Urologist-led PAE,
or a radiology clinic?
Prostate artery embolization was developed by interventional radiologists, and most PAE in Orange County is still run start to finish by radiology and vascular clinics. In this practice a urologist leads it: Dr. Hari Sawkar decides whether PAE is right for you, prepares you for it, and manages everything afterward, and an experienced interventional radiologist performs the embolization itself. The procedure is the same either way. What changes is who decides you need it, what else is checked first, what your options are, and who answers the phone afterward.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated September 2026
How PAE is usually delivered
The typical path runs through more than one office. A primary doctor or urologist decides your prostate is enlarged and sends you to a radiology clinic, which then runs the rest: its own consultation, the embolization, and a follow-up check before discharging you. If you cannot urinate the next week, run a fever, or are still getting up four times a night three months later, you are sent back to urology, sometimes to a doctor who has never seen your case.
None of those doctors is doing anything wrong. The structure is the problem: nobody with prostate expertise owns your care from start to finish, and you become the courier between offices.
What changes when a urologist leads your PAE
Each part of PAE goes to the specialist best trained for it: the urologist for the decision and the care around it, the interventional radiologist for the catheter work.
The prostate is confirmed as the problem
A slow stream, urgency, and night trips can come from the bladder, a stricture, an infection, or medication as easily as from prostate size. A urologist checks before anyone books a procedure, with a symptom score, a post-void residual, a prostate volume, a PSA, and a cystoscopy when the picture is unclear.
Every option is on the table
Dr. Sawkar performs UroLift, Rezūm, and Aquablation and leads PAE care. When PAE is recommended, it is because it fits your anatomy and goals better than the other three, not because it is the only procedure on offer.
The catheter work goes to a catheter specialist
The embolization itself is performed by an experienced interventional radiologist, the specialist trained for catheter procedures, working from the complete urologic picture: your prostate volume, shape, median lobe, and bladder findings are in hand before the procedure day.
Complications go to the specialist who knows them
Urinary retention, a urinary infection, and a bladder that needs a little help are urology problems. Here they are handled by your urologist, the same day, without a new referral.
If it is not enough, the next step is already in the room
Roughly 1 in 5 men seek further treatment in the years after PAE. In this practice that conversation happens with the same urologist and the same records, and the answer can be a repeat PAE or one of the other three procedures, whichever fits.
One point of contact, before and after
You and your referring doctor deal with one urology practice for the consultation, the preparation, and every follow-up. The practice coordinates the embolization with the interventional radiologist, so the hand-off is never yours to manage.
Side by side
An interventional radiologist performs the embolization in both columns. Read the rows for what surrounds it.
| PAE at a radiology clinic | Urologist-led PAE | |
|---|---|---|
| Who decides you need treatment | The clinic, after a referral or self-referral | A urologist, after ruling out other causes first |
| The workup | Usually focused on suitability for embolization: symptoms, prostate imaging, and the arteries | Symptom score, post-void residual, volume, PSA, cystoscopy when indicated, then the arterial imaging |
| Options on the table | PAE | PAE, UroLift, Rezūm, Aquablation, medication, or watchful waiting |
| Who performs the embolization | An interventional radiologist | An interventional radiologist |
| Setting and recovery | Outpatient, home the same day | Outpatient, home the same day |
| A catheter, an infection, or a fever afterward | Usually back to a urologist | Managed by your urologist |
| If PAE is not enough | Usually a new referral and a new workup | Decided by the same urologist, with the same records |
| Your point of contact | The clinic, then a urologist | Your urologist, start to finish |
A fair summary of how most programs are organized, not a comment on any individual radiologist. The embolization in expert hands is excellent in either setting; the difference is who owns your care around it.
Is urologist-led PAE unusual?
Yes. PAE came out of interventional radiology, most of the published trials were run by radiologists, and most programs are still run by radiology practices from start to finish. A urology practice that owns the PAE pathway, deciding, preparing, and following up while an interventional radiologist performs the procedure, is uncommon, and the other PAE programs that come up in an Orange County search are interventional radiology and vascular practices.
The evidence for PAE, including the randomized trials, the UK-ROPE registry, and its place in American Urological Association guidance, does not depend on which specialty runs the program. The judgment about whether you should have it, and what to do if it is not enough, does. That judgment is what a urologist brings, and it is why this practice leads PAE care instead of simply referring men to a radiology clinic.
Ask who manages you afterward
If the answer is a different office, you have found the hand-off. Ask who you call if you cannot urinate or run a fever the week after.
Ask what else was checked
A post-void residual, a volume, a PSA, and a look at the bladder when needed. If none of that happened, the diagnosis was assumed, not confirmed.
Ask what they would do instead
A provider who can offer only one procedure will recommend it. A provider who offers four can tell you which one fits, and why.
Common questions
Should a urologist or an interventional radiologist handle my PAE
The embolization itself is a catheter procedure, and an experienced interventional radiologist is the right specialist to perform it. The question that matters more is who leads your care around it. A urologist-led program confirms the prostate is really the problem, weighs PAE against the other treatments, and manages retention, infection, or persistent symptoms afterward. In this practice, Dr. Sawkar does all of that and an interventional radiologist performs the embolization.
Does Dr. Sawkar perform the embolization himself
No. The embolization is performed by an experienced interventional radiologist, the specialist trained for catheter procedures. Dr. Sawkar decides whether PAE is right for you, handles all of the preparation, and manages your recovery and follow-up, so you get each part of PAE from the doctor best trained to do it.
What does urologist-led PAE mean
A urologist runs your care from start to finish: the evaluation that decides whether PAE is right, the choice among PAE and the other treatments, the preparation, and every follow-up. An interventional radiologist performs the embolization itself. You are never left to manage the hand-off between offices yourself.
Who offers PAE in Orange County
Most prostate artery embolization in Orange County is offered by interventional radiology and vascular clinics that run the whole course. Dr. Hari Sawkar, board-certified urologist and Chief of Urology at Providence St. Joseph Hospital, leads PAE care for his patients, with the embolization performed by an interventional radiologist, and performs UroLift, Rezūm, and Aquablation himself, so the recommendation is never limited to one tool.
What happens if PAE does not work
Roughly 1 in 5 men seek further treatment in the years after PAE. In a urologist-led program, the next step, whether a repeat PAE, UroLift, Rezūm, or Aquablation, is decided by the same urologist with the same records, not by a new referral to a new office.
Do I need a referral for urologist-led PAE
Original Medicare and most PPO plans let you book a consultation with Dr. Sawkar directly; HMO plans, including Medicare Advantage HMOs, usually require a referral from your primary doctor. From there the practice coordinates the embolization with the interventional radiologist, and referring physicians receive notes at each step.
One urologist, start to finish
Evaluation, preparation, and every follow-up with the same urologist. Same-day and next-day appointments, telehealth available, Medicare and most PPO plans accepted. For the fastest response, send the office a secure message; the reply comes back by text.
Chief of Urology, Providence St. Joseph Hospital · Every BPH option under one urologist · Orange County's highest-volume Aquablation surgeon