by Patient WH, born 10th March 1942
The initial issues
From year 2014, I very occasionally experienced a difficulty in urinating during the night hours, almost always after having had a few pints of beer or even after a long passenger flight. After alcohol consumption, the retention issue always subsided by about 5 am in the morning, and I now realise it was because of alcohol intake causing prostatic swelling. This was particularly evidenced at the time because my prostate was considered by the medical profession to be “large”.
Total urinary retention
In early June 2019 I was unable to urinate, requiring me to call for medical assistance during the night when, after 9 hours of retention, a bladder catheter was inserted and I had this fitted for nearly three months. Several visits were made to Trial Without Catheter (TWOC) Clinics at hospital during the period but to no effect. Various surgeons considered laser treatment on the prostate and major surgery for removal in part or totally.
Benefits of prostate artery embolisation in terms of side-effects
The Surgeon Head of Urology at my local hospital considered a PAE procedure to be advisable to reduce the size of my prostate which was compressing the urethra and causing total retention. Long term side-effects are zero compared with surgery such as Holmium laser enucleation or retropubic enucleation, which may result in incontinence.
After discussion and with the possibility of failure to solve the retention issue and bladder catheter removal, I was introduced to Dr. Nigel Hacking at The Spire Hospital, Southampton for possible PAE treatment. A CT scan was conducted showing scattered areas of calcification within the enlarged gland consistent with previous or chronic prostatis, also showing a prostate size of 194 mls in volume.
Subsequently, a day appointment was made in August 2019 for the PAE procedure itself. My bladder catheter remained in place throughout the process, which was conducted under sedation with me being conscious throughout, although I may have slept on occasion during the hour and half procedure. The two arteries supplying my prostate were entered via the groin. No pain was experienced throughout the actual PAE procedure and I walked back to my room after the PAE.
In my opinion PAE is quite definitely a better option than surgery if it is considered clinically advisable
Post-prostate artery embolisation experience
Three hours after the procedure, in my day-room at the hospital, I started to endure referred perianal pain, and pain at the end of the penis. This pain was quite severe and, as a result, I was given intravenous morphine overnight at the hospital. The pain dissipated by early morning and I was discharged home. I was informed by Dr. Hacking that this referred pain for me was not unique but rather unusual.
After discharge I was prescribed non-steroidal anti-inflammatory pain relief. Urination and defecating was painful during the initial 7 days post PAE with some blood staining in the urine. The bladder catheter remained in place. I felt quite tired during the first 10 days and I did not engage in much physical activity.
After 10 days (Sep 2019) the catheter was removed at my local surgery and it took some six hours for me to pass any urine. Over a period of some days, urination became more frequent and regulated, most likely because I had not had self-controlled urination for some months. Urination and defecation were commensurate for a number of days. Residual pain in the penis, but reducing, remained for about a month.
An MRI Scan was undertaken in October and Dr. Hacking assessed my prostate to be 60% of its original size, and informed me that it would likely reduce further.
Urination became quite normal in regularity and with some ”force”, as it remains at the time of writing this resumé.
A further MRI scan, in May 2020, showed my prostate to have a volume of 94 mls (less than half the size of 9 months previously).
In my opinion PAE is quite definitely a better option than surgery if it is considered clinically advisable.