A non-surgical, image-guided procedure that shrinks an enlarged prostate by reducing its blood supply — without any cuts to the prostate, without general anesthesia, and with full preservation of sexual function.
PAE is an interventional radiology procedure performed through a tiny incision in the wrist or groin — no larger than a pinhole. Using X-ray guidance, a thin catheter is threaded through the arterial system to the prostatic arteries.
Tiny microspheres (small particles) are then injected to partially block the blood flow supplying the prostate. With reduced blood supply, the prostate gradually shrinks over the following weeks and months, relieving the pressure on the urethra and improving urinary flow.
PAE is a true alternative for men who are poor surgical candidates due to medical conditions, those on blood thinners, men with very large prostates, or anyone who wants to avoid surgery and general anesthesia entirely.
As a urologist, Dr. Sawkar evaluates the full BPH picture — prostate size, symptoms, anatomy, and your other treatment options — before recommending PAE. He performs PAE in collaboration with experienced interventional radiologists, and unlike standalone IR practices, can offer the full menu of BPH treatments (UroLift, Rezūm, Aquablation, robotic surgery) if PAE isn't the best fit for you.
Light sedation and local anesthesia are given at the access site — typically the wrist (radial artery) or groin. No general anesthesia is required.
A micro-catheter is advanced through the arteries under real-time X-ray (fluoroscopy) guidance. Contrast dye is used to identify and map the prostatic arteries precisely.
Tiny biocompatible particles are injected to block blood flow to the enlarged prostate tissue on both sides, causing it to gradually shrink.
Most patients go home the same day or after one overnight stay. The prostate shrinks progressively over 4–12 weeks, and symptom improvement follows.
The prostate is never directly accessed. The only entry point is a tiny pinhole in the wrist or groin — far from the urinary tract.
Because no tissue is cut near the ejaculatory ducts or neurovascular bundles, ejaculatory and erectile function are well-preserved in the majority of men.
PAE can be performed on men who cannot safely undergo general anesthesia, are on anticoagulants, or have other conditions that make traditional surgery risky.
PAE can be performed on prostates of virtually any size, including very large glands over 100 cc that may be challenging for even surgical approaches.
Most patients go home the same day or after a brief overnight observation. Recovery is typically 1–2 weeks before return to full activity.
PAE does not preclude future BPH treatments. If additional therapy is ever needed, surgical and other minimally invasive options remain available.
| Feature | PAE | UroLift | Rezūm | Aquablation | TURP (Surgery) |
|---|---|---|---|---|---|
| Approach | Through artery (wrist/groin) | Through urethra | Through urethra | Through urethra (robotic) | Through urethra (resection) |
| Anesthesia | Conscious sedation only | Local / mild sedation | Local / mild sedation | ✗ General or spinal | ✗ General or spinal |
| Cuts to Prostate | ✓ None | ✓ None | ✗ Tissue ablated by steam | ✗ Tissue resected by waterjet | ✗ Tissue resected |
| Sexual Function | ✓ Well preserved | ✓ Well preserved | ✓ Well preserved | ✓ Largely preserved | ✗ Retrograde ejaculation common |
| Very Large Prostates | ✓ Excellent option | Limited (30–80 cc) | Limited (30–80 cc) | ✓ Effective up to ~150 cc | Limited |
| Poor Surgical Candidates | ✓ Yes | ✓ Yes | ✓ Yes | ✗ Requires general anesthesia | ✗ May not be suitable |
| Time to Symptom Improvement | 4–12 weeks | 2–4 weeks | 2–3 months | 4–6 weeks | 4–6 weeks |
PAE is particularly valuable for men who want to avoid surgery entirely, are not good candidates for general anesthesia, have very large prostates, or have not found relief from other therapies.
PAE may be the right choice if you:
The procedure is performed under conscious sedation, so you will be relaxed and comfortable throughout. Afterward, some men experience mild pelvic discomfort, urinary urgency, or flu-like symptoms for a few days — often called "post-embolization syndrome." This is normal and resolves within 1–2 weeks. Prescription pain medications are provided to manage any discomfort.
The procedure typically takes 2–3 hours depending on the arterial anatomy. Patients are observed for several hours afterward and most go home the same day. Some men opt for a one-night observation stay.
Because PAE works by causing the prostate to shrink gradually, symptom improvement typically begins within 4–6 weeks and continues over 3–6 months. Most men experience meaningful relief by 3 months. The prostate can continue to shrink for up to a year after the procedure.
PAE is generally safe, but like all procedures carries some risk. Potential side effects include temporary urinary symptoms, post-embolization syndrome (mild flu-like symptoms), and rarely, non-target embolization of nearby tissue. Serious complications are uncommon. Dr. Sawkar and his interventional radiology partners will review all risks specific to your anatomy during your consultation.
Yes — Medicare covers PAE for BPH, and we accept Medicare and most major PPO plans. Our office verifies your specific benefits before the procedure so there are no surprises.