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Joe Shelton with his wife and caretaker, Liz Shelton.
Minimally Invasive Procedure for Enlarged Prostate Helps UAMS Patient Enjoy Life Again
| Joe Shelton, 85, knew he had to do something when his sleep started being interrupted at least three times every night by the pressure to urinate.
He would get out of bed, stumble to the bathroom, then wait for his bladder to empty — but often nothing would come out except a dribble. So he’d go back to bed, only to be awakened again, and again, by the same frustrating urge.
“I knew my prostate was getting bigger,” he said, referring to a common medical condition that afflicts many men as they age: benign prostatic hyperplasia (BPH), or enlarged prostate.
Located just below the bladder, the prostate gland enlarges over time, sometimes blocking the flow of urine out of the bladder, which can cause bladder, urinary tract or kidney problems.
“When you’re young, it’s the size of a hickory nut,” Shelton said. But by age 85, he said, “My prostate was between the size of an orange and a grapefruit.”
A bicycling enthusiast of many years who used to ride his age in miles every birthday, Shelton was worried. He had always been quick to fall asleep once his head hit the pillow, and he had always enjoyed a full night’s sleep, which helped him keep up with his biking hobby as well as the two grandchildren and three great-grandchildren that he and Liz, his wife of 62 years, saw regularly.
Shelton said he spoke with urologist Timothy Langford, M.D., professor and chair of the Urology Department at the University of Arkansas for Medical Sciences (UAMS). However, the options that Langford suggested required surgery, which was not recommended for Shelton.
Meanwhile, Shelton said he figured out that he could manipulate his bladder by sitting on the commode and pressing down with both hands at just the right angle to start the flow of urine.
Then, one night, “a terrible thing happened,” he said. “I couldn’t empty my bladder at all.”
A trip to the emergency room revealed the problem: his appendix was on the verge of bursting.
Shelton immediately underwent an emergency appendectomy at UAMS. When the appendix becomes blocked, perhaps by bacteria or undigested food, blood can no longer flow through it, and it becomes inflamed and swollen, which causes severe abdominal pain. The pressure can cause it to burst, which constitutes a medical emergency because bacteria can then spread throughout the abdominal cavity.
During the surgery, doctors inserted a Foley catheter, a flexible tube that is placed in the bladder through the urethra to continuously drain urine from the bladder into a collection bag outside the body. It is often used during appendectomies when a patient has an enlarged prostate, since the surgery can further obstruct urinary retention.
While necessary to manage bladder drainage during an appendectomy and the recovery period, the catheter isn’t recommended for long-term use because it is prone to becoming infected.
“I lived with that for about 28 days,” Shelton said. “It was almost an answer to my prayers.”
But once it was removed, his previous problem returned. And now, following the appendectomy, the area was too sensitive for him to use the bladder-mashing maneuver.
“I actually prayed to pee,” Shelton said.
Then he learned online about a minimally invasive procedure to alleviate an enlarged prostate that involves no anesthesia and is done on an outpatient basis. Called prostate artery embolization (PAE), it is performed by interventional radiologists rather than urologists. It is considered safe and has a technical success rate of greater than 95:1 and a clinical success rate upwards of 80:1 at five years.
But it isn’t widely known in Arkansas, despite being brought to UAMS in 2022 by Robert Dixon, M.D., an interventional radiologist who retired earlier this year.
Langford arranged for Shelton to see Adam Berry, D.O., an interventional radiologist at UAMS who trained under Dixon and specializes in PAE.
At the time, in February 2024, PAE wasn’t a treatment option included in the American Urological Association (AUA) guidelines, but it was being considered for inclusion. By July, when the AUA updated its guidelines, PAE was given the green light when performed by a skilled interventional radiologist.
The AUA determined after several years that PAE is supported by a large body of evidence, and now calls it “a safe outpatient procedure” that studies suggest provides long-term relief for most patients. In fact, the professional association now urges urologists to collaborate with interventional radiologists to identify patients who may benefit from PAE.
Recognition of the procedure by urologists is a game-changer, Berry said, in that it should bring more widespread recognition to a safe procedure that preserves sexual function, doesn’t cause incontinence and doesn’t preclude future surgical options.
While not recommended for everyone, the AUA now calls PAE “an excellent initial treatment option for many men.”
Berry said the procedure has existed for 20 years in other areas of the country, and UAMS has been offering it for two years, but many doctors and patients in Arkansas remain unaware of it.
Yet more than a third of Arkansans are older than 50, and Berry said BPH affects 50% of men over 50, 60% of men over 60 and 70% of men over 70.
Shelton underwent the procedure Feb. 27, 2024, at UAMS while moderately sedated but not under anesthesia. Berry began by inserting a micro-catheter through a small puncture wound in a numbed area of the groin, into the artery that supplies blood flow to the prostate.
Assisted by fluoroscopy, an imaging technique that uses X-rays to create a real-time video of the inside of the body, he injected microscopic particles until blood flow to the prostate was blocked.
The procedure can be performed in a UAMS outpatient area or in the UAMS Health Urology Center in Little Rock’s Premier Medical Plaza and generally requires a two- to four-hour visit. It typically takes only five to 10 minutes to inject the particles, but the process can be challenging because the prostatic arteries are very small, sometimes hindering navigation of the catheter through twists and turns, he said.
“We go in one side of the prostate, then do the other side through the same arterial access site,” he said. “You go into both prostatic arteries, and there was no problem with this one.”
The patient starts experiencing relief within a week. Berry explained that without blood flow, the prostate shrinks, which takes one or two weeks, and “we leave a suture device under the skin to close the blood vessel, which the body absorbs on its own,” so an in-person follow-up visit isn’t necessary.
However, Berry prefers to call his patients one to two days after the procedure and again at one month to review medications that can be discontinued and confirm urinary symptoms are significantly improved.
In Shelton’s case, the Foley catheter remained in place until Langford removed it 28 days later in the UAMS Urology Clinic.
“I never had any pain,” Shelton said. “I felt so good when I left. I could be a spokesperson for anybody that wants to know about it. I don’t drizzle. I don’t strain. I haven’t been able to urinate like this since I was 25 years old.”
Berry said PAE is just as effective as transurethral resection of the prostate (TURP), which is considered “the gold standard” for an enlarged prostate and is available at UAMS but comes with some risks that didn’t make it an option for Shelton.
“Mr. Shelton is now able to void independently with no symptoms,” Berry said. “If he had known about the PAE option earlier, he could have avoided being in acute urinary retention and having a catheter placed.”
Berry and Langford said Shelton’s case demonstrates the clear advantages of the comprehensive, multidisciplinary care that is uniquely available at UAMS, the only academic medical center in Arkansas.
“There are a lot of silent sufferers — men who experience urinary problems that are too embarrassing to talk about with friends,” said Berry. “This is a very easy option. And it is covered by Medicare.”
“From a urology standpoint, it should be offered as an option,” Langford said. “It is very technically demanding, but I’m just glad we have that expertise at UAMS.”
Nine months later, Shelton remains so thrilled about the procedure that he asked to share his story to help other men. One of the best things about it, he said, is that his anatomy remains intact.
He said Berry’s expertise and bedside manner were impressive.
“He instills so much confidence,” Shelton said. “He is one of the nicest guys. We wanted to adopt him!”
To schedule an appointment with Berry, call 501-686-6918.