For years, urologists have treated patients with worsening Benign Prostatic Hyperplasia (BPH), a condition affecting almost half of all men over age 50. As an enlarging prostate pinches the urethra, BPH sufferers experience compromised lifestyles and challenging urinary symptoms such as weakened urine stream and increased nocturnal urination. Left untreated, the worsening symptoms of BPH can cause severe consequences within the bladder and kidneys, such as completely blocking the bladder’s urine flow.
To treat BPH, urologists perform various surgeries to remove prostatic tissue. Due to morbidity associated with these procedures, demand has increased for less invasive treatment that achieves similar results. Numerous minimally invasive procedures have been developed within urology. However, interventional radiology has an option to offer with less side effects.
Developed in 2012, prostatic artery embolization (PAE) is a technique to treat BPH that builds on skills IRs have used for years. Using a micro-catheter via femoral or radial artery access, microspheres are injected endovascularly to block the arterial supply to the prostate. As the prostate shrinks and softens over several months due to curbed blood supply, urination improves.
Since PAE received FDA approval in June 2017, demand for the procedure has increased among patients and referring physicians. PAE is technically difficult due to the anatomy involved, and therefore training is necessary for any IR starting a PAE program.
UNC Assistant Professor Dr. Ari Isaacson and Adjunct Associate Professor Dr. Sandeep Bagla, two leaders in PAE in the US, have collaborated to develop the first PAE course offering CME credits. It is a one-day intensive course on all aspects of the procedure called STREAM. The first iteration occurred in January 2018 in Washington, DC, was a sell-out course, drawing 120 attendees. Multiple industry sponsors — Boston Scientific, Merit Medical, Terumo Medical Corporation, Embolx, Cook Medical and Medtronic — offered gracious sponsorship of the course, keeping costs reasonable for attendees.
The STREAM faculty also included Dr. Mathew Raynor, UNC Professor of Urology, as well as Department of Radiology Chair Dr. Matt Mauro. In a nine-hour day, attendees received detailed learning on PAE work-up, selection of procedural equipment, prostatic arterial anatomy and multi-disciplinary review of PAE cases. Special guests included a retired General who had under gone the procedure, as well as two malpractice lawyers who discussed pertinent legal ramifications.
Due to the popularity of the inaugural STREAM, Isaacson and Bagla decided to offer STREAM 2.0 in June 2018. With a revamped extended 1.5 day curriculum and several new speakers, the new version aims to improve on the first.
As Isaacson notes: “PAE provides a safe, sexual function sparing option for the treatment of BPH. There’s a growing interest among [IRs] to offer PAE to their patients. However, the technique is very difficult to perform because of the size and tortuosity of the prostatic arteries involved in the procedure. Dr. Bagla and I developed a course that trains IRs in all aspects of PAE, leaving them equipped to build their own PAE program. I feel fortunate to be a part of this collaborative process and look forward to STREAM 2.0 this June.”
