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Mikhaylov Y. Illustrations of clinically relevant celiacomesenteric trunk anatomic variants. J Vasc Surg Cases Innov Tech 2024; 10:101451. [PMID: 38559374 PMCID: PMC10979192 DOI: 10.1016/j.jvscit.2024.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Yana Mikhaylov
- Department of General, Acute Care, Trauma Surgery, Cape Fear Valley Health, Fayetteville, NC
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, NC
- College of Medicine, Drexel University, Philadelphia, PA
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Sciberras N, Zammit SC, Sidhu R. Small bowel intussusception - aetiology & management. Curr Opin Gastroenterol 2024; 40:175-182. [PMID: 38190421 DOI: 10.1097/mog.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. RECENT FINDINGS There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. SUMMARY A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.
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Affiliation(s)
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, UK
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Shin BNH, Qu L, Rhee H, Chung E. Systematic review and network meta-analysis of re-intervention rates of new surgical interventions for benign prostatic hyperplasia. BJU Int 2024. [PMID: 38600763 DOI: 10.1111/bju.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To assess the re-intervention rates of new surgical benign prostatic hyperplasia (BPH) interventions, as the clinical durability of new surgical interventions for BPH is not widely known. METHODS A critical review of new surgical BPH therapies namely 'UroLift®', 'Aquablation', 'Rezum', 'prostatic artery embolisation (PAE)' and 'temporary implantable nitinol device (iTIND)' was performed on PubMed, the Cochrane Library, and Embase databases between May 2010 and December 2022 according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. All relevant articles were reviewed, and the risk of bias was evaluated using the Cochrane risk assessment tool and Newcastle-Ottawa Scale. RESULTS Of the 32 studies included, there were 10 randomised controlled trials and 22 prospective observational cohorts. A total of 2400 participants were studied with a median patient age of 66 years, a median prostate volume of 51.9 mL, and a median International Prostate Symptom Score of 22. The lowest re-intervention rate at 12 months was for Aquablation at 0.01%, followed by Rezum at 0.02%, iTIND at 0.03%, and PAE at 0.05%. Network meta-analysis (NMA) showed that the best-ranked treatment at 12 months was transurethral resection of the prostate (TURP), followed by Aquablation, iTIND, Rezum, and UroLift. Re-intervention rates with these new BPH interventions are comparable, although some interventions reported better outcomes than TURP in the shorter term. CONCLUSIONS While this systematic review and NMA showed that the re-intervention rate with these new surgical BPH interventions appears to be comparable to TURP in the short term, further studies are required to directly compare these various BPH procedures.
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Affiliation(s)
- Brian Ng Hung Shin
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Liang Qu
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
- AndroUrology Centre, Brisbane, Qld, Australia
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Tian Y, Zhang M, Man H, Wu C, Wang Y, Kong L, Liu J. Study of ischemic progression in different intestinal tissue layers during acute intestinal ischemia using swept-source optical coherence tomography angiography. J Biophotonics 2024; 17:e202300382. [PMID: 38247043 DOI: 10.1002/jbio.202300382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
In acute intestinal ischemia, the progression of ischemia varies across different layers of intestinal tissue. We established a mouse model and used swept-source optical coherence tomography (OCT) to observe the intestinal ischemic process longitudinally in different tissue layers. Employing a method that combines asymmetric gradient filtering with adaptive weighting, we eliminated the vessel trailing phenomenon in OCT angiograms, reducing the confounding effects of superficial vessels on the imaging of deeper vasculature. We quantitatively assessed changes in vascular perfusion density (VPD), vessel length, and vessel average diameter across various intestinal layers. Our results showed a significant reduction in VPD in all layers during ischemia. The mucosa layer experienced the most significant impact, primarily due to disrupted capillary blood flow, followed by the submucosa layer, where vascular constriction or decreased velocity was the primary factor.
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Affiliation(s)
- Yu Tian
- Department of Surgical, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Mingshuo Zhang
- Hebei North University, Zhangjiakou, China
- Department of Hand & Foot Surgery, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Hongbo Man
- Hebei North University, Zhangjiakou, China
- Department of Hand & Foot Surgery, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Chunnan Wu
- Department of General Surgery, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yimin Wang
- Department of Surgical, Hebei Medical University, Shijiazhuang, Hebei Province, China
- Department of General Surgery, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Linghui Kong
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Jian Liu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
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Richardson AJ, Kumar J, Richardson K, Bhatia A, Pennix T, Shah K, Maini A, Jalaeian H, Bhatia S. Safety of Prostatic Artery Embolization via Transradial Access versus Transfemoral Access. J Vasc Interv Radiol 2024; 35:541-547. [PMID: 38103863 DOI: 10.1016/j.jvir.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To compare prostatic artery embolization (PAE) via transradial access (TRA-PAE) versus transfemoral access (TFA-PAE) to assist access selection. MATERIAL AND METHODS Procedural outcomes and adverse events were evaluated in 998 patients who underwent PAE at a single center from April 2014 to August 2022; 821 (82%) underwent TRA-PAE (Group R) and 177 (18%) underwent TFA-PAE (Group F). Mean age and prostate size of Groups R and F were 69.2 years (SD ± 8.4) and 117.4 g (SD ± 63.1) and 75.2 years (SD ± 12.1) and 127.2 g (SD ± 83.6), respectively (P < .01 and P = .16; postpropensity matching: P = .38 and P = .35, respectively). Indications for PAE included lower urinary tract symptoms, acute or chronic urinary retention, and hematuria. Procedural and patient-specific metrics were reviewed. Technical success was defined as bilateral PAE. Adverse events were recorded according to the Society of Interventional Radiology (SIR) adverse events classification. Statistical significance was defined as P < .05. RESULTS Technical success was achieved in 798 (97.2%) patients in Group R and 165 (93.2%) patients in Group F. Mean procedural time, single- and continuous-rotation fluoroscopy time, dose area product, and air kerma were significantly lower in Group R than in Group F (P < .001). Moreover, 6 (0.7%) patients in Group R and 9 (5.5%) patients in Group F had access site ecchymoses, whereas 5 (0.6%) patients in Group R and 6 (3.6%) in Group F had access site hematomas. Two patients experienced transient ischemic attacks (TIAs) after TRA-PAE and recovered without intervention. Two occult radial artery occlusions were noted, but no patient experienced hand ischemia. CONCLUSIONS In a large single interventional radiologist cohort, TRA-PAE demonstrated similar technical success to that of TFA-PAE with lower access site hemorrhagic complications and radiation requirements; however, TIA and occult radial artery occlusions remain a concern.
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Affiliation(s)
- Andrew J Richardson
- Department of Interventional Radiology, Jackson Memorial Hospital, Miami, Florida.
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth Richardson
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ansh Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas Pennix
- Department of Interventional Radiology, Jackson Memorial Hospital, Miami, Florida
| | - Khushi Shah
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Aneesha Maini
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Müllhaupt G, Hechelhammer L, Graf N, Mordasini L, Schmid HP, Engeler DS, Abt D. Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial. Eur Urol Focus 2024:S2405-4569(24)00045-2. [PMID: 38531756 DOI: 10.1016/j.euf.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up. METHODS We conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests. KEY FINDINGS AND LIMITATIONS Of the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was -7.78 points after PAE and -11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] -0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference -5.71, 95% CI -10.72 to -0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79-300.51; p = 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS The improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling. PATIENT SUMMARY In this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP. This trial is registered on ClinicalTrials.gov as NCT02054013.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spital Thun, Thun, Switzerland.
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Nicole Graf
- Biostatistics Department, Clinical Trials Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Uroviva Practice Sursee, Uroviva Group, Sursee, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spitalzentrum Biel, Biel, Switzerland
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Ganapathy A, Mohakud S, Rout S, Joy P, Alagappan A, Manokaran A. A radio-anatomical study of median arcuate ligament syndrome: unveiling the morphology and morphometry of median arcuate ligament, celiac trunk, and superior mesenteric artery. Abdom Radiol (NY) 2024:10.1007/s00261-024-04231-w. [PMID: 38494467 DOI: 10.1007/s00261-024-04231-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE In the context of medical literature, a significant lacuna exists in understanding median arcuate ligament syndrome (MALS). While clinical aspects are well documented, literature lacks a robust exploration of the anatomical relationship between the celiac trunk and the median arcuate ligament (MAL). METHODS Morphometric parameters, including the vertebral level of MAL origin, MAL thickness, celiac trunk (CeT) origin level, diameter, and distances between CeT/Superior Mesenteric Artery (SMA) and the MAL center were observed on 250 CT angiograms. Cadavers (n = 11) were dissected to examine the same parameters and histo-morphological examination of MAL tissue was done. RESULTS Radiological findings established average MAL thickness of 7.79 ± 2.58 mm. The celiac trunk typically originated at T12. The average distance between the celiac trunk and the MAL center was 1.32 ± 2.04 mm. The angle of the celiac trunk to the abdominal aorta was primarily obtuse. The average celiac trunk diameter was 5.53 ± 1.33 mm. Histological examinations revealed a diverse MAL composition, indicating variable mechanical properties. CONCLUSION This study provides comprehensive morphometric data on the anatomical relationship between the MAL and the celiac trunk. In contrast to available literature which says the average MAL thickness of > 4 mm is an indicator of increased thickness, we observed much higher average thickness in the studied population. The findings contribute to a better understanding of normal anatomical variations which can serve as reference values for accurate radiological diagnosis of MALS. The histological examination revealed the heterogeneous nature of the MAL tissue composition, suggesting variable mechanical properties and functions in different regions.
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Affiliation(s)
- Arthi Ganapathy
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
| | - Sudipta Mohakud
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sipra Rout
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Praisy Joy
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Alamelu Alagappan
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Aarthi Manokaran
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
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Bhatia A, Porto JG, Maini A, Langade D, Herrmann TRW, Shah HN, Bhatia S. One-year outcomes after prostate artery embolization versus laser enucleation: A network meta-analysis. BJUI Compass 2024; 5:189-206. [PMID: 38371212 PMCID: PMC10869668 DOI: 10.1002/bco2.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 02/20/2024] Open
Abstract
Background Although holmium laser enucleation (HoLEP) is considered a size-independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post-operative and short-term efficacy of PAE and HoLEP. Methods PubMed, Cochrane Library and EMBASE databases were searched. Network meta-analysis was performed following PRISMA-N-guidelines. Post-operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post-void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD = 0), evidence indicated no statistically significant difference between treatments compared. Results Qualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3 months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: -2.21: 95%CI: (-10.20, 5.78), favouring PAE], QoL score improvement [WMD: -0.22:95%CI: (-1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (-59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1-year follow-up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (-1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (-1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (-32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (-2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP-OR: 0.68, 95%CI: (0.25, 1.37)]. Conclusion HoLEP was superior to PAE at 3 months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1 year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long-term outcome of PAE are needed to establish the durability of early outcomes after PAE.
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Affiliation(s)
- Ansh Bhatia
- Department of Interventional Radiology, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
- Seth GS Medical College and KEM HospitalMumbaiIndia
| | | | - Aneesha Maini
- School of MedicineGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Thomas R. W. Herrmann
- Department of UrologySwitzerland Urology Spital Thurgau AG (STGAG)FrauenfeldSwitzerland
| | - Hemendra Navinchandra Shah
- Department of Urology, Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Shivank Bhatia
- Department of Interventional Radiology, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
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Gemma L, Pecoraro A, Sebastianelli A, Spatafora P, Sessa F, Nicoletti R, Gravas S, Campi R, Serni S, Gacci M. Impact of minimally invasive surgical procedures for Male Lower Urinary Tract Symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00795-2. [PMID: 38355729 DOI: 10.1038/s41391-024-00795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Surgical treatments for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) are affected by potentially bothersome side effects on sexual, and, above all, ejaculatory function. Several minimally invasive techniques have been proposed in the last years in order to overcome these consequences. Our aim is to summarize and evaluate the efficacy on LUTS relieve and the impact on sexual/ejaculatory function of Rezum, prostate artery embolization (PAE), implantation of a prostatic urethral lift (PUL) and the temporary implantable nitinol device (TIND). METHODS A systematic review of the English-language literature was conducted using the MEDLINE, Embase, and Web of Science databases from January 2000 to October 2022, according to the PRISMA guidelines (PROSPERO ID: CRD42023466515). Randomized controlled trials (RCTs), prospective studies and non-comparative or comparative studies assessing the impact on functional and ejaculatory function after minimally invasive surgical therapies for Male LUTS were evaluated. Risk of bias assessment was performed according to the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool for comparative studies, and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for RCTs. RESULTS Overall, 47 studies were included (n = 4 for TIND; n = 9 for Rezum; n = 13 for PUL; n = 21 for PAE). Most studies relied on prospective patient cohorts and were rated as low risk of bias. Across studies assessing the efficacy of Rezum, a significant improvement in terms of IPSS (ranging from -47% to -56%) and Qmax (ranging from +39% to +87%) was reported. On the other hand, according to IIEF-5 score, Rezum had a minimal impact on sexual function (ranging from -1% to -3%). PUL showed a positive impact on IPSS (ranging from -35% to -58.2%) and Qmax (ranging from +49.9% to +114.7%) and sexual function. Finally, PAE showed encouraging functional results with IPSS score reducing from -12.8% to 63.3% and Qmax improving from +8% to 114.9% but the available evidence regarding the potential impact of PAE on sexual outcomes were limited. CONCLUSION Rezum, PAE, PUL and TIND are safe and feasible techniques associated with a significant functional improvement. While available data suggest a minimal impact of Rezum and PUL on ejaculatory function, the evidence after PAE and TIND are still limited. Therefore, our review lays the foundation for further research aiming to identify the criteria to select best candidates for uMIST to tailor the management in light of specific patient- and disease- factors.
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Affiliation(s)
- Luca Gemma
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rossella Nicoletti
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Riccardo Campi
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Choi PJK, Pradhan J, Thite S, Pydi R, Sathya Prakash G, Golek TM, Moore S, Shah A, Girishkumar H. Diagnostic and Surgical Implications of Non-occlusive Mesenteric Ischemic Ileus Associated With Common Celiacomesenteric Trunk: A Case Report and Literature Review. Cureus 2024; 16:e54837. [PMID: 38533166 PMCID: PMC10963211 DOI: 10.7759/cureus.54837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
The celiacomesenteric trunk (CMT), an exceedingly rare anatomic variant uniting the celiac artery and superior mesenteric artery (SMA), holds significant clinical and surgical implications. Despite its rarity, understanding these implications is crucial for effective management. This report outlines the case of a 99-year-old female presenting with septic shock and abdominal pain, with imaging revealing an incidental CMT. This paper aims to elucidate the surgical implications associated with CMT through a comprehensive case review and literature search. A 99-year-old female with multiple cardiovascular comorbidities presented with altered mental status and right lower quadrant abdominal pain. Upon arrival, the patient exhibited disorientation, an inability to follow commands, hypoxia, and hypotension. Significant laboratory findings included a white count of 20.6 x 109/L, lactate of 6.1 mmol/L, glucose of 53 mg/dL, alanine transaminase (ALT)/aspartate aminotransferase (AST) of 186/336 U/L, and creatinine of 4.2 mg/dL. Immediate interventions involved high-flow oxygen, fluid resuscitation, intravenous antibiotics, and admission to the ICU for septic shock. A CT angiogram (CTA) revealed an incidental large common trunk comprising the celiac trunk and superior mesenteric artery (SMA). There was a high-grade stenosis at the origin of the SMA. However, all the vessels were widely patent distally, and acute mesenteric occlusion was ruled out. By day 12, the patient achieved clinical stability after conservative management and was discharged. Complications such as aneurysm, dissection, stenosis, thrombosis, or acute occlusion of a CMT may necessitate complex surgical interventions, including endovascular procedures or open hepatic surgery. Understanding these technical complexities is vital for avoiding surgical complications in critically ill patients.
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Affiliation(s)
| | | | - Sania Thite
- Surgery, BronxCare Health System, New York, USA
| | - Reshma Pydi
- Surgery, BronxCare Health System, New York, USA
| | | | - Tiffany-Marie Golek
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Sarah Moore
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Ajay Shah
- Surgery, BronxCare Health System, New York, USA
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11
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Altman R, Ferreira R, Barragan C, Bhojani N, Lajkosz K, Zorn KC, Chughtai B, Annamalai G, Elterman DS. Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. BMC Urol 2024; 24:22. [PMID: 38281906 PMCID: PMC10822184 DOI: 10.1186/s12894-023-01397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). METHODS A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. RESULTS Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. CONCLUSION PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
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Affiliation(s)
- Rachel Altman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Roseanne Ferreira
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Camilo Barragan
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network/Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kevin C Zorn
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Ganesan Annamalai
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Vascular and Interventional Radiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
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12
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Goto T, Fujimura H, Shintani T, Shibuya T, Miyagawa S. Use of selective visceral angiography in surgical strategy planning for celiac artery aneurysm in the celiacomesenteric trunk. J Cardiothorac Surg 2024; 19:11. [PMID: 38243244 PMCID: PMC10797990 DOI: 10.1186/s13019-024-02483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The celiacomesenteric trunk (CMT) is a common duct of the celiac artery (CA) and the superior mesenteric artery originating from the aorta, which is an uncommon anatomical variant of visceral artery circulation. Because of the variety of visceral circulation in those with CMT, the visceral circulation associated with each branch should be evaluated prior to surgical treatment of visceral artery aneurysm in the CMT. CASE PRESENTATION A 64-year-old woman was diagnosed with a CA aneurysm in the CMT. Aneurysmectomy of the aneurysm was performed successfully. On preoperative selective visceral angiography, the CA was seen to bifurcate into the common hepatic and splenic artery. The left gastric artery was directly isolated from the aorta and perfused to the common hepatic and splenic artery through collateral circulation. These findings showed that celiac artery embolization is anatomically feasible, even in cases of celiac artery aneurysm rupture. CONCLUSIONS Selective visceral angiography can contribute to surgical strategy planning for CA aneurysm with CMT.
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Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Shintani
- Department of Cardiovascular Surgery, Nippon Life Hospital, Osaka, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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13
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Salem J, Becher KF, Bschleipfer T, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Schönburg S, Abt D. [Minimally invasive treatment of benign prostatic hyperplasia : The German S2e guideline 2023-part 4]. Urologie 2024; 63:58-66. [PMID: 38193989 DOI: 10.1007/s00120-023-02249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options. OBJECTIVE Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome. MATERIALS AND METHODS Summary and overview of chapters 11-13 on minimally invasive therapies for LUTS/BPO of the current long version of the German S2e guideline. RESULTS In case of absolute indication for surgery or after unsatisfactory or undesired medical therapy, minimally invasive treatments such as UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA), and prostatic artery embolization (PAE) can be considered. These indirect/delayed ablative therapies offer lower morbidity and the possibility of performing them under local anesthesia, but they are inferior to direct ablative/resective techniques in terms of effectiveness and sustainability. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations for new minimally invasive therapies for LUTS/BPO, which present alternative treatment options for selected patients.
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Affiliation(s)
- Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Schillingsrotterstr. 39-41, 50996, Köln, Deutschland.
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland.
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | | | | | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Halle-Wittenberg, Deutschland
| | - Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Schweiz
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14
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Vigneswaran G, Maclean D, Doshi N, Harris M, Bryant TJC, Hacking NC, Somani B, Modi S. Cardiovascular Comorbidities Do Not Impact Prostate Artery Embolisation (PAE) Outcomes: Retrospective Analysis of the National UK-ROPE Registry. Cardiovasc Intervent Radiol 2024; 47:115-120. [PMID: 38012342 PMCID: PMC10770187 DOI: 10.1007/s00270-023-03608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Prostate artery embolisation (PAE) is a key treatment for the management of symptomatic benign prostatic hyperplasia (BPH). Common cardiovascular risk factors might be associated with suboptimal outcomes and thus influence patient treatment selection. The aim of the study was to evaluate whether cardiovascular comorbidities affect PAE outcomes. METHODS Retrospective subset analysis of the UK Registry of Prostate Artery Embolisation (UK-ROPE) database was performed with patients who had a full documented past medical histories including hypertension, diabetes, coronary artery disease (CAD), diabetes and smoking status as well as international prostate symptom score (IPSS) at baseline and at 12 months. Multiple regression was performed to assess for any significant predictors. RESULTS Comorbidity data were available for 100/216 patients (mean age 65.8 ± 6.4 years), baseline IPSS 20.9 ± 7.0). Regression analysis revealed that the presence of hypertension (53.7% IPSS reduction vs. absence 51.4%, p = 0.94), diabetes (52.6% vs. absence 52.1%, p = 0.6), CAD (59.2% vs. absence 51.4%, p = 0.95), no comorbidities (49.8% vs. any comorbidity present 55.3%, p = 0.66), smoking status (non-smoker, 52.6%, current smoker, 61.5%, ex-smoker, 49.8%, p > 0.05), age (p = 0.52) and baseline Qmax (p = 0.41) did not significantly impact IPSS reduction at 12 months post-PAE. Baseline prostate volume significantly influenced IPSS reduction (≥ 80 cc prostates, 58.9% vs. < 80 cc prostates 43.2%, p < 0.05). CONCLUSION The presence of cardiovascular comorbidities/smoking history does not appear to significantly impact PAE symptom score outcomes at 12 months post procedure. Our findings suggest that if the prostatic artery can be accessed, then clinical success is comparable to those without cardiovascular comorbidities.
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Affiliation(s)
- Ganesh Vigneswaran
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
- Cancer Sciences, University of Southampton, Southampton, UK
| | - Drew Maclean
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Neel Doshi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
- Cancer Sciences, University of Southampton, Southampton, UK
| | - Mark Harris
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Timothy J C Bryant
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Nigel C Hacking
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK.
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15
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Najwa A, Zineb I, Sara EG, Lamiae R, Najlaa L, Siham EH, Nazik A, Latifa C. Solitary infantile myofibromatosis in the upper extremities: Case report. Radiol Case Rep 2024; 19:21-23. [PMID: 38046916 PMCID: PMC10692447 DOI: 10.1016/j.radcr.2023.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 12/05/2023] Open
Abstract
Infantile myofibromatosis (IM) is a mesenchymal tumor that may present in infants in a couple of major forms: solitary (myofibroma) and multicentric (myofibromatosis) which can be more subdivided into IM without or with visceral involvement. The tumors present as nodular lesions in the soft tissues, bones, and/or internal organs. Although the success of imaging in suggesting the correct diagnosis can't be denied, histopathology and Immunohistochemical examinations are necessary to confirm the diagnosis of IM as it might be misdiagnosed as a malignant tumor. We report a case of solitary infantile myofibromatosis in the upper extremities discovered in a 9-year-old girl. She had swelling and an enlargement on the posterior forearm on the ulnar side. The X-ray showed a lytic lesion with swollen soft tissue. The patient underwent an MRI which suggested the diagnosis of myofibroma. Then, solitary myofibroma was confirmed histologically. Infancy's most prevalent fibrous tumor is IM. Its prognosis depends on the visceral involvement. Imaging, especially MRI is the ideal tool to diagnose it.
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Affiliation(s)
- Amsiguine Najwa
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Izi Zineb
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - El Ghaffouli Sara
- Department of Pediatric Anatomopathology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Rouas Lamiae
- Department of Pediatric Anatomopathology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Lrhorfi Najlaa
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - El Haddad Siham
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Allali Nazik
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Chat Latifa
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
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16
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Miłow JJ, Joźwiak J. Expect the unexpected: bezoar-caused gastric perforation in the 19-year-old patient, after traffic accident. Polski Merkuriusz Lekarski 2024; 52:128-131. [PMID: 38518244 DOI: 10.36740/merkur202401119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
A 19-year-old female involved in a traffic accident presented to the Emergency Room (ER) with no trauma-related symptoms but a palpable mass in the epigastrium. Imaging revealed a massive trichobezoar causing gastric perforation. Urgent laparotomy was performed, and a 1.5-kilogram bezoar was removed, along with repairing coexisting gastric ulcers. The patient had a history of trichophagia, suggesting a psychiatric association. This case highlights the potential of trichobezoars to cause gastric perforation, even in patients admitted for unrelated reasons. CT-scan proves effective in diagnosing such cases. While a traffic accident might be a plausible cause, the presence of a bezoar can elevate the risk of complications. Psychiatric evaluation is recommended when trichophagia is identified. The study underscores the need for vigilance in unexpected scenarios, demonstrating the importance of multidisciplinary approaches in managing such cases.
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Affiliation(s)
- Jerzy Janusz Miłow
- MARIA SKŁODOWSKA-CURIE VOIVODESHIP SPECIALIST HOSPITAL IN ZGIERZ, ZGIERZ, POLAND
| | - Justyna Joźwiak
- MARIA SKŁODOWSKA-CURIE VOIVODESHIP SPECIALIST HOSPITAL IN ZGIERZ, ZGIERZ, POLAND
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17
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Moramarco L, Grande AM, Vertemati M, Aseni P. Prostate Artery Embolization in the Treatment of Massive Intractable Bleeding from Prostatic Neoplasms: A Case Report and Systematic Review. J Clin Med 2023; 13:65. [PMID: 38202072 PMCID: PMC10780233 DOI: 10.3390/jcm13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
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Affiliation(s)
- Lorenzo Moramarco
- Radiologia—Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonino M. Grande
- Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Paolo Aseni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
- Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milan, Italy
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18
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Ritenour A, Mousa A. Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion. J Vasc Surg Cases Innov Tech 2023; 9:101314. [PMID: 37860725 PMCID: PMC10582744 DOI: 10.1016/j.jvscit.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023] Open
Abstract
Acute occlusion of celiomesenteric trunk variants such as a replaced common hepatic artery origin from a superior mesenteric artery can be catastrophic and requires immediate attention to reverse simultaneous mesenteric and hepatic ischemia and prevent death. We report the case of a 73-year-old woman with acute occlusion of her celiomesenteric trunk and proximal superior mesenteric artery who underwent successful endovascular repair with stent graft via brachial access. In the present case report, we describe a surgically relevant classification system of celiomesenteric trunk variants, highlight the feasibility of endovascular intervention in this uncommon scenario, and describe our technique.
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Affiliation(s)
- Amber Ritenour
- Vascular Surgery Services, WVU Heart and Vascular Institute, WVU Medicine, Parkersburg, WV
| | - Albeir Mousa
- Vascular Surgery Services, WVU Heart and Vascular Institute, WVU Medicine, Parkersburg, WV
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, Thomas Memorial Hospital, WVU Medicine, Charleston, WV
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19
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Mao Y, Yao Y, Li X, Zhang C, Chen X, Wang Y. Absence of the celiac trunk: Definition, classification, multidetector computed tomography angiographic findings, and their probable embryological mechanisms. Vascular 2023; 31:1214-1221. [PMID: 35634715 DOI: 10.1177/17085381221106318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to identify the types and prevalence of absence of the celiac trunk by using multidetector computed tomography (MDCT) angiography, and analyze their probable embryological mechanisms. METHODS A retrospective study was carried out on 2500 abdominal MDCT angiography images. The absence of the celiac trunk was defined as that the celiac trunk is not exist, more specifically, there is not such an arterial trunk containing at least two major branches of the celiac trunk. Various types of the absence of the celiac trunk were investigated. RESULTS Of the 2500 patients, 19 (0.76%) patients were identified as an absence of the celiac trunk. According to its definition and classification, the absence of the celiac trunk could be divided into five types: type I (LGA + CHA + SA + SMA), type II (HM trunk + LGA + SA), type III (SM trunk + LGA + CHA), type IV (GM trunk + CHA + SA), and type V (other type); and these types were observed in 5 patients (0.20%), 9 patients (0.36%), 3 patients (0.12%), 0 patients (0.00%), and 2 (0.08%) patients, respectively. There were more examples of the types I and II than of the types III-V (p = 0.004). CONCLUSION We systematically classified the absence of the celiac trunk based on its MDCT angiography findings. Abnormal interruptions and persistence of the longitudinal anastomosis, regression of vascular root, and emergence of replaced artery could all be the embryological mechanisms of various types of the absence of the celiac trunk.
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Affiliation(s)
- Yi Mao
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
| | - Yun Yao
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
| | - Xiaoguang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
| | - Chunlai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
| | - Xiao Chen
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
| | - Yi Wang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing Clinical Research Centre of Imaging and Nuclear Medicine, Chongqing, China
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20
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Garzelli L, Ben Abdallah I, Nuzzo A, Zappa M, Corcos O, Dioguardi Burgio M, Cazals-Hatem D, Rautou PE, Vilgrain V, Calame P, Ronot M. Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit. Br J Radiol 2023; 96:20230232. [PMID: 37493183 PMCID: PMC10607400 DOI: 10.1259/bjr.20230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/27/2023] Open
Abstract
Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options.AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome.
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Affiliation(s)
| | - Iannis Ben Abdallah
- Université Paris Cité, France & Service de chirurgie vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Alexandre Nuzzo
- Intestinal Stroke Center, Service de gastroenterologie, MICI et Insuffisance intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Magaly Zappa
- Université des Antilles & Service de radiologie, Centre Hospitalier André Rosemon, Cayenne, France
| | - Olivier Corcos
- Intestinal Stroke Center, Service de gastroenterologie, MICI et Insuffisance intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Marco Dioguardi Burgio
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Dominique Cazals-Hatem
- Université Paris Cité, France & Service d’anatomopathologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Pierre-Emmanuel Rautou
- Université Paris Cité, France & Service d’hépatologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Valérie Vilgrain
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Paul Calame
- Université Bourgogne Franche-comté, Service de radiologie, CHU Besançon, France
| | - Maxime Ronot
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
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Jankauskas T, Buržinskis E, Kaupas RS, Basevičius A, Jievaltas M. Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania. Medicina (Kaunas) 2023; 59:1871. [PMID: 37893589 PMCID: PMC10608601 DOI: 10.3390/medicina59101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.
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Affiliation(s)
- Tautvydas Jankauskas
- Radiology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Edgaras Buržinskis
- Surgery Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rytis Stasys Kaupas
- Radiology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Algidas Basevičius
- Radiology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Mindaugas Jievaltas
- Urology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Murad L, Bouhadana D, Nguyen DD, Chughtai B, Zorn KC, Bhojani N, Elterman DS. Treating LUTS in Men with Benign Prostatic Obstruction: A Review Article. Drugs Aging 2023; 40:815-836. [PMID: 37556075 DOI: 10.1007/s40266-023-01054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/10/2023]
Abstract
Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life.
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Affiliation(s)
- Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
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Agarwal L, Dash NR, Pal S, Agarwal A, Madhusudhan KS. Pattern of Aorto-coeliac Calcification Correlating Cervical Esophago-gastric Anastomotic Leak After Esophagectomy for Cancer: a Retrospective Study. J Gastrointest Cancer 2023; 54:759-767. [PMID: 35965285 DOI: 10.1007/s12029-022-00856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Cervical esophagogastric anastomotic leak (CEGAL) is a troublesome complication after esophagectomy and gastric pull-up. The aim of the study was to identify the preoperative clinical and radiological factors associated with increased risk of CEGAL. METHODS Consecutive patients whose clinical and imaging data were available and who underwent cervical esophago-gastric anastomosis following esophagectomy and gastric pull-up for esophageal cancer, between January 2013 and January 2021, were included. The patient details were collected from a prospectively maintained database. The demographic, clinical, and laboratory data including preoperative hemoglobin and serum albumin levels were recorded. Preoperative computed tomographic (CT) images were reviewed by two independent radiologists to assign vascular calcification scores for proximal aorta, distal aorta, aortic bifurcation, celiac trunk, and celiac artery branches. The primary outcome evaluated was clinically evident neck leak. Univariate and multivariate analysis of the clinical and radiological factors was performed to identify significant predictors. RESULTS A total of 100 patients (mean age: 54.7 years; 60 males, 40 females) were included in the study and of them, 27 developed CEGAL. Compared to the group without CEGAL, the patient group with CEGAL had significantly higher mean age (60.3 vs. 52.7 years, p < 0.01), and higher incidences of diabetes mellitus (25.9% vs 10.9%, p = 0.03), major proximal aortic calcification (29.6% vs. 6.3%, p < 0.01), and major celiac trunk calcification (22.2% vs. 6.3%, p = 0.02). Multivariate regression analysis identified age and presence of major proximal aortic calcification as independent risk factors for the development of CEGAL. CONCLUSION Major calcification of the proximal aorta and advanced age are independent risk factors for CEGAL after esophagectomy.
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Affiliation(s)
- Lokesh Agarwal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110025, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110025, India.
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110025, India
| | - Ayushi Agarwal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Curtin P, Chang C, Uflacker A. Prostatic Arterial Embolization for Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement. Curr Urol Rep 2023; 24:427-441. [PMID: 37314610 DOI: 10.1007/s11934-023-01170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW Prostatic artery embolization (PAE) is an emerging minimally invasive technique for lower urinary tract symptom reduction from benign prostatic hypertrophy (BPH). While the technique is becoming increasingly popular with patients and interventional radiologists, most urologists remain skeptical of the PAE's long-term efficacy and comparative success to the gold standard transurethral resection of the prostate. RECENT FINDINGS PAE has been found in multiple meta-analyses to perform similarly to the gold standard transurethral resection of the prostate (TURP) with regard to patient-driven measures like IPSS and IPSS-QoL, while also performing favorably in objective measurements including Qmax and PVR out to at least 12 months post intervention. Furthermore, PAE has a demonstrated shorter hospital length of stay and fewer adverse events when compared to TURP. PAE provides patients with an alternative to transurethral options for the management of LUTS in the setting of bladder outlet obstruction. While long-term evidence demonstrating the durability of PAE is still forthcoming, the procedure has been demonstrated to be safe according to multiple meta-analyses. Patients deserve to be counseled on PAE as an alternative to surgery and made aware that while the overall treatment effect may not be as robust or durable, the procedure carries a favorable adverse event profile that is attractive to patients wishing to avoid a trans-urethral approach.
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Affiliation(s)
- Patrick Curtin
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Andre Uflacker
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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25
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Sapoval M, Thiounn N, Descazeaud A, Déan C, Ruffion A, Pagnoux G, Duarte RC, Robert G, Petitpierre F, Karsenty G, Vidal V, Murez T, Vernhet-Kovacsik H, de la Taille A, Kobeiter H, Mathieu R, Heautot JF, Droupy S, Frandon J, Barry Delongchamps N, Korb-Savoldelli V, Durand-Zaleski I, Pereira H, Chatellier G. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. Lancet Reg Health Eur 2023; 31:100672. [PMID: 37415648 PMCID: PMC10320610 DOI: 10.1016/j.lanepe.2023.100672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
Background Prostatic artery embolisation (PAE) is a minimally invasive treatment of symptomatic benign prostatic hyperplasia (BPH). Our aim was to compare patient's symptoms improvement after PAE and medical treatment. Methods A randomised, open-label, superiority trial was set in 10 French hospitals. Patients with bothersome lower urinary tract symptoms (LUTS) defined by International Prostatic Symptom Score (IPSS) > 11 and quality of life (QoL) > 3, and BPH ≥50 ml resistant to alpha-blocker monotherapy were randomly assigned (1:1) to PAE or Combined Therapy ([CT], oral dutasteride 0.5 mg/tamsulosin hydrochloride 0.4 mg per day). Randomisation was stratified by centre, IPSS and prostate volume with a minimisation procedure. The primary outcome was the 9-month IPSS change. Primary and safety analysis were done according to the intention-to-treat (ITT) principle among patients with an evaluable primary outcome. ClinicalTrials.gov Identifier: NCT02869971. Findings Ninety patients were randomised from September 2016 to February 2020, and 44 and 43 patients assessed for primary endpoint in PAE and CT groups, respectively. The 9-month change of IPSS was -10.0 (95% confidence interval [CI]: -11.8 to -8.3) and -5.7 (95% CI: -7.5 to -3.8) in the PAE and CT groups, respectively. This reduction was significantly greater in the PAE group than in the CT group (-4.4 [95% CI: -6.9 to -1.9], p = 0.0008). The IIEF-15 score change was 8.2 (95% CI: 2.9-13.5) and -2.8 (95% CI: -8.4 to 2.8) in the PAE and CT groups, respectively. No treatment-related AE or hospitalisation was noticed. After 9 months, 5 and 18 patients had invasive prostate re-treatment in the PAE and CT group, respectively. Interpretation In patients with BPH ≥50 ml and bothersome LUTS resistant to alpha-blocker monotherapy, PAE provides more urinary and sexual symptoms benefit than CT up to 24 months. Funding French Ministry of Health and a complementary grant from Merit Medical.
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Affiliation(s)
- Marc Sapoval
- Université de Paris Cité, PARCC - INSERM Unité-970, Paris, France
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas Thiounn
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Aurélien Descazeaud
- Centre Hospitalier Universitaire de Limoges, Department of Urology, Limoges, France
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
- Université Lyon 1, Faculté de médecine Lyon Sud, Equipe 2 - Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Lyon, France
| | - Gaële Pagnoux
- Department of Uroradiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology and Transplantation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Grégoire Robert
- Centre Hospitalier Universitaire de Bordeaux, Department of Urology, Université de Bordeaux, Bordeaux, France
| | - Francois Petitpierre
- Centre Hospitalier Universitaire de Bordeaux, Department of Diagnostic and Therapeutic Imaging, Bordeaux, France
| | - Gilles Karsenty
- Department of Urology and Renal Transplantation, Assistance publique-Hôpitaux de Marseille, Hôpital de la Conception, Aix-Marseille Université, Marseille, France
| | - Vincent Vidal
- Centre Hospitalier Universitaire de la Timone, Interventional Radiology Section, Department of Medical Imaging, Assistance publique-Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, LiiE, CERIMED, Marseille, France
| | - Thibaut Murez
- Centre Hospitalier Universitaire de Montpellier, Department of Urology and Renal Transplantation, Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Centre Hospitalier Universitaire de Montpellier, Department of Diagnostic and Interventional Radiology, Hôpital Arnaud-de-Villeneuve, Montpellier, France
| | - Alexandre de la Taille
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Hicham Kobeiter
- Department of Diagnostic and Interventional Medical Imaging, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Université Paris Est, Créteil, France
| | - Romain Mathieu
- Centre Hospitalier Universitaire de Rennes, Department of Urology, Rennes, France
| | - Jean-Francois Heautot
- Centre Hospitalier Universitaire de Rennes, Vascular Medicine Unit, Department of Radiology, Hôpital Pontchaillou, Rennes, France
| | - Stéphane Droupy
- Centre Hospitalier Universitaire De Nîmes, Department of Urology and Andrology, Université de Montpellier, Nîmes, France
| | - Julien Frandon
- Centre Hospitalier Universitaire De Nîmes, Department of Medical Imaging, Université de Montpellier, Nîmes, France
- Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Nicolas Barry Delongchamps
- Université de Paris Cité, Inserm Unit U1151, Paris, France
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Virginie Korb-Savoldelli
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
- Department of Clinical Pharmacy, Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, France
| | - Isabelle Durand-Zaleski
- Université de Paris Cité, CRESS, INSERM UMR1153, INRA, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital de l'Hôtel Dieu, Université Paris Est Créteil, URCEco, Paris, France
| | - Helena Pereira
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, Paris, France
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Gilles Chatellier
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, Paris, France
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
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Jalamneh B, Nassar IJ, Sabbooba L, Ghanem R, Nazzal Z, Kiwan R, Awadghanem A, Maree M. Exploring Anatomical Variations of Abdominal Arteries Through Computed Tomography: Classification, Prevalence and Implications. Cureus 2023; 15:e41380. [PMID: 37546145 PMCID: PMC10400811 DOI: 10.7759/cureus.41380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND AND AIMS Variations in the branches of the abdominal aorta are relatively prevalent and can impact certain surgeries. The accurate identification and differentiation of these variations pre- and intraoperatively are crucial to avoid negative clinical sequelae. This study aimed to investigate the prevalence of variations in some branches of the abdominal aorta and to identify the most frequent variants as well as any rare variants not previously classified in the existing classification systems. The study's findings may help improve the understanding and management of these variations. MATERIALS AND METHODS This retrospective study was conducted at the Department of Radiology at An-Najah National University Hospital (NNUH) and included 550 abdominal computed tomography (CT) angiographic scans for patients (51.5% males, 48.5% females) performed between January 2017 and January 2023. RESULTS Variations were most common in the hepatic arteries (34.7%), followed by the renal arteries (31.3%). Variations in the celiac trunk were the least frequent (9.8%). The gastro-splenic trunk (type V) was the most common celiac trunk variant. The most common hepatic artery variant was the replacement of the right hepatic artery (type III). Accessory renal arteries were more frequent on the left side and among males (P = 0.01). The celiac trunk variations had a significant association with the hepatic artery variations (P = 0.001) and the renal artery variations (P = 0.011), respectively. CONCLUSION There is a high prevalence of anatomical variations in the described vessels, and it matches the results in the reported literature. Our findings also suggest the possible coexistence of variants. We have also encountered rare variants, especially in the hepatic arterial system. Some of the hepatic arterial system variants are not included in the older classification systems, calling for an extension of the old systems (Michel's and Hiatt classification systems) or replacement with the newer (CRL or EX-CRL classification systems) to account for rare variants not previously classified. Radiologists and surgeons should be proficient in identifying and differentiating these variations to take precautions and actions for each variant individually.
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Affiliation(s)
- Basil Jalamneh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | | | - Leen Sabbooba
- Department of General Practice, Palestinian Ministry of Health, Ramallah, PSE
| | - Raya Ghanem
- Department of Dermatology, King Abdullah University Hospital, Ar-Ramtha, JOR
| | - Zaher Nazzal
- Department of Community and Family Medicine, An-Najah National University, Nablus, PSE
| | - Ruba Kiwan
- Department of Medical Imaging, Health Science North, Northern Ontario School of Medicine Sudbury, Ontario, CAN
| | - Ahmed Awadghanem
- Department of Radiology, An-Najah National University Hospital, Nablus, PSE
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Mosab Maree
- Department of Radiology, An-Najah National University Hospital, Nablus, PSE
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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van Kollenburg RAA, van Riel LAMJG, de Bruin DM, de Reijke TM, Oddens JR. Novel minimally invasive treatments for lower urinary tract symptoms: a systematic review and network meta-analysis. Int Braz J Urol 2023; 49:411-427. [PMID: 37267609 PMCID: PMC10482440 DOI: 10.1590/s1677-5538.ibju.2023.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/19/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE To review and compare the effectivity of novel minimally invasive treatments (MITs) to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) in men. METHODS Medline, Embase, and Cochrane databases were searched from January 2010 to December 2022 for randomized controlled trials (RCTs) evaluating MITs, compared to TURP or sham, in men with LUTS. Studies were assessed by risk of bias tool, and evidence by GRADE. Functional outcomes by means of uroflowmetry and IPSS were the primary outcomes, safety and sexual function were secondary outcomes. As part of this review, a network meta-analysis (NMA) was conducted. MITs were ranked based on functional outcome improvement probability. RESULTS In total, 10 RCTs were included, evaluating aquablation, prostatic urethral lift, prostatic artery embolization (PAE), convective water vapor thermal treatment or temporary implantable nitinol device. All MITs showed a better safety profile compared to TURP. Functional outcome improvement following aquablation were comparable to TURP. In the NMA, aquablation was ranked highest, PAE followed with the second highest probability to improve functional outcomes. Other novel MITs resulted in worse functional outcomes compared to TURP. Level of evidence was low to very low. CONCLUSIONS Five MITs for treatment of LUTS were identified. Aquablation is likely to result in functional outcomes most comparable to TURP. Second in ranking was PAE, a technique that does not require general or spinal anesthesia. MITs have a better safety profile compared to TURP. However, due to high study heterogeneity, results should be interpreted with caution.
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Affiliation(s)
- Robertus Arnoldus Antonius van Kollenburg
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Luigi Antonio Maria Johannes Gerardus van Riel
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Daniel Martijn de Bruin
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Theodorus Maria de Reijke
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Jorg Reinier Oddens
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
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28
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Weidlich A, Pablik J, Schaser KD, Winkler D, Mehnert E, Fritzsche H. Solitary, adult-onset, intraosseous myofibroma of the rib: a case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231182791. [PMID: 37359281 PMCID: PMC10288404 DOI: 10.1177/2050313x231182791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Myofibromas are rare benign tumors with myofibroblastic origin. They occur especially in cutis and subcutaneous tissue of the head and the neck, less frequently on the extremities. Myofibromas grow very slowly and are often painless, which is why patients often present relatively late. In the literature, there were many reports about intraosseous myofibromas of the craniofascial bones but reports of the trunk and extremities in adults are very rare. The authors present a very rare case of an intraosseous myofibroma of the ribs resulting in pathological fracture, including a research of literature from other cases of intraosseous myofibromas of the trunk or extremities.
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Affiliation(s)
- Anne Weidlich
- Anne Weidlich, University Hospital Carl Gustav Carus Dresden, Fetscherstr 74, 01307 Dresden, Germany.
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29
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Türkyılmaz Z, Kula O, Çelik AO, Demirel T, Günay B. Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model. Surg Radiol Anat 2023:10.1007/s00276-023-03180-1. [PMID: 37340150 DOI: 10.1007/s00276-023-03180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Knowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches. METHODS The computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined. RESULTS Normal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo. CONCLUSION Preoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.
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Affiliation(s)
- Zeliha Türkyılmaz
- Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey.
| | - Osman Kula
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Ahmet Onur Çelik
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Tuğrul Demirel
- Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Burak Günay
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
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Treffalls RN, Stonko DP, DeMartino RR, Morrison JJ. Acute management of mesenteric emergencies: Tailoring the solution to the problem. Semin Vasc Surg 2023; 36:234-249. [PMID: 37330237 DOI: 10.1053/j.semvascsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.
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Affiliation(s)
- Rebecca N Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - David P Stonko
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan J Morrison
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Capdevila F, Insausti I, San Miguel R, Sanchez-Iriso E, Montesino M. Cost-Utility Analysis of Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03443-9. [PMID: 37142802 DOI: 10.1007/s00270-023-03443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To perform a post hoc cost-utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS We conducted a cost-utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. RESULTS At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. CONCLUSIONS Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.
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Affiliation(s)
- Ferran Capdevila
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain.
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain.
| | - Iñigo Insausti
- Department of Radiology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Ramon San Miguel
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Eduardo Sanchez-Iriso
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Manuel Montesino
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Department of Urology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
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Cai H, Zhu C, Fang J. Ultrasound-guided perineal laser ablation versus prostatic arterial embolization for benign prostatic hyperplasia: two similar short-term efficacies. Acta Radiol 2023; 64:2033-2039. [PMID: 36437581 DOI: 10.1177/02841851221140214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are many ways to treat prostatic hyperplasia; these are currently more inclined to minimally invasive treatment. We mainly compared the differences between two treatment methods, ultrasound-guided transperineal laser ablation (US-TPLA) and prostatic artery embolization (PAE). PURPOSE To evaluate the efficacy and safety of US-TPLA and PAE in the treatment of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS The clinical information for 40 patients with BPH admitted to our hospital between June 2018 and January 2021 were retrospectively analyzed. The changes in International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume (PV), and the incidence of complications were compared between groups. RESULTS The IPSS (P < 0.001; P < 0.001), QoL (P < 0.001; P < 0.001), Qmax (P < 0.001; P < 0.001), PVR (P < 0.001; P < 0.001), and PV (P < 0.001; P < 0.001) at three and six months after US-TPLA and PAE improved with respect to those before surgery. There was no significant difference in IPSS (P = 0.235; P = 0.151), QoL (P = 0.527; P = 0.294), Qmax (P = 0.776; P = 0.420), PVR (P = 0.745; P = 0.607), and PV (P = 0.527; P = 0.573) between the groups at three and six months after surgery. No serious complications occurred in either group. CONCLUSION US-TPLA and PAE seem to have a similar short-term efficacy. The efficacy of the two procedures is comparable, and neither is associated with serious complications. US-TPLA and PAE are both effective complementary measures for the treatment of BPH.
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Affiliation(s)
- Huaijie Cai
- Department of Ultrasound, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, PR China
| | - Conghui Zhu
- Department of Interventional Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, PR China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
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Zeng Y, Yang F, Hu X, Zhu F, Chen W, Lin W. Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis. Eur Radiol 2023; 33:2792-2799. [PMID: 36449058 DOI: 10.1007/s00330-022-09258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/25/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Transmural intestinal necrosis (TIN) is related to high mortality in patients with acute mesenteric ischemia (AMI). Radiological predictive factors of TIN in AMI remains controversial. This study aimed to identify the CT-based predictive factors of TIN in AMI. METHODS EMBASE and PUBMED were searched for publications predicting TIN using radiological features. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of individual studies. Data were presented in terms of diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval (CI). The random-effects models were used for the meta-analysis. RESULTS Eleven studies including 1037 cases with AMI were considered. The meta-analysis showed that bowel wall thinning (DOR = 13.10; 95% CI: 3.71, 46.25), decreased or absent bowel wall enhancement (DOR = 5.77; 95% CI: 2.95, 11.30), bowel dilation (DOR = 3.23; 95% CI: 2.03, 5.15), pneumatosis intestinalis (DOR = 5.78; 95% CI: 2.24, 14.95), porto-mesenteric venous gas (DOR = 5.36; 95% CI: 2.14, 13.40), and arterial occlusive AMI (DOR = 2.66; 95% CI: 1.53, 4.63) were risk factors for predicting TIN. Bowel wall thinning and porto-mesenteric venous gas displayed high specificity to diagnose TIN (98%, 95%, respectively). The subgroup analysis showed that decreased or absent bowel wall enhancement (DOR = 8.23; 95% CI: 4.67, 14.51) and bowel dilation (DOR = 3.14; 95% CI: 1.55, 6.39) were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI. CONCLUSIONS For predicting TIN, there are specific radiological features. The radiological predictors of TIN may differ according to the various causes of AMI. Future primary studies should further evaluate the relationships between radiological signs and TIN based on different etiologies. KEY POINTS • Bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilation, pneumatosis intestinalis, porto-mesenteric venous gas, and arterial occlusive AMI were risk factors for predicting TIN. • Decreased or absent bowel wall enhancement and bowel dilation were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI.
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Affiliation(s)
- Yi Zeng
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu, 610041, Sichuan, China
| | - Fan Yang
- Department of Radiology, Chengdu First People's Hospital, Chengdu, 610041, Sichuan, China
| | - Xiaoyan Hu
- Department of Radiology, Chengdu First People's Hospital, Chengdu, 610041, Sichuan, China
| | - Fei Zhu
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Weixia Chen
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Road, Chengdu, 610041, Sichuan, China.
| | - Wei Lin
- Department of Radiology, Chengdu First People's Hospital, Chengdu, 610041, Sichuan, China
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Zoppo CT, Taros T, Harman A. Top 50 most cited articles on prostatic artery embolization for benign prostatic hyperplasia: A bibliometric review. World J Clin Urol 2023; 12:1-9. [DOI: 10.5410/wjcu.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Bibliometric analysis can be used to assess the current state of the literature and publication trends on a given topic. There has not been a review of this kind on prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH). PAE is a relatively new and somewhat controversial treatment option for BPH. Given the novelty and controversy, there has been much research published on the topic recently.
AIM To survey the current state of research on PAE for BPH by using bibliometric analysis to analyze the top 50 most highly cited articles.
METHODS A cross-sectional study was performed using the Web of Science database to identify the most cited articles published on PAE for BPH as of June 2022. Articles that did not primarily focus on PAE or BPH as an indication were eliminated. The 50 most cited articles were carried forward for analysis.
RESULTS All but 6 articles were published in the last decade with contributions from 15 countries. Fifty-two percent of the studies had a C level of evidence. The majority were published in the Journal of Vascular and Interventional Radiology and Cardiovascular and Interventional Radiology. Twenty percent (n = 10) of the articles were published in urologic journals. On average, articles published in urologic journals tended to be more recent. The mean year of publication for an article in a urological journal was 2016.6 compared to 2013.9 in a non-urologic journal (P = 0.02). Seventy percent of the articles focused on clinical outcomes, while only 2% focused on practice guidelines. Self-citations accounted for 11.4 citations per article on average, corresponding to 14.7% of all citations analyzed.
CONCLUSION The most influential papers on this topic represent a fairly recent body of work with contributions from a wide variety of countries and journals. The fact that articles in urologic journals were published significantly more recently than articles on the list in non-urologic journals may suggest that the field of urology is starting to accept PAE for a wider range of indications. Finally, while there has been much high-quality research published, more influential studies on practice guidelines and technique may be beneficial.
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Affiliation(s)
- Christopher Thomas Zoppo
- Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01604, United States
| | - Trenton Taros
- Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01604, United States
| | - Aaron Harman
- Interventional Radiology, Prostate Laser Center, Houston, TX 77030, United States
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El Ouali I, Berrada K, Dokal ID, Saouab R, El Fenni J, Salaheddine T. A misleading tumor: A rare form of infantile fibromatosis. SAGE Open Med Case Rep 2023; 11:2050313X231157485. [PMID: 36860305 PMCID: PMC9969429 DOI: 10.1177/2050313x231157485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
Infantile fibromatosis is a rare mesenchymal disorder characterized by the fibrous proliferation of the skin, bone, muscle, and viscera. The clinical features vary from solitary to multicentric forms with similar pathological features. Although the tumor is histologically benign, it is a highly infiltrating lesion making the prognosis poor for patients with craniofacial involvement affection due to the major risk of nerve vascular and airway compression syndrome. The solitary form of infantile fibromatosis observed in the dermis, subcutis, or fibromatosis tends to occur predominantly in males and typically affects craniofacial deep soft tissues. We present a case of an unusual symptom presentation and a rarely observed location of a solitary fibromatosis form, affecting the muscle of the forearm and infiltrating the bone in a 12-year-old girl. Imaging findings were suggestive of rhabdomyosarcoma, but histopathology set the diagnosis of an infantile fibromatosis. The patient, then, received chemotherapy, and amputation was proposed due to the inextricability of this benign yet aggressive tumor, an option that was refused by her parents. We discuss through this article the clinical, radiological, and pathological features of this benign yet aggressive condition, the potential differential diagnosis, the prognosis, and treatment options substantiated with concrete examples from the literature.
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Marchi A, Pellerin O, Querub C, Ahmar MA, Gaeta AD, Déan C, Meria P, Thiounn N, Sapoval M, Boeken T. Long-term outcomes of prostate artery embolization for acute urinary retention: An analysis of 88 patients. Diagn Interv Imaging 2023:S2211-5684(23)00023-2. [PMID: 36801097 DOI: 10.1016/j.diii.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The purpose of this study was to assess long-term outcome of prostate artery embolization (PAE) in patients presenting with acute urinary retention related to benign prostatic hyperplasia. MATERIALS AND METHODS All consecutive patients who underwent PAE for acute urinary retention due to benign prostatic hyperplasia from August 2011 to December 2021 in a single institution were retrospectively included. There were 88 men with a mean age of 72 ± 12 (standard deviation [SD]) years (range: 42-99 years). Patients underwent a first attempt of catheter removal two weeks after PAE. Clinical success was defined as the absence of acute urinary retention recurrence. Correlations between long-term clinical success and patient variables or bilateral PAE were searched for using Spearman correlation test. Catheter-free survival was assessed using Kaplan-Meier analysis. RESULTS Successful catheter removal in the month following PAE was performed in 72 (72/88; 82%) patients and 16 (16/88; 18%) patients had immediate recurrence. Clinical success persisted for 58 (58/88; 66%) patients at long-term follow-up (mean follow-up: 19.5 months ± 16.5 [SD]; range: 2-74 months). Recurrence occurred at a mean of 16.2 months ± 12.2 (SD) (range: 1.5-43 months) post-PAE. Overall, 21 (21/88; 24%) patients of the cohort underwent prostatic surgery, at a mean of 10.4 months ± 12.2 (SD) (range: 1.2-42.4 months) from initial PAE. No correlations between patients variables or bilateral PAE and long-term clinical success were identified. Kaplan-Meier analysis showed a three-year catheter free probability of 60%. CONCLUSION PAE is a valuable technique for acute urinary retention related to benign prostatic hyperplasia, with a long-term success rate of 66%. However acute urinary retention relapse affects 15% of patients.
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Lucas-Cava V, Sánchez-Margallo FM, Insausti-Gorbea I, Sun F. Comparative efficacy and safety of prostatic urethral lift vs prostatic artery embolization for benign prostatic hyperplasia: a systematic review and network meta-analysis. BJU Int 2023; 131:139-152. [PMID: 35417622 DOI: 10.1111/bju.15748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/31/2022] [Accepted: 04/10/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess and compare the clinical efficacy and safety of prostatic urethral lift (PUL) and prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) by means of a systematic review and network meta-analysis. METHODS A systematic literature search was performed using PubMed and Web of Science from inception to March 2021 to identify randomized controlled trials (RCTs) that compared PUL or PAE with either transurethral resection of the prostate (TURP) or sham procedures as control interventions. Qualitative and quantitative analyses were performed to pool the data on direct and indirect comparisons between interventions using STATA 14. RESULTS Eight RCTs with 675 participants were included in our network meta-analysis. Quantitative synthesis revealed that TURP was the most efficacious intervention for clinical (International Prostate Symptoms Score and quality of life) and functional outcomes (maximum urinary flow rate and post-void residual urine volume), and was associated with a lower reintervention rate compared with PAE (risk ratio [RR] 2.08 with 95% confidence interval [CI] 0.96 to 4.51) and PUL (RR 2.33 with 95% CI 0.50 to 10.86), although the difference were not statistically significant. Indirect comparison indicated that PUL and PAE resulted in similar outcomes. PAE was associated with fewer minor adverse events (AEs; RR 0.75 with 95% CI 0.48 to 1.18) and PUL with fewer major AEs (RR 0.72 with 95% CI 0.17 to 3.13) when compared with TURP. Whilst PAE had a better ranking with regard to improvement of most clinical and functional outcomes, PUL was the best ranked procedure regarding erectile function, as measured by the International Index of Erectile Function 5, but no significant difference was observed. CONCLUSION Current evidence suggests that PUL and PAE have similar clinical efficacy and safety profiles in the management of LUTS associated with BPH. However, the quality of evidence is relatively low because of the paucity of RCTs available, and results should be interpreted with caution.
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Affiliation(s)
- Vanesa Lucas-Cava
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Francisco Miguel Sánchez-Margallo
- Scientific Director, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.,CIBER de enfermedades cardiovasculares, Madrid, Spain
| | - Iñigo Insausti-Gorbea
- Department of Interventional Radiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fei Sun
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.,CIBER de enfermedades cardiovasculares, Madrid, Spain
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Malaussena Z, Pittala K, Diab ARF, Docimo S. Prediction models in hernia repair: a systematic review. Surg Endosc 2023; 37:3364-3379. [PMID: 36595065 DOI: 10.1007/s00464-022-09842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hernias can present with unique challenges when it comes to management and repair. Prediction models can be a useful tool for clinicians to better anticipate and understand the severity of a hernia, the type of surgical technique, or presurgical planning that may be required to treat the patient, and the risk of complications. Our goal is to evaluate and consolidate prediction models in hernia repair present in the literature for which physicians can reference to best improve patient outcomes and postoperative management. METHODS We performed a literature search in PubMed using keywords, "rectus width to defect width ratio," "predicting myofascial release," "computed tomography hernia repair prediction," "component separation radiology prediction hernia," "fat volume and hernia repair," "body morphometrics and Query hernia repair," "body morphometrics and reherniation," "computed tomography findings and risk of emergency hernia repair," "loss of domain and hernia radiology," and "volumetry and hernia repair." We searched for publications that used radiographic parameters to predict hernia severity, interventions, and outcomes. RESULTS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we found twenty-three studies related to prediction models in hernia repair published between 2000 and 2021. We summarized studies pertaining to predicting acute care, predicting operative planning with loss of domain and component separation, predicting complications, paraesophageal hernia predictions, and predicting postoperative respiratory complications. CONCLUSION Radiographic prediction models can be an objective and efficient way for surgeons to analyze hernias and better understand a patient's situation so that they can inform patients about the best treatment options and the risk of complications.
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Affiliation(s)
- Zachary Malaussena
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Karthik Pittala
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Abdul-Rahman F Diab
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Seizilles de Mazancourt E, Pagnoux G, Codas Duarte R, Moldovan PC, Ruffion A, Colombel M, Badet L, Fassi-Fehri H. Prostatic arterial embolization versus holmium laser enucleation of the prostate: 1-year outcomes. World J Urol 2023; 41:151-157. [PMID: 36451037 DOI: 10.1007/s00345-022-04225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Holmium Laser Enucleation of the Prostate (HoLEP) and Prostatic Artery Embolization (PAE) are novel techniques for the treatment of benign prostatic hyperplasia lower urinary tract symptoms (BPH-LUTS). The objective of this study was to describe and compare the functional results and complications of these two techniques at one year follow-up. MATERIALS AND METHODS We performed a retrospective, monocentric study of all patients consecutively treated in our center with HoLEP or PAE for symptomatic or complicated BPH between January 2016 and December 2019. Data regarding patient and perioperative characteristics, follow-up biological results, functional questionnaires and uroflowmetry were collected from medical records. RESULTS A total of 490 and 57 patients were treated with HoLEP and PAE, respectively. The demographic and clinical characteristics of the two groups were similar. The operative time was significantly higher for PAE (p < 0.001) and hospitalization time longer after HoLEP (p = 0.0006). The urinary catheterization time was longer after PAE (p < 0.001). The prostatic volume treated was higher with HoLEP than with PAE (56% versus 26%, p < 0.001). The mean difference in IPSS from baseline to 12 months was significantly higher after HoLEP than after PAE: - 17.58 versus - 8 (p < 0.001). The mean difference in QoL-IPSS from baseline to 12 months was significantly higher after HoLEP: - 4.09 versus - 2.27 (p < 0.001). The rate of postoperative adverse events in the first three months was similar between the two groups:35% after HoLEP and 33% after PAE (p = 0.88). CONCLUSIONS HoLEP and PAE both significantly improved BPH-LUTS, with HoLEP having an advantage over PAE.
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Affiliation(s)
| | - Gaelle Pagnoux
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Paul Cezar Moldovan
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Marc Colombel
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Badet
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Jung JH, McCutcheon KA, Borofsky M, Young S, Golzarian J, Kim MH, Narayan V, Dahm P. Prostatic arterial embolisation for men with benign prostatic hyperplasia: a Cochrane review. BJU Int 2023; 131:32-45. [PMID: 35696302 DOI: 10.1111/bju.15823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the effects of prostatic arterial embolisation (PAE) compared to other procedures for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). METHODS We included randomised controlled trials (RCTs), as well as non-randomised studies (NRSs) enrolling men with BPH undergoing PAE vs other surgical interventions via a comprehensive search up until 8 November 2021. Two independent reviewers screened the literature, extracted data, assessed risk of bias, performed statistical analyses by using a random-effects model, and rated the certainty of evidence (CoE) of RCTs and NRSs. RESULTS We found data to inform two comparisons: PAE vs transurethral resection of prostate (TURP; six RCTs and two NRSs), and PAE vs sham (one RCT). This abstract focuses on the primary outcomes in a comparison of PAE vs TURP. Short-term follow-up: based on RCT evidence, there may be little to no difference in urological symptom score improvement (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; low CoE) and quality of life (QoL; MD 0.28, 95% CI -0.28 to 0.84; low CoE) measured by International Prostatic Symptom Score. We are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19-2.97; very low CoE). Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urological symptom scores (MD 2.58, 95% CI -1.54 to 6.71; low CoE) and QoL (MD 0.50, 95% CI -0.03 to 1.04; low CoE). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20-4.05; very low CoE). CONCLUSION Compared to TURP, the impact on urological symptoms and QoL improvement as perceived by patients appears to be similar. This review did reveal major uncertainty as to how major adverse events compare.
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Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Center of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | | | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Shamar Young
- Division of Interventional Radiology and Vascular Imaging, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jafar Golzarian
- Division of Interventional Radiology and Vascular Imaging, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Vikram Narayan
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
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Gao X, Hua Y, Meng H, Dong L, Zhang L, Jiang X, Chen L. The value of MSCT in evaluating the passability of bezoar by conservative treatment for bezoars-induced small bowel obstruction. Abdom Radiol (NY) 2023; 48:236-43. [PMID: 36242605 DOI: 10.1007/s00261-022-03700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore the multi-slice spiral computed tomography (MSCT) imaging characteristics of patients with bezoars-induced small bowel obstruction (BI-SBO) to evaluate the risk of conservative treatment. MATERIALS AND METHODS This retrospective study included 72 patients with BI-SBO who underwent whole-abdominal MSCT scan within 1 day before treatment. The patients were classified as the non-pass group and pass group depending on whether bezoar can pass after conservative treatment. The CT images were observed and measured by two radiologists. Statistical analysis was performed by using Student's t test, Pearson's chi-squared test, Fisher's exact test, Logistic linear regression, and receiver operating characteristic curve (ROC). RESULTS The study population consisted of 72 patients with a mean age of 52.2 ± 16.2 years (32 men and 40 women with an age range of 13-81 years). There were statistical differences between the two groups in the bezoar appearance, maximum HU of bezoar, thickness of intestinal wall, mesenteric haziness, mesenteric fluid, and peritoneal fluid (P = 0.002, 0.024, 0.017, 0.006, 0.021, and 0.030). The appearance of bezoar and mesenteric haziness is independent risk factors affecting whether bezoar can be passed by the conservative treatment. Sensitivity (41.7%) was decreased, NPV (76.3%) was not significantly changed, specificity (93.8%) and PPV (76.9%) were improved when both parameters were met to assess failure of conservative treatment. CONCLUSION The observation of important signs by MSCT and its reconstruction technology is of great clinical value in evaluating the passability of bezoar by conservative treatment, and which can provide radiographic basis for clinical treatment selection.
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Raizenne BL, Zheng X, Oumedjbeur K, Mao J, Zorn KC, Elterman D, Bhojani N, McClure T, Te A, Kaplan S, Sedrakyan A, Chughtai B. Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study. World J Urol 2023; 41:179-188. [PMID: 36463348 DOI: 10.1007/s00345-022-04218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/04/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND There are growing interests for minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) uses selective angioembolization of prostatic arteries, thereby reducing size to improve LUTS/BPH. However, real-world data comparing surgical outcomes between MISTs and tissue resective techniques are lacking. We assessed the differences in surgical outcomes between PAE, transurethral resection of the prostate (TURP), and prostatic urethral lift (PUL) in a real-world population for LUTS/BPH. METHODS We present an observational population-based study of 12,902 men with BPH in New York State who received PAE, TURP, and PUL in outpatient and ambulatory surgery settings from 2014 to 2018. For short-term outcomes, we report 30-day and 90-day risks of readmission to inpatient and emergency room (ER) with/without complications and compared them across groups using χ2 tests and mixed-effect logistic regressions. For long-term outcomes, we report surgical retreatment and stricture rates using Kaplan-Meier failure curves and compared them using Log rank tests and Cox regression models. RESULTS Of 12 902 men, 335 had PAE, 11,205 had TURP, and 1362 had PUL. PAE patients had the highest 30-day (19.9%) and 90-day (35.6%) risks of readmission to inpatient or ER (p < 0.01). Non-specific abdominal pain was the main diagnosis associated with 30-day and 90-day readmissions to inpatient or ER after PAE (14.3% and 26.8%, respectively). After 2 years of follow-up, PAE patients had the highest retreatment rate of 28.5% (95%CI 23.7-34.2%) compared to TURP (3.4% (95%CI 3.1-3.8%)) and PUL (8.5% (95%CI 5.6-12.9%)) (p < 0.001). CONCLUSION In a real-world population, PAE was associated with the most frequent 30-day and 90-day readmission to inpatient or ER and the highest retreatment rate among all surgical techniques even when controlled for individual patient comorbidities and surgical volume.
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Affiliation(s)
- Brendan L Raizenne
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | | | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Timothy McClure
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA
| | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Bilal Chughtai
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA. .,Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA.
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Sciacqua LV, Vanzulli A, Di Meo R, Pellegrino G, Lavorato R, Vitale G, Carrafiello G. Minimally Invasive Treatment in Benign Prostatic Hyperplasia (BPH). Technol Cancer Res Treat 2023; 22:15330338231155000. [PMID: 36794408 PMCID: PMC9936536 DOI: 10.1177/15330338231155000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Review efficacy and safety of minimally-invasive treatments for Low Urinary Tract Symptoms (LUTS) in patients affected by Benign Prostate Hyperplasia (BPH). We performed a systematic review of the literature from 1993 to 2022 leveraging original research articles, reviews, and case-studies published in peer-reviewed journals and stored in public repositories. Prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), high intensity focused ultrasound (HIFU), laser treatments and Cryoablation are valid and safe alternatives to the gold standard (surgery) in the treatment of LUTS in patients affected by BPH, with fewer undesired effects being reported.
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Affiliation(s)
- L V Sciacqua
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - A Vanzulli
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - R Di Meo
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - G Pellegrino
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - R Lavorato
- Researcher at Diagnostic and Interventional Radiology Department, IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - G Vitale
- Department of Medical Biotechnology and Translational Medicine, 9304University of Milan, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Milan, Italy
| | - G Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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44
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Veyg D, Mohanka R, Rumball IP, Liang R, Garcia-Reyes K, Bishay V, Fischman AM. Comparison of 24-Month Clinical Outcomes after Prostatic Artery Embolization in Prostate Glands Larger versus Smaller than 80 mL: A Systematic Review. J Vasc Interv Radiol 2022; 34:578-584.e1. [PMID: 36470516 DOI: 10.1016/j.jvir.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/05/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This review was undertaken to compare the clinical outcomes of prostatic artery embolization (PAE) in patients with >80 versus <80 mL prostatic volume (PV) at the 24-month follow-up to determine whether PV predicted the effectiveness or durability of PAE. MATERIALS AND METHODS The PubMed/MEDLINE database was searched for articles published between 2010 and 2022 using the search term "(prostat∗ artery embolization) AND (long term OR follow-up OR 24-month)." Articles were included if they discussed PAE for benign prostatic hyperplasia (BPH) and reported a minimum follow-up of 24 months. Articles with <10 patients were excluded. A subgroup analysis was performed to evaluate for any difference in clinical outcomes at the 24-month post-PAE follow-up between studies with a mean PV of >80 mL and those with a mean PV of <80 mL. RESULTS A total of 14 studies with 2,260 patients were included, all of which demonstrated significant reduction in symptoms at the 24-month follow-up after PAE. Four studies were included as part of the >80-mL PV subgroup (n = 467), and 10 studies were included as part of the <80-mL PV subgroup (n = 1,793). There was a statistically significant difference between the mean preprocedural PV (128.5 vs 64.0 mL; P = .015). At the 24-month follow-up, there were no significant differences between groups across any of the compared parameters. The collective incidence of major adverse events reported in the studies within this review was <1%. CONCLUSIONS PAE is both safe and durable for patients suffering from BPH and can be effective across a wide range of baseline PVs.
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Affiliation(s)
- Daniel Veyg
- Long Island Jewish Medical Center, Northwell Health System, Queens, New York.
| | - Rajat Mohanka
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ian P Rumball
- Zucker School of Medicine at Hofstra University/Northwell Health System, Hempstead, New York
| | - Richard Liang
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | | | - Vivian Bishay
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Aaron M Fischman
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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45
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Wu X, Zhou A, Heller M, Kohlbrenner R. Prostatic Artery Embolization Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Cost-Effectiveness Analysis. J Vasc Interv Radiol 2022; 33:1605-1615. [PMID: 35964881 DOI: 10.1016/j.jvir.2022.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/22/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare the cost effectiveness of prostatic artery embolization (PAE) with that of transurethral resection of the prostate (TURP) for the treatment of medically refractory benign prostatic hyperplasia (BPH). MATERIALS AND METHODS A cost-effectiveness analysis with Markov modeling was performed, comparing the clinical course after PAE with that after TURP for 3 years. Probabilities were obtained from the available literature, and costs were based on Medicare reimbursements and published cost analyses. Outcomes were measured using quality-adjusted life-year (QALY). Statistical analyses included base case calculation, probabilistic sensitivity analysis, and deterministic sensitivity analysis to assess the robustness of the conclusion under different clinical scenarios. RESULTS Base case calculation showed comparable outcomes (PAE, 2.845 QALY; TURP, 2.854 QALY), with a cost difference of $3,104 (PAE, $2,934; TURP, $6,038). The incremental cost-effectiveness ratio was $360,249/QALY. PAE was dominant in 23.2% and more cost effective in 48.4% of the probabilistic sensitivity analysis simulations. PAE was better if its recurrence risk was <20.4% per year and even when the TURP recurrence risk was assumed to be 0%. TURP would be more cost effective when its procedural cost was <$3,367 or the PAE procedural cost >$4,409. PAE remained cost effective when varying the risks and costs of the minor and major short-term or long-term adverse events of both procedures. TURP would be the better strategy if the utility of BPH recurrence was <0.85 QALY. CONCLUSIONS PAE is a cost-effective strategy to treat medically refractory BPH, resulting in comparable health benefits at a lower cost than that of TURP even when accounting for extreme alterations in adverse events, costs, and recurrence rates.
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Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Alice Zhou
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Michael Heller
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Ryan Kohlbrenner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
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Qamhawi Z, Little MW. The State of Evidence in Prostate Artery Embolization. Semin Intervent Radiol 2022; 39:571-576. [PMID: 36561795 PMCID: PMC9767761 DOI: 10.1055/s-0042-1759733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.
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Affiliation(s)
- Zahi Qamhawi
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Mark W. Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
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47
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Rostambeigi N, Golzarian J, Little MW. Updates on Preprocedural Evaluation and Patient Selection for Prostatic Artery Embolization. Semin Intervent Radiol 2022; 39:547-554. [PMID: 36561799 PMCID: PMC9767769 DOI: 10.1055/s-0042-1760274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostatic artery embolization (PAE) is a safe and effective treatment for benign prostatic hyperplasia. Patient evaluation is a critical and important part of this growing practice. History taking should include symptoms score evaluations for lower urinary tract symptoms, erectile function, and prostatitis symptoms score. The objective evaluations commonly include measurement of prostate specific antigen, postvoid residual volume, and uroflowmetry as well as urodynamic studies in selective patients. Imaging evaluation may include computed tomography angiography or magnetic resonance angiography, elucidating prostate volume, prostate gland morphology, vasculature, and prostate cancer. With evolving knowledge on PAE, we aim to discuss patient evaluation and selection based on updated evidence and discuss specific scenarios.
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Affiliation(s)
- Nassir Rostambeigi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jafar Golzarian
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Mark W. Little
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
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48
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Bilhim T. Long-Term PAE Results: What Do We Know. Semin Intervent Radiol 2022; 39:577-580. [PMID: 36561801 PMCID: PMC9767787 DOI: 10.1055/s-0042-1759732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostatic artery embolization (PAE) is a minimally invasive technique with proven safety and efficacy to treat lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) or benign prostatic hyperplasia (BPH). In this review, we discuss the required level of evidence to implement and adopt treatment options for patients with LUTS due to BPO/BPH. Focus is given on the long-term (>3 years) data after PAE with reported outcomes including cohort sizes, follow-up times, reintervention rates (repeat PAE and prostatectomy), need for LUTS/BPO medical therapy, and improvements in International Prostate Symptom Score/quality of life score, peak flow rate (Qmax), postvoid residual, prostate volume, and prostate-specific antigen. The durability of treatment effects after PAE and need for prostatic reinterventions need to be taken into consideration when discussing treatment options with patients and referring colleagues from other medical specialties. Developments in medical devices used for PAE have allowed for a continuous drop in unilateral PAE rates over the last 12 years and will probably play a role in optimizing technical and thus clinical outcomes for patients with LUTS due to BPH/BPO.
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Affiliation(s)
- Tiago Bilhim
- Saint Louis Hospital, Centro Hospitalar Universitário de Lisboa Central (CHULC) Lisbon, Portugal
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49
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Wang XY, Chai YM, Huang WH, Zhang Y. Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and meta-analysis. World J Clin Cases 2022; 10:11812-11826. [PMID: 36405270 PMCID: PMC9669846 DOI: 10.12998/wjcc.v10.i32.11812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Prostate artery embolization (PAE) is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) is the gold standard therapy for LUTS/BPH.
AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.
METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH. Sources included PubMed, Embase, Cochrane library databases, and Chinese databases before June 2022. A systematic review and meta-analysis were conducted. Outcome measurements were combined by calculating the mean difference with a 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.
RESULTS Eleven studies involving 1070 participants were included. Compared with the TURP group, the PAE group had a similar effect on the International Index of Erectile Function (IPSS) score, Peak urinary flow rate (Qmax), postvoid residual volume (PVR), Prostate volume (PV), prostatic specific antigen (PSA), The International Index of Erectile Function short form (IIEF-5) scores, and erectile dysfunction during 24 mo follow-up. Lower quality of life (QoL) score, lower rate of retrograde ejaculation and shorter hospital stay in the PAE group. There was no participant death in either group. A higher proportion of haematuria, urinary incontinence and urinary stricture was identified in the TURP group.
CONCLUSION PAE may be an appropriate option for elderly patients, patients who are not candidates for surgery, and patients who do not want to risk the potential adverse effects of TURP. Studies with large cases and long follow-up time are needed to validate results.
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Affiliation(s)
- Xiao-Yan Wang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yu-Meng Chai
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Wen-Hui Huang
- School of Information Science and Engineering, Shandong Normal University, Jinan 250014, Shandong Province, China
| | - Yong Zhang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Cawich SO, Fortune M, Deshpande R, Gardner M, Pearce N, Johnson P, Naraynsingh V, Costa ALF. A Comparison of the Celiacomesenteric Trunk in the Caribbean with Global Prevalence Calculated by a Systematic Review. Radiol Res Pract 2022; 2022:1-12. [PMID: 36267126 PMCID: PMC9578919 DOI: 10.1155/2022/1715631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Typically, the celiac trunk and superior mesenteric artery branch off separately from the anterior aspect of the abdominal aorta. The celiacomesenteric trunk (CMT) is a rare variant in which those arteries share a common origin. We sought to compare the prevalence of CMT in the Caribbean with the global prevalence as calculated by a systematic review. Methods In this study, we evaluated all consecutive patients who had multiphase contrast-enhanced CT scans at two major referral centres in the Caribbean from August 30, 2017, to September 1, 2019. In patients with a CMT, we recorded demographic and anatomic details. We then conducted a systematic literature search and retrieved raw data to calculate the global prevalence (number of individuals with a CMT divided by the sum total of study samples). We compared CMT prevalence in our sample with the global prevalence using Pearson's chi-square and Fisher's exact tests. Statistical significance was considered to be present when the P value was <0.05. Results From 832 CTs, 665 scans met the inclusion criteria. There were 16 (2.41%) CMTs: 3 (0.45%) classic CMTs, 12 (1.8%) hepato-mesenteric trunks, and 1 (0.15%) hepato-spleno-mesenteric trunk. Forty-two studies reported on CMTs in a total of 74,320 persons. The global CMT prevalence was comparable (3.88%; P = 0.054), but the incidence of hepato-mesenteric variants was significantly lower in our sample (1.8% vs. 3.24%; P = 0.0352). Conclusion There was no difference in the prevalence of a classic CMT in the Caribbean compared to the global prevalence. However, the hepato-mesenteric trunk (incomplete CMT variant) was significantly less prevalent in the Caribbean. Advances in Knowledge: Healthcare professionals performing hepatobiliary interventions must be aware of these differences in order to minimize morbidity during their interventions.
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