###### PAE in Clinic - 14 pt drop in IPSS (24 to 10) - 2-3 point drop in QoL (5 to 2.5) - 70% durable at 5 years - If repeat and had inital response, then 65% chance it will work again ###### Pre-medications - Ancef 1 g IV - Toradol 15 mg IV (also give a dose after PAE in recovery) - Decadron 10 mg IV ###### Home Rx - Percocet 5/325 #10 - Macrobid 100 mg bid x 3 days (Bactrim x 3 days as backup if allergic) - Medrol dose pak - Pyridium 200 mg Q8 PRN (but not if CKD stage 3 or 4) - Naproxen 250 mg bid x 7 days - Pepcid (while taking naproxen) - Colace x 7 days - Oxybutinin 5 mg q8hr if catheterized - Stay on alpha blocker (Flomax/tamsulosin) for 1 month post PAE - Stop 5-ARI (finasteride or dutasteride) at time of procedure If rectal spasm: - B&O Suppository (this is no longer available) - Oxybutinin XL 10 mg daily x10 days - Rectal Valium and trospium work great too <br> ###### Setup If less than 6 ft tall (maybe 5'10" for me) ok to use radial ###### Longer catheters: - Boston Scientific Truselect 175 cm - Merit 150 cm Bern 5 Fr - Terumo MG1 or 2 <br> ###### Cone Beam at NGH (8 sec spin) - 4 for 56 aortic bifurcation XperCT 6 sec x-ray delay - 3 for 36 common iliac XperCT 4 sec x-ray delay - 2.5 for 27.5 internal iliac XperCT 3 sec x-ray delay (50/50 contrast) (Ari's protocol for internal iliac artery run) - 8 sec spin - Emboguide and find the prostate artery <br> ###### Embolization - 2.0 Fr progreat and 014 Fathom - Azure coils for collaterals - 100-300u embospheres (can go bigger if there are collaterals you can't coil) - Or 200 um hydropearls - Gelfoam prostate artery in the way out - Verapamil 1 mg in 1 mL at a time (up to 5 mg) to protect collaterals <br> ###### Follow up - Call the next day - Gives patients his email - Refer back to urologist for 3 month f/u - Call patient at 6 weeks - Dysuria, frequency, discomfort (down to the penis due to urethritis) 3-5 days ###### Redo Think about a Pena cava collateral ###### Prostate Volume L x W x H x 0.52 ###### Sheaths Flexor Rabbe 6 Fr - up and over Ansel - good to straighten out ipsilateral side Destination 45 cm 6 Fr #pae