What Causes Post-PAE Syndrome?

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Have you been considering Prostate Artery Embolization (PAE) as a treatment option for an enlarged prostate? PAE is a minimally invasive procedure that uses tiny particles to block blood flow to the prostate gland, shrinking its size and relieving bothersome urinary symptoms. While PAE is generally safe and effective, it can cause a temporary side effect called Post-PAE Syndrome (PES).

In this blog we’ll discuss the causes and symptoms men may experience after undergoing PAE. If you’re experiencing symptoms or have questions about PAE and potential side effects, consider consulting a specialist for prostate. Our team at Prostate Specialists of Miami is here to help answer your questions. Contact us at (786) 500-5347 to schedule your consultation.

What is PAE?

Prostatic artery embolization (PAE) is a minimally invasive procedure used to treat benign prostatic hyperplasia (BPH), an enlargement of the prostate gland. BPH is a common condition in aging men that can cause bothersome urinary symptoms like frequent urination, urgency, and difficulty emptying the bladder completely.

PAE works by blocking blood flow to the prostate, causing it to shrink and relieve pressure on the urethra (the tube that carries urine from the bladder out of the body). While PAE is generally safe and effective, some men experience a group of side effects known as post-PAE syndrome (PES).

What Happens During Prostatic Artery Embolization?

Before discussing post-PAE syndrome, let’s go over what happens during PAE. Prostatic artery embolization is performed by a prostate specialist called an interventional radiologist (IR doctor). IR doctors use imaging techniques like X-rays to see inside your body and treat conditions without needing a traditional surgical incision.

Here’s how the PAE procedure typically unfolds:

Catheter Insertion

The IR doctor inserts a thin, flexible tube called a catheter into an artery in your groin or wrist. Using real-time X-ray guidance, this catheter is meticulously threaded through your arteries until it reaches the blood vessels supplying your enlarged prostate.

Blood Vessel Mapping (optional)

In some cases, your doctor might perform a special X-ray called an arteriogram. During this step, a contrast dye is injected through the catheter. This dye shows up brightly on X-ray images, essentially creating a map of the blood vessels feeding your prostate.

Blocking Blood Flow

Once the catheter is precisely positioned, your doctor will introduce tiny round particles called microspheres through the catheter. These microspheres travel through the catheter and lodge themselves within the arteries feeding your prostate. By blocking blood flow to the enlarged prostate tissue, these microspheres essentially starve the tissue, causing it to shrink over time.

Treating Both Sides

The IR doctor will typically maneuver the catheter to target both sides of your prostate, repeating the steps to ensure complete embolization.


After embolization is complete, the doctor removes the catheters and applies pressure to the insertion sites to stop any bleeding. You’ll be monitored for a few hours before being discharged home, usually on the same day.  The good news is that within days of the procedure, the shrunken prostate should begin to alleviate your bothersome urinary symptoms.

Understanding Post-PAE Syndrome (PES)

PES is a collection of side effects that can occur following PAE. The good news is that PES is usually temporary, resolving within a few days. However, being aware of the potential symptoms and treatment options can help you manage any discomfort and ensure a smooth recovery.

Causes of PES

The main culprit behind PES is thought to be inflammation and tissue necrosis (death of tissue) in the prostate and surrounding tissues. PAE disrupts blood flow to shrink the prostate, and this process can irritate the tissues, leading to inflammation.  In some cases, some tissue death may also occur.  The body’s inflammatory response to this irritation and tissue death is believed to be the root cause of PES symptoms.

Leakage of embolic material used during PAE and certain individual patient factors like age and underlying health conditions may also play a role in PES, although more research is needed to confirm these potential risk factors.

Symptoms of PES

Urinary Symptoms

  •     Frequent urination
  •     Urgent urination
  •     Painful urination (dysuria)
  •     Temporary worsening of urinary flow

General Symptoms

  •     Flu-like symptoms (fever, chills, fatigue)
  •     Nausea and vomiting
  •     Pelvic pain or groin pain

Less Common Symptoms

  •     Blood in the urine (hematuria)
  •     Blood in the semen (hematospermia)
  •     Difficulty achieving or maintaining an erection (though uncommon)

If you experience any of these symptoms following PAE, contact your doctor. They can determine if your symptoms are due to PES or another cause and recommend appropriate treatment.

Treatment Options for PES

The good news is that PES usually resolves on its own within a few days. However, there are treatment options available to help manage symptoms and improve comfort during this time. Here’s a look at some common approaches:

  • Medications: Pain relievers, anti-inflammatory medications, and alpha-blockers can help manage pain, inflammation, and improve urinary flow.
  • Rest and Activity Modification: Getting plenty of rest, avoiding strenuous activity, and limiting activities that worsen urinary symptoms can all aid recovery.
  • Sitz Baths and Ice Packs: Soaking in a warm sitz bath or applying ice packs to the groin can provide relief for pain and discomfort.

Following your doctor’s specific instructions regarding medications, activity restrictions, and other treatments is crucial for optimal recovery.

Additional Points to Consider

  • Early intervention is key: If you experience any concerning symptoms following PAE, don’t hesitate to contact your doctor. Early intervention can help prevent symptoms from worsening.
  • Most men recover well: The majority of men who experience PES see their symptoms improve within a short period.
  • PES is not a sign of PAE failure: While PES can be uncomfortable, it doesn’t necessarily indicate that the PAE procedure itself was unsuccessful.

If you have any questions or concerns about PES, talking to your doctor is always the best course of action. They can provide personalized guidance and ensure a smooth recovery from PAE.

Questions About Post-PAE Syndrome?

Do you have questions about Post-PAE Syndrome or wonder if you’re a good candidate for PAE? No need to spend time searching online for “artery embolization near me.” Contact Prostate Specialists of Miami instead. Our team can help you understand your treatment options, including minimally invasive approaches like PAE.

At Prostate Specialists of Miami, you’ll have the opportunity to consult Dr. Adam S. Gropper, a highly experienced prostate artery embolization doctor with over 20 years of dedicated expertise in improving men’s health.

Contact us at (786) 500-5347 or visit our website to fill out our online form and schedule your consultation with one of the industry’s top prostate artery embolization doctors. Dr. Gropper will thoroughly evaluate your condition, discuss if you’re a prime candidate for PAE, and answer all of your questions about Post-PAE Syndrome.

Before you go, we invite you to download our FREE guide, “5 Reasons to Choose Prostate Artery Embolization,” and discover why PAE could be the best choice for you.

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Prostate Specialists of Miami
15400 Biscayne Boulevard #104
Aventura, FL 33160
(786) 500-5347

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