This document discusses building a practice for prostate artery embolization (PAE). It describes establishing a PAE team in 2012 and promoting the technique through an interventional radiology clinic, media outlets like newspapers and TV, and a website. The document outlines the speaker's PAE protocol and technique, and presents results from their first 22 cases, showing improvements in IPSS, prostate volume, and urinary flow rates post-procedure with only minor complications. It concludes that PAE is a feasible, safe, and effective technique that could replace TURP procedures but remains challenging, and greater promotion is needed to increase awareness and support for the technique.

1. Mohamed Shaker , MD
MSIR , MCIRSE , MPAIRS
Ass.Prof. of Interventional Radiology
Ain Shams University
Cairo-Egypt

2. Building PAE PracticeBuilding PAE Practice
 GEST 2012 , New York , USAGEST 2012 , New York , USA
 Our team established in June 2012Our team established in June 2012

4. Building PAE PracticeBuilding PAE Practice
 Co-operation with urologistsCo-operation with urologists

5. Building PAE PracticeBuilding PAE Practice
- Promoting for the technique in your IR clinic and- Promoting for the technique in your IR clinic and
/or establishing a clinic for PAE/or establishing a clinic for PAE
- Promotion through the media- Promotion through the media
- Promotion through the internet- Promotion through the internet
Targeting the patient

6. Building PAE PracticeBuilding PAE Practice
Promoting for the technique in your IRPromoting for the technique in your IR
clinic and /or establishing a clinic for PAEclinic and /or establishing a clinic for PAE
Targeting the patient

8. Building PAE PracticeBuilding PAE Practice
Promotion through the mediaPromotion through the media
Targeting the patient

9. Newspapers Articles

10. TV Medical shows

11. Building PAE PracticeBuilding PAE Practice
Promotion through the internetPromotion through the internet
Targeting the patient

12. Facebook Page

13. Facebook Page

14. Web Site
www.prostate-eg.com

15. Our ProtocolOur Protocol
 Pelvic US with measurement of PVRUPelvic US with measurement of PVRU
 Urine analysis +/- urine culture and sensitivityUrine analysis +/- urine culture and sensitivity
 PSA ; total and free/totalPSA ; total and free/total
 TRUSTRUS
 MRIMRI
 Urine flowmetryUrine flowmetry
 IPSSIPSS
 QOLQOL
 CBC , renal function tests , coagulation profileCBC , renal function tests , coagulation profile

16. Our TechniqueOur Technique
 Urinary catheterUrinary catheter
 Local anesthesiaLocal anesthesia
 Unilateral right femoral approachUnilateral right femoral approach
 Catheterize Internal iliac arteries by a 5F CobraCatheterize Internal iliac arteries by a 5F Cobra
or RUC catheteror RUC catheter
 Oblique viewOblique view
 Catheterize anterior division.Catheterize anterior division.
 Rotational angiography with cone beam CTRotational angiography with cone beam CT
 Prostatic arteries are selectively catheterizedProstatic arteries are selectively catheterized
with a 2.7 fr. microcatheter ( Progreat ).with a 2.7 fr. microcatheter ( Progreat ).
 Embolization using PVA particles 150 – 250 μm.Embolization using PVA particles 150 – 250 μm.

17. Our TechniqueOur Technique

18. ResultsResults
 We performed 22 cases to dateWe performed 22 cases to date
 All cases were technically successfulAll cases were technically successful
 20 cases of bilateral embolization and 2 cases of20 cases of bilateral embolization and 2 cases of
unilateral embolizationunilateral embolization
 We have just finished our study including our firstWe have just finished our study including our first
14 cases with follow up at least for 6 months14 cases with follow up at least for 6 months
 Rest of patients were done during last 6 monthsRest of patients were done during last 6 months
and are still under follow up .and are still under follow up .

19. ResultsResults
- Mean IPSS score before PAE was 24.7 and 6 months after PAE was 12.4 with
significant P value of 0.0006 .

20. ResultsResults
- Mean prostatic volume before PAE by MRI was 84.6 and 6 months after PAE
was 52 with mean volume reduction 38.6 %

21. ResultsResults
- Mean PVRU before PAE was 78.2 and 6 months after PAE was 8.6 with
significant P value of 0.0007 .

22. ResultsResults
- Mean Qmax before PAE was 12.2 and 6 months after PAE was 17 with
significant P value of 0.0004 .

23. ResultsResults
 No major complication were recorded.No major complication were recorded.
 Minor complication in the form of fungal cystitis tookMinor complication in the form of fungal cystitis took
place in 1 patient (7.1%) and was successfully treatedplace in 1 patient (7.1%) and was successfully treated
by antifungal drugs with suprapubic cystostomy.by antifungal drugs with suprapubic cystostomy.

24. ConclusionConclusion
- PAE is a breakthrough interventional technique , suggested
to be popular as UAE and may replace TURP.
- PAE is a feasible , safe , and highly effective technique ...
Neverthless challenging .
- We need to increase the number of IR doing this technique to
make it more popular and increase the awareness of patients
thus increasing the support in our battle with the urologists

25. THANK YOU