract infections) they had. One of my main goals in life was to research methods to help shrink my prostate but to also keep it doing its job in assisting with orgasms. I am 68 now. I looked at various ways to increase my urine flow over the last twelve years. My flow had gone down to 4ml a second measured with a measuring cup (normal male rate is 10 to 21 ml a second) and I knew I had to do something to fix it. Let me list some of those methods looked at. First line defense. Medicine for BPH. There are several drugs that help with keeping the urine flowing in males. The main medicine recommended is FLOMAX. Some men prefer to not take FLOMAX (alpha blockers) because they can diminish the sexual experience (lose the gallop). FLOMAX would also cause me lower back problems.
TURP – once considered the Gold Standard way to increase urine flow in a male. Basically an Urologist will go in with a rooter rooter blade type device and cut away parts of the prostate.
UROLIFT – a Urologist will go in with a device and pin back the prostate gland with clips.
HoLEP -holmium laser enucleation of the prostate – similar to the TURP but the Urologist will use a laser beam to cut away the prostate gland that is interfering with the flow of urine.
Green Light Laser – similar to the HoLEP procedure above.
Butterfly – spring like metal piece is placed through the penis and into the swollen prostate and then allowed to spring out and push the prostate walls back. Currently not FDA approved.
Aquablation – high pressure low heat water jet to remove prostate gland material squeezing on the urethra
The procedures mentioned above are done by Urologist Doctors.
When asking a Urologist about doing a PAE (mentioned below and what I used) is like going to a Ford dealership and asking to buy a Corvette (made by Chevrolet). Since Urologists don’t do PAE they want you to use procedures done by Urologists to fix BPH. To clarify my comments my brother-in-law is an Urologist. We have discussed these things many times.
PAE – prostate artery embolization. This is where an Interventional Radiologist (IR) doctor places small beads into the arteries supplying blood to the prostate. It slows the flow of blood and allows the prostate to shrink. The shrinkage doesn’t happen immediately but over the next couple of weeks up to six months the prostate will shrink and urinary flow will increase. This procedure was developed in Portugal just after the turn of the century. The procedure is also done to successfully treat uterine fibroids in women if they don’t want to have a hysterectomy (with a 90% success rate). My doctor used size 250 embolization beads during my PAE. Smaller beads could completely seal the arteries while bigger beads could allow too much blood to flow. PAE is not used when there is a prostate cancer chance present so you must know your PSA level. My PSA has always been under 1.
I used Dr Charles Nutting in Lone Tree, Colorado and drove 500 miles for the operation. I was told he was one of the top two doctors in the United States doing the PAE and has done over 600 PAE procedures. Dr Nutting was very friendly and cordial to me. I have to admit I ask a lot of questions and do a lot of research on every procedure I go through and I can come across as perhaps being obnoxious with my concerns.
Back to my story line. I have researched prostate reduction procedures for twelve years now. But what put me over the edge were mutual traveling friends we have who had to cancel their Spain trip due to the husband’s kidney failure due to back pressure from an enlarged prostate and subsequent high blood pressure. Blessings to them in getting me in to have the PAE operation performed (after learning of his kidney failure I had the PAE procedure done two weeks later). Our friend had the Greenlight Laser and his kidneys are on the mend because he needed instant relief. The PAE procedure is more of a slower but steady realization of a cure. However men who use urinary catheters still have the PAE procedure done. Off note if having the PAE and you have never had a urinary catheter placed in your penis you most likely will not need one. However most all other Urology procedures mentioned above will need a urinary catheter after the operation.
Day of the procedure.
Taken into a private area and given a gown. I also wore a beanie because I am bald and don’t want to be cold. They also give you a warm blanket. Nurse asked if I wanted to use the toilet before the procedure. Make sure you do it. Nurse discreetly slid the gown up slightly from the right side and shaved the area where the needle would be going into the femoral artery. Entry was just above the leg/abdomen fold. Doctor came in and said there will be slight sedation to help keep the pelvis from moving during the procedure. He also said he would be telling me at times I would be feeling a warming sensation when they injected dyes to locate the correct arteries. The machine will map out the arteries to assist the doctor in his placement of the beads. The beads become lodged in the prostate capillaries and stay there permanently and do not dissolve nor do they move to other organs. I would say the procedure took a little over an hour. I had no discomfort but did feel the warming when the dyes went in. No time was I uncomfortable. The doctor had said that 95% of the time he could reach both sides of the prostate from the one entry point into the femoral artery on my right leg. They use a special clip to close the artery puncture called the StarClose, a metal clip that remains in the body. That puncture sealed and healed well and I didn’t ever notice any discomfort from it.
They slid me onto a gurney and wheeled me into the recovery area reminding me to not lift my head while the artery sealed up. This was for about 45 minutes. Then I was allowed to get up and use the bathroom, it was a welcome relief. Total time at the clinic was about 2.5 hours. The doctor came to talk to me and I said I had no discomfort from the procedure. He said I would be feeling discomfort moving forward. I had picked up the five meds they recommended from the local Wal-Mart before the procedure (total $56). The doctor’s office had an excellent typed up sheet telling what times to take each med. They had checked off the first couple on the chart which had been given to me after the procedure. I would be remiss not talking about Pyridium, one of the meds. It colors the urine bright orange and is used to lower the chance of postoperative infection. I am not really into taking pain meds so I only took ibuprofen the night of the procedure and the next morning.
I had a 500 mile drive back home. No discomfort except to urinate every 80 miles. And thankfully they had given me a portable urinal to catch the urine while sitting. That became my new friend (literally) on the way home. For the next three days after getting home there was a little discomfort starting to pee but I just tensed up an arm muscle to distract myself and you can get your pee going because it seems like the discomfort is just when you start peeing.
Why didn’t I use a local IR Doctor? The local doctor wanted me to be on FLOMAX prior to the operation and wanted to do the PAE with a urinary catheter in place. Dr Nutting told me he used a urinary catheter in the first 100 PAE he did but undated resonating equipment did away with that need. And Dr Nutting has done 50 times more PAE procedures (600 total).
Medicare pays for PAE. CPT code is 37243
Three and one half days after the procedure urinary output was twice what it was before. Eight milliliters a second versus four milliliters. Our international travel friends want to spread the news that men need to take care of their prostate problems and be more proactive or other problems can and will develop. I said I would be doing my part to get the word out.”
– Leigh V.
My quality of life was okay. Yet one month I experienced what seemed like three consecutive periods. I then noticed that my stomach looked puffy on one side. I went to the emergency room and that’s when I found out that I had a large fibroid. The ER doctor said they would have to crack open my uterus like a grapefruit. It was frightening. I started to research how to have the fibroid removed or reduced in size. I did more due diligence than any other medical issue I had experienced in the past, speaking with five doctors. I had a horrible consultation with a doctor at a hospital that told me if I didn’t have open surgery to remove the fibroid that I could die in a car accident if a seat belt pushed into my stomach. I then read about UFE and had a consultation with Dr. Kovaleski.
When it was explained to me why the procedure was done through the wrist, I felt comfortable that my well-being was top priority.
During the consultation with Dr. Kovaleski, I felt comfortable that he was confident with the procedure, having done many around the country. I felt extremely prepared with medications. Prior to the procedure, I had been scared of medication putting me to sleep and feeling nausea afterward. I even cried when I walked in. I then felt so cared for, and when I woke up from the procedure, I felt looked after, and all of the medication really helped me to ease through recovery.
Prostate Artery Embolization Patient Testimonial
– Tina L.
– Vicki P.