BIDMC Interventional Radiology Outpatient Procedure Effectively Treats BPH

Paul W., 56, of Jamaica Plain, Mass., considers himself a generally healthy guy who happens to have benign prostatic hypertrophy (BPH), or prostate gland enlargement.

It's a condition that 50 percent of men in their 50s and up to 90 percent of men in their 70s and 80s share. While common and noncancerous, it's not always easy to live with. Those with BPH have a benign growth on their prostate gland that can weaken or delay the urination stream, cause frequent urination at night, and even require a catheter to urinate.

"I had to rush to the BIDMC Emergency Department in the middle of the night at least twice before," said Paul, who previously needed weeklong catheter placements. "It basically brought my life to a halt."

After his third placement at the end of December 2019 and coping with the side effects of prostate medications, Paul told himself he needed to try a different approach, but he didn't necessarily want to pursue surgery. While the current standard of care for BPH surgery is transurethral resection of the prostate (TURP), possible side effects include bleeding, pain, bladder control issues, and sexual dysfunction. It also requires hospitalization and the use of a catheter post-surgery.

'It Sounded Like He Was Doing Something Unique'

About 10 miles away in Wellesley, Ed Wagner, 61, was also contending with BPH symptoms, including hourly nighttime trips to the bathroom that left him fatigued by morning. After several appointments with his urologist and a 16-month course of prostate medication, Ed began to consider surgical options. It was around this time that his wife noticed an article about a minimally invasive BPH treatment—prostate artery embolization (PAE)—on the BIDMC Facebook page.

"After I read the article, I was in a meeting with a BIDMC Radiology nurse manager and asked her about the procedure," said Cynthia Wagner, MS, CCC-SLP, who ran BIDMC's Department of Speech-Language Pathology and worked there for 18 years. "She told me how the medical center's interventional radiologists are leaders in PAE and how effectively the technique treats BPH without open surgery.

"It sounded like Dr. Sahil Mehta was doing something unique," Ed added. "For me, this wasn't just an alternative to urological procedures; this was a better and newer idea."

Through a pin-size hole in the wrist or groin, an interventional radiologist specially trained in the procedure, such Mehta, inserts a small catheter into the artery supplying the prostate to reduce blood flow, allowing the gland to shrink. PAE does not require general anesthesia and patients can go home the same day.

"We're using this technique to treat dozens of men with BPH each month," said Mehta, who is one of the nation's leading PAE experts. "In the last year alone, we've treated more than 100 men who sought alternatives to TURP or urological procedures. It's incredible how effective PAE is in reducing symptoms and providing a novel, extremely minimally invasive solution."

And the results are quick: A few weeks post-procedure, the prostate size can shrink by 30 percent or more, easing urinary symptoms, sparing erectile function, and significantly increasing one's quality of life.

'We Help Them Reclaim Their Life'

Paul first learned about the minimally invasive treatment through his brother-in-law, whose friend underwent PAE and had positive outcomes. While doing his own research on the procedure in Boston, Paul found the BIDMC Interventional Radiology (IR) team online.

"I was very comfortable meeting with Dr. Mehta," said Paul, whose procedure was in June 2020. "He was excellent at explaining the procedure, and his experience and high success rate drew me to him."

Ed recalled a similar first impression: "Dr. Mehta's sharp, he's quick, he understands the issues, and he clearly explained what was going to happen and that I would be in and out in one day."

Because of the intricate nature of PAE, the most successful treatments are by physicians who have treated numerous patients, and the BIDMC IR team performs among the most PAEs of any medical institution in the country.

"Of all the procedures I perform, PAE is perhaps the most gratifying," Mehta said. "The impact you can have on a patient is incredible. Universally, they're no longer tied to worrying about pulling over during a road trip or traveling on a long flight because they need a restroom close by. We help them reclaim their life."

Within two weeks of their procedures, both Paul and Ed were experiencing significant positive changes that have continued to unfold.

"I'm so happy for two reasons," Ed said. "One, the PAE was very successful—for the first time in years, going to the restroom is easy for me—and two, I didn't need a surgical procedure."

"I can still see improvements six months post-procedure," Paul added. "My quality of life has tremendously improved, I'm off my prostate medications, and I'm feeling great now. I'm really satisfied with the results."

BIDMC's Interventional Radiology team has performed among the most PAEs in the country and is currently seeing new patients. To schedule a consultation, email BIDMC Interventional Radiology or call 617-754-2523.