NO - We do not take health insurance. However, procedures can be done depending on the category of your health insurance.

YES - However, it will depend on the type of health insurance the patient has.

YES - However, it will depend on the type of health insurance the patient has.

After hospital discharge, the patient should not do any physical activities for 7 days. The biggest concern is with the puncture site (groin) where the catheter is inserted to reach the prostate arteries.

We suggest that the patient stays for a period of 10-15 days with no sexual intercourse so that the prostate and seminal vesicles remain at rest for that period. Note that the first ejaculations may contain some blood or have brownish content. The patient should not worry, however, should keep in touch with our team so we can guide you properly.

If the patient lives near the city of São Paulo, he will return to his home on the same day. If the patient resides outside of São Paulo, he may return home two days after the embolization.

NO - There is no problem in traveling by airplane or car after the procedure. However, if you return by car, you will be recommended no to drive a car to avoid bleeding where the catheter was inserted.

NO - Old age is not a contraindication. However, patients with advanced age are more likely to have atherosclerotic lesions (narrowing or dilatation of the arteries) that may hinder the procedure. Clinical evaluation of the patient is of great importance, along with complementary tests (laboratory, imaging and urological tests).

NO - According Brazilian Federal Medical Council (CFM RESOLUTION No. 2,111 / 2014), PAE is considered a non-experimental procedure, valid in medical practice.

YES - However, the patient must have the SUS card and must be seen by the Urology team (Prostate Sector/Urology Division) of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo.

The procedure is done under local anesthesia, using lidocaine in the groin area where the catheter will be inserted. Depending on the clinical conditions and patient wish, mild sedation may be done.

Usually, the patient does not feel pain during the procedure. During the first three days, the patient may have increased urinary frequency and feel burning while urinating. This is related to the ischemia caused in BPH nodules after PAE. However, these symptoms are controlled with orally administered drugs and closely monitored by the medical and nursing team responsible for the treatment.

Ejaculation is not affected by PAE, and there are no reports of retrograde ejaculation after this procedure. As the prostate produces 10-30% of seminal fluid volume, some patients (about 10-20% in our records, which includes more than 300 patients treated up to 2016) may have decreased ejaculate volume. This may occur due to reduced prostate volume after PAE.

The purpose of PAE is to cause ischemia (blockage of blood supply only at the site of BPH nodules) and consequent coagulative necrosis of BPH nodules. This necrosis is benign and intentional. Studies have shown that theoretically, the higher the necrosis degree, the better the post embolization results. This occurs mainly in the transition zone (central gland) of the prostate. It is necrosis that will cause relaxation of glandular tissue and reduction of prostate size.

Yes. Studies have shown varying prostate reduction percentages. The average reduction is around 30%. Although there is a decrease in prostrate size in almost all treated patients, there are some patients who present improvement of symptoms and quality of life despite no reduction in prostate volume.

If the prostate does not reduce in size, or if it starts to grow again, some symptoms may come back. However, prostate size solely should not be a patient concern. There are several cases in which the prostate does not reduce in size and there is nevertheless improvement in symptoms. However, if the symptoms return, a new embolization may be performed. If the patient does not wish to undergo another PAE procedure, other treatments (medical or surgical) may be performed.

NO - PAE does not interfere in a negative way if there is a need for the patient to undergo traditional surgical treatment. It is quite the opposite: because embolization diminishes prostate vascularity, surgery can be done with less risk of bleeding. There are studies being performed demonstrating that PAE can help surgical treatment.

To date, PAE is only indicated for the treatment of lower urinary tract symptoms due to prostatic growth owed to benign prostatic hyperplasia (BPH), according to the Brazilian Federal Council of Medicine (CFM).

YES – Urologist evaluations before and after PAE are mandatory. The urologist is the specialist who will always accompany you regarding urogenital diseases. The Brazilian Federal Council of Medicine states that PAE should not be performed without prior evaluation and indication by the urologist.

NO - The patient will continue to take drugs only for 10-15 days after PAE. After this period, the symptoms begin to improve and the patient does not need to take the medication for BPH indications anymore.

Our results are very satisfying and rewarding. We have observed, in more than 300 treated patients, a success rate of 90-95% related to the improvement of urinary symptoms and of patients' quality of life. In more severe cases, in patients who were using a bladder catheter, the success rate is 90% upon catheter removal. However, we have observed that, after 2-3 years, 15-20% of patients may present recurrent symptoms. If necessary, these patients can be retreated with embolization. In these cases, a detailed investigation should be done to verify the actual cause of symptom recurrence. We have observed that patients with bladder problems were those with the highest failure rate.

If there is any immediate intercurrence, the patient will be treated in the same institution where the procedure was performed. If the patient has health insurance and wants to be treated in another place, our team can accompany or help the professional who will assist him. We have permanent phone contact with our patients to assure their assistance and peace of mind.

In general, improvement of symptoms will usually be felt after 7-10 days post embolization. There are patients who show improvement in the first week, however, this is highly variable. Studies show a significant reduction in prostate size (approximately 25%) as early as in the first month after embolization.

If urinary symptoms have worsened and the patient is using a probe (urethral catheter - Foley), the first attempt to remove it will be done one week after PAE. The results show 90% success in probe removal around 10-12 days after embolization.

The embolization technique has been performed for decades, demonstrating that the spheres remain in the terminal microcirculation of solid organs (such as the prostate, liver, etc.). We did a work in HCFMUSP which was published in 2013, demonstrating that the spheres remain in the prostate causing tissue ischemia. However, it is extremely important that the professional has experience in this type of intervention. Otherwise, other organs such as bladder, rectum and seminal vesicle may be affected. Up to now, according to scientific publications, only one case published by a Portuguese group presented a severe complication, requiring partial resection of the bladder (+/- 2.5 cm). Other complications reported to date are of less significance and resolved with medications, demonstrating the safety of embolization.

This material is harmless to the body; therefore, it does not initiate this type of response to "destroy" it, and does not cause any problems to the organism.

If necessary, the patient can stop taking BPH medicine immediately after PAE. However, for greater comfort, we advise the patient to stop taking the drug 15 days after embolization.

NO - There are no reports of rejection or adverse effect due to the use of acrylic resin microspheres in prostatic embolization. The same material has been used for decades, worldwide, for the embolization of uterine fibroids with remarkable results.

Urologist evaluation is imperative, and includes general clinical examination and rectal exam. The Brazilian Federal Medicine Council states that the following complementary exams need to be done: preoperative blood and urine examination, urodynamic study (functional evaluation of the bladder), ultrasonography and magnetic resonance imaging of the prostate.

The preoperative tests can be done in your hometown. However, the original tests should be evaluated by our medical team prior to PAE. It is also necessary that MRI images be recorded on a CD and delivered to the team prior to the procedure.

Prof. Dr. Carnevale is the pioneer of this technique. In the year 2007 he participated in an experimental study of prostatic embolization in dogs at the Harvard University in the United States. The study demonstrated a 40% reduction in prostate volume one month after embolization. This work was a basis and incentive for the Urology and Radiology teams of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo to treat two patients using the PAE technique, for the first time in the world, with the intention of treating lower urinary tract symptoms. Since then, the technique has gained national and international repercussion and countless professionals have come to learn from the Brazilian team. In addition, Prof. Carnevale has traveled to different continents promoting and teaching the prostrate embolization technique as an alternative treatment for patients with urinary symptoms due to prostate enlargement owed to BPH.

In more than 300 patients treated since 2008, we have observed a rate of symptom relapse of approximately 15% after a mean period of 5 years. This relapse of the symptoms has been described in patients with bladder problems (hypocontractility) due to many years of urinary obstruction and in patients with very advanced atherosclerosis.

We emphasize that if this occurs (relapse of the symptoms), the embolization procedure can be repeated. However, a thorough evaluation should be made by our specialists. If necessary, other traditional surgical procedures may be performed by the urologist.

An adequate evaluation by your urologist and our medical team (with urologists which are experts in this technique) is essential.

If necessary, request an appointment.

NO - There is no need to stay in the hospital. The procedure takes approximately two hours and the patient is discharged on the same day.

YES - However, the patient must have done all preoperative tests, and these must be evaluated by the Interventional Radiologist and Urologist.