51
|
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] [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.
Collapse
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
| |
Collapse
|
52
|
A Comparison of the Celiacomesenteric Trunk in the Caribbean with Global Prevalence Calculated by a Systematic Review. Radiol Res Pract 2022; 2022:1715631. [PMID: 36267126 PMCID: PMC9578919 DOI: 10.1155/2022/1715631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
Collapse
|
53
|
Chang YC, Chen SJ, Huang WH, Huang CP, Chen YH, Chen WC. Prostate Cancer after Percutaneous Arterial Embolization of the Prostate: A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12102378. [PMID: 36292067 PMCID: PMC9600189 DOI: 10.3390/diagnostics12102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
We report a patient with prostate cancer found 2 years after percutaneous arterial embolization (PAE) of the prostate with a rapid increase in prostate specific antigen (PSA) 3 months later, even though the initial result was low. He did not consult a urologist during or after PAE until acute urinary retention developed. The clinical stage was cT2cN1M1b with Gleason grade 5 + 5 = 10. An increase in PSA a short interval after PAE may suggest the presence of prostate cancer. We suggest that patients undergoing PAE should consult a urologist, and that PSA levels should be checked every 3 months in the first year after PSA.
Collapse
Affiliation(s)
- Ying-Chieh Chang
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Wei-Hsuan Huang
- Department of Urology, Everan Hospital, Taichung 41159, Taiwan
| | - Chi-Ping Huang
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yung-Hsiang Chen
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Wen-Chi Chen
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Correspondence:
| |
Collapse
|
54
|
Theurich AT, Leistritz L, Leucht K, Franiel T, Teichgräber U, Foller S, Grimm MO. Influence of Prostate Artery Embolization on Different Qualities of Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction. Eur Urol Focus 2022; 8:1323-1330. [PMID: 35125344 DOI: 10.1016/j.euf.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/06/2021] [Accepted: 01/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prostate artery embolization (PAE) is an increasingly used minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic obstruction (BPO) OBJECTIVE: To analyze the impact of PAE on voiding and storage symptoms. DESIGN, SETTING, AND PARTICIPANTS Between July 2014 and May 2019, 351 consecutive men with BPO who underwent PAE were included in a single-center study. INTERVENTION PAE is an interventional radiological procedure embolizing the prostatic arteries with microspheres. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint represented assessment of the International Prostatic Symptom Score (IPSS) at baseline and at 1, 3, 6, 12, and 24 mo after PAE. Secondary endpoints comprised assessment of IPSS quality of life (QoL), International Index of Erectile Function, peak urinary flow rate, postvoid residual volume, prostate volume, and prostate-specific antigen at the same time points. Data were analyzed using standard statistical methods, generalized estimating equations (symptom improvement over time as odds ratios), and McNemar-Bowker test (degree of improvement compared between symptoms). RESULTS AND LIMITATIONS Clinical success rates for PAE were 68%, 73%, and 66% at 1, 12, and 24 mo, respectively. The median IPSS improved significantly from 22 to 10 points after 2 yr (p < 0.001). Storage (-50%) and voiding (-58%) symptoms improved similarly (each p < 0.001), with nocturia decreasing least frequently but significantly (p < 0.001). After 1 and 2 yr, 35% (95% confidence interval [CI] 29-41%) and 30% (95% CI 21-40%) of patients reported alleviated storage, and 39% (95% CI 33-45%) and 38% (95% CI 29-49%) reported alleviated voiding symptoms, respectively. QoL improved from 5 to 2 points (p < 0.001). The main limitation is the number of patients lost during follow-up. CONCLUSIONS PAE significantly improved voiding and storage symptoms to a similar extent. This study may aid in counseling patients about this minimally invasive BPO treatment. PATIENT SUMMARY Prostate artery embolization (PAE) is a minimally invasive treatment option for patients with voiding and storage symptoms from benign prostate enlargement. Our analysis shows that PAE improves relevant lower urinary tract symptoms.
Collapse
Affiliation(s)
- Anne Tabea Theurich
- Department of Urology, Friedrich-Schiller University, Jena University Hospital, Jena, Germany
| | - Lutz Leistritz
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Katharina Leucht
- Department of Urology, Friedrich-Schiller University, Jena University Hospital, Jena, Germany
| | - Tobias Franiel
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller University, Jena University Hospital, Jena, Germany
| | - Ulf Teichgräber
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller University, Jena University Hospital, Jena, Germany
| | - Susan Foller
- Department of Urology, Friedrich-Schiller University, Jena University Hospital, Jena, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Friedrich-Schiller University, Jena University Hospital, Jena, Germany.
| |
Collapse
|
55
|
Frandon J, Belaouni A, Pellerin O, Thiounn N, Serrand C, Droupy S, Petitpierre F, Vernhet-Kovacsik H, Murez T, Vidal V, Ghelfi J, Pagnoux G, Codas R, de Forges H, Beregi JP, Sapoval M. Efficacy and safety of prostate artery embolization for patients with lower urinary tract symptoms and indwelling urinary catheter: A retrospective multicenter study. Diagn Interv Imaging 2022; 103:601-606. [PMID: 35963778 DOI: 10.1016/j.diii.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this multicenter study was to evaluate the clinical success at three months of prostate artery embolization (PAE), assess PAE safety in centers with various experiences and identify factors associated with PAE success. PATIENTS AND METHODS This multicenter, retrospective study included patients who underwent PAE for lower urinary tract symptoms (LUTS) including those with indwelling urinary catheter. PAE clinical success was defined as either 25% improvement of the International Prostate Symptom Score (IPSS) or 1-point improvement of quality of life (QoL) score, or catheter removal at three months. Multivariable analyses were performed using a logistic regression adjusted on patient variables, technical parameters and center experience in PAE. RESULTS A total of 383 men (mean age, 68.4 ± 9.7 [standard deviation] years; range: 46-94) with LUTS, including 99 (25.8%) patients with indwelling urinary catheter, were included in seven centers from January 2017 to March 2019. Five patients reported major complications (1.3%), three (0.8%) penile ulceration, three (0.8%) acute urinary retention, one (0.3%) prostatic abscess, and 56 (14.6%) minor complications. Follow up data were available for 271 patients (center 1: n = 159; other centers: n = 112). Clinical success was reported in 232 patients (85.6%). In multivariable analyses, presence of cardiovascular comorbidities (diabetes, stroke history, myocardial infarction and lower limb artery disease) was the single independent variable inversely associated with PAE clinical success (odds ratio = 0.396; 95% confidence interval: 0.17-0.91; P = 0.029). There was no center effect. CONCLUSION Our results show that PAE is safe and effective in centers with various PAE experiences. Cardiovascular comorbidity is the single independent variable associated with PAE failure.
Collapse
Affiliation(s)
- Julien Frandon
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France.
| | - Asmaa Belaouni
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Olivier Pellerin
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, INSERM U970, Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Nicolas Thiounn
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 75006 Paris, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), CHU Nîmes, 30029 Nîmes France
| | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - François Petitpierre
- Department of Diagnostic and Interventional Imaging, Groupe Hospitalier Pellegrin, 33000 Bordeaux, France
| | - Hélène Vernhet-Kovacsik
- Department of Radiology, CHU de Montpellier, Arnaud de Villeneuve Hospital, University of Montpellier, 34090 Montpellier, France
| | - Thibaut Murez
- Department of Urology, CHU de Montpellier, Lapeyronie Hospital, University of Montpellier, 34295 Montpellier, France
| | - Vincent Vidal
- Department of Diagnostic and Interventional Imaging, AP-HM, Hôpital de La Timone; Université Aix-Marseille, CERIMED, Faculté de Médecine, EA 4264, Laboratoire d'Imagerie Interventionnelle Expérimentale, 13005 Marseille, France
| | - Julien Ghelfi
- Department of Diagnostic and Interventional Imaging, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U 1209, 38700 La Tronche, France
| | - Gaele Pagnoux
- Service d'Imagerie Urinaire et Vasculaire, Hospices Civils de Lyon; Faculté de Médecine Lyon Est, 69002 Lyon, France
| | - Ricardo Codas
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon; Faculté de Médecine Lyon Est, 69002 Lyon, France
| | - Hélène de Forges
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Marc Sapoval
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, INSERM U970, Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| |
Collapse
|
56
|
Fuentes G, Molina GA, Jiménez MA, Espinoza SM, Lara AG, Enriquéz JJ, Ayala AV, Jiménez G, Rubio CB. Intestinal ischemia in a patient with vascular malformation: a recipe for disaster. J Surg Case Rep 2022; 2022:rjac376. [PMID: 36003223 PMCID: PMC9393191 DOI: 10.1093/jscr/rjac376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
Anatomical variations of the celiac and mesenteric artery have been described over the past two centuries; many of these variations will have no clinical repercussions and will only be found incidentally or during imaging studies. However, these variations can lead to severe complications if undetected during surgery, transplantation or when they are affected by ischemia. Therefore, prompt treatment is needed to overcome these dangerous scenarios. We present the case of a 71-year-old patient who had a celiacomesenteric trunk and developed transient intestinal ischemia; however, he suffered severe acidosis and hyperlactatemia that ultimately led to organ failure and death.
Collapse
Affiliation(s)
| | - Gabriel A Molina
- Department of General Surgery, IESS Quito Sur & Universidad San Francisco (USFQ) , Quito , Ecuador
| | - Marie A Jiménez
- Department of Anesthesiology , IESS Quito Sur, Quito , Ecuador
| | | | - A Gabriela Lara
- Department of General Surgery , IESS Quito Sur, Quito , Ecuador
| | - Juan J Enriquéz
- Department of General Surgery , IESS Quito Sur, Quito , Ecuador
| | - Andres V Ayala
- Department of General Surgery, IESS Quito Sur & Universidad de las Americas , Quito , Ecuador
| | - Galo Jiménez
- Department of General Surgery , IESS Quito Sur, Quito , Ecuador
| | - Cristina B Rubio
- School of Medicine, Universidad San Francisco (USFQ) , Quito , Ecuador
| |
Collapse
|
57
|
Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
58
|
Amouyal G, Tournier L, De Margerie-Mellon C, Pachev A, Assouline J, Bouda D, De Bazelaire C, Marques F, Le Strat S, Desgrandchamps F, De Kerviler E. Safety Profile of Ambulatory Prostatic Artery Embolization after a Significant Learning Curve: Update on Adverse Events. J Pers Med 2022; 12:jpm12081261. [PMID: 36013210 PMCID: PMC9409998 DOI: 10.3390/jpm12081261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background: to report the safety of outpatient prostatic artery embolization (PAE) after a significant learning curve. Methods: a retrospective bi-institutional study was conducted between June 2018 and April 2022 on 311 consecutive patients, with a mean age of 69 years ± 9.8 (47–102), treated by outpatient PAE. Indications included lower urinary tract symptoms, acute urinary retention, and hematuria. When needed, 3D-imaging and/or coil protection of extra-prostatic supplies were performed to avoid non-target embolization. Adverse events were monitored at 1-, 6-, and 12-month follow-ups. Results: bilateral PAE was achieved in 305/311 (98.1%). Mean dose area product/fluoroscopy times were 16,408.3 ± 12,078.9 (2959–81,608) μGy.m2/36.3 ± 1.7 (11–97) minutes. Coil protection was performed on 67/311 (21.5%) patients in 78 vesical, penile, or rectal supplies. Embolization-related adverse events varied between 0 and 2.6%, access-site adverse events between 0 and 18%, and were all minor. There was no major event. Conclusion: outpatient PAE performed after achieving a significant learning curve may lead to a decreased and low rate of adverse events. Experience in arterial anatomy and coil protection may play a role in safety, but the necessity of the latter in some patterns may need confirmation by additional studies in randomized designs.
Collapse
Affiliation(s)
- Gregory Amouyal
- Ramsay Santé—Hôpital Privé Geoffroy Saint-Hilaire, 75005 Paris, France; (F.M.); (S.L.S.)
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Correspondence: ; Tel.: +33-670132138; Fax: +33-142494126
| | - Louis Tournier
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Constance De Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Atanas Pachev
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Jessica Assouline
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Damien Bouda
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Cédric De Bazelaire
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Florent Marques
- Ramsay Santé—Hôpital Privé Geoffroy Saint-Hilaire, 75005 Paris, France; (F.M.); (S.L.S.)
| | - Solenne Le Strat
- Ramsay Santé—Hôpital Privé Geoffroy Saint-Hilaire, 75005 Paris, France; (F.M.); (S.L.S.)
| | - François Desgrandchamps
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
- Urology Department, Hôpital Saint-Louis, 75010 Paris, France
- SRHI/CEA—Institut de Recherche Clinique Saint-Louis, Hôpital Saint-Louis, 75010 Paris, France
| | - Eric De Kerviler
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| |
Collapse
|
59
|
Durant AM, Moore J, Voleti S, Wu S, Mi L, Narang G, Cheney S, Humphreys M. Salvage versus primary holmium laser enucleation of the prostate: trends, outcomes and safety analysis. World J Urol 2022; 40:2305-2312. [PMID: 35867143 DOI: 10.1007/s00345-022-04098-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To study the safety, efficacy and trends in index procedures leading to salvage holmium laser enucleation of the prostate (S-HoLEP). METHODS This was a single-institution retrospective review of HoLEPs performed between 2006 and 2020. Patients who underwent S-HoLEP were compared to those undergoing primary holmium laser enucleation of the prostate (P-HoLEP). The endpoint of primary interest were functional outcomes. Changes in index procedures over the study period were analyzed. RESULTS A total of 633 HoLEPs were performed during the study, with 217 being S-HoLEP. The S-HoLEP cohort was older than P-HoLEP cohort, 71.2 years vs 68.8 years (p = 0.03). All other factors were well matched. The most common index procedures prior to S-HoLEP included transurethral resection of the prostate (TURP) (87, 40.1%), transurethral microwave thermotherapy (TUMT) (44, 20.3%), photoselective vaporization of the prostate (PVP) (24, 11.1%) and prostatic urethral lift (PUL) (24, 11.1%). Preoperative prostate volume, IPSS and Qmax were similar between groups. Intra-operatively, S-HoLEP had longer procedure and morcellation times (p = 0.01 and 0.007). Postoperatively, the S-HoLEP cohort had longer catheter duration and hospitalization (both p < 0.001). Postoperative Qmax, IPSS and 90-day complication rates were similar. On temporal analysis, minimally invasive surgical therapies (MIST) have become more prevalent as index procedures. CONCLUSION S-HoLEP is safe and efficacious for patients requiring additional BPH surgical intervention. S-HoLEP patients had longer operative times and hospital stays but equivalent postoperative functional outcomes compared to P-HoLEP. As MIST mature and gain traction, it is expected that rates of S-HoLEP will continue to rise.
Collapse
Affiliation(s)
- Adri M Durant
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | | | - Sandeep Voleti
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Sarah Wu
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Lanyu Mi
- Department of Quantitative Health Sciences, Scottsdale, AZ, USA
| | - Gopal Narang
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Scott Cheney
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mitchell Humphreys
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| |
Collapse
|
60
|
Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E. Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period. Cardiovasc Intervent Radiol 2022; 45:1324-1336. [PMID: 35778579 DOI: 10.1007/s00270-022-03199-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/04/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Assess long-term outcomes of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Single centre retrospective study from 2009-2019 including 1072 patients who received PAE and had available follow-up. Patients were evaluated yearly at 1-10 years post PAE using the International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. The need for prostatic medication, re-intervention rates, repeat PAE and prostatectomy rates were assessed with Kaplan-Meier survival analysis and compared between different embolic agents using Cox regression analysis. RESULTS Mean follow-up time was 4.39 ± 2.37 years. At last follow-up visit, mean IPSS and QoL improvements were - 10.14 ± 8.34 (p < .0001) and - 1.87 ± 1.48 (p < .0001) points, mean PV reduction was - 6.82 ± 41.11 cm3 (p = 0.7779), mean PSA reduction was - 1.12 ± 4.60 ng/mL (p = 0.9713), mean Qmax increase was 2.72 ± 6.38 mL/s (p = 0.0005), mean PVR reduction was - 8.35 ± 135.75 mL (p = 0.6786). There were 335 patients (31.3%) needing prostatic medication after PAE. Re-intervention rates were 3.4% at 1 year, 21.1% at 5 years and 58.1% at 10 years. Repeat-PAE rates were 2.3% at 1 year, 9.5% at 5 years and 23.1% at 10 years. Prostatectomy rates were 1.1% at 1 year, 11.6% at 5 years and 35.0% at 10 years. No significant differences were found between polyvinyl alcohol particles, Bead Block, Embospheres and Embozenes. CONCLUSION PAE induces durable long-term LUTS relief, with re-intervention rates of 20% in the first 5 years and 30%-60% > 5 years post-PAE.
Collapse
Affiliation(s)
- Tiago Bilhim
- Interventional Radiologist, Interventional Radiology Unit, Saint Louis Hospital, R. Luz Soriano 182, 1200-249, Lisbon, Portugal. .,NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal. .,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
| | - Nuno Vasco Costa
- Interventional Radiologist, Interventional Radiology Unit, Saint Louis Hospital, R. Luz Soriano 182, 1200-249, Lisbon, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Daniel Torres
- Interventional Radiologist, Interventional Radiology Unit, Saint Louis Hospital, R. Luz Soriano 182, 1200-249, Lisbon, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Luís Campos Pinheiro
- NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | | |
Collapse
|
61
|
Sheridan A, Reynolds E, Maynes E, Wind G, Leighton MX, Granite G. A Hepatogastrophrenic Trunk, Celiacomesenteric Trunk, and a Middle Mesenteric Artery in a 68-Year-Old White Male Donor. Diagnostics (Basel) 2022; 12:diagnostics12071597. [PMID: 35885503 PMCID: PMC9325176 DOI: 10.3390/diagnostics12071597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
A detailed understanding of the enteric vascular supply is of great importance for pre-operative planning. In the case of this 68-year-old white male donor, the following variations were observed: a hepatogastrophrenic trunk, a celiacomesenteric trunk, and a middle mesenteric artery. Literature review was conducted to understand the frequency and clinical significance of these variations.
Collapse
Affiliation(s)
- Ariana Sheridan
- Directorate for Education, Training, and Research, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA;
| | - Elizabeth Reynolds
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
| | - Elizabeth Maynes
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
| | - Gary Wind
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
| | - Maria Ximena Leighton
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
| | - Guinevere Granite
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
- Correspondence: ; Tel.: +1-301-295-1500
| |
Collapse
|
62
|
Saro H, Solyman MT, Zaki M, Hasan MN, Thulasidasan N, Clovis S, Elhage O, Popert R, Sabharwal T. Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1748758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose Prostate artery embolization (PAE) has been established as an effective treatment option for benign prostate hyperplasia or hematuria of prostatic origin. We aim to confirm the effectiveness and safety of PAE in elderly patients aged ≥ 80 years old.
Materials and Methods Between January 2014 and August 2020, PAE was attempted on 54 elderly patients with lower urinary tract symptoms (LUTS) or prostatic hematuria who were unfit for surgical treatment or opted for PAE. Outcome parameters (International Prostate Symptom Score [IPSS], quality of life [QoL] score, International Index of Erectile Function score (IIEF), maximal urinary flow rate, postvoid residual, and prostate volume) were collected and analyzed at baseline, 6 months, 1, 2, and 3 years.
Results The mean patient age was 85.29 years (range: 80–98). Technical success was achieved in 50 patients (92.6%). Mean IPSS improved from 18 at baseline to 7.7, 8.5, 8.6, and 9.1 at 6 months, 1, 2, and 3 years. Mean QoL improved from 4.9 at baseline to 2.8, 1.7, and 1.5 at 6 months, 1, and 2 years. Mean prostate volume reduced from a baseline of 152.7 to 123.5 mL within 6 months and 120.5 mL after 7 months of PAE. Urinary catheter removal was successful in 13 out of 19 patients with urinary retention. PAE succeeded in stopping bleeding in 16 out of 17 patients with prostate-induced hematuria.
Conclusion PAE is a feasible low-risk treatment for LUTS with or without urinary retention or prostatic hematuria in elderly patients.
Collapse
Affiliation(s)
- Hossam Saro
- Interventional Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Radiology Department, Sohag University Hospitals, Sohag, Egypt
| | - M. Th. Solyman
- Radiology Department, Sohag University Hospitals, Sohag, Egypt
| | - Mohammed Zaki
- Radiology Department, Sohag University Hospitals, Sohag, Egypt
| | - M.A. N. Hasan
- Radiology Department, Sohag University Hospitals, Sohag, Egypt
| | - N. Thulasidasan
- Interventional Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharon Clovis
- Urology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Oussama Elhage
- Urology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rick Popert
- Urology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tarun Sabharwal
- Interventional Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
63
|
Xu YC, Yang F, Fu DL. Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol 2022; 28:2057-2075. [PMID: 35664036 PMCID: PMC9134138 DOI: 10.3748/wjg.v28.i19.2057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels. A variant of the hepatic artery, which is not a rare finding during pancreatic surgery, is prone to intraoperative injury. Inadvertent injury to the hepatic artery may affect liver perfusion, resulting in necrosis, liver abscess, and even liver failure. The preoperative identification of hepatic artery variations, detailed planning of the surgical approach, careful intraoperative dissection, and proper management of the damaged artery are important for preventing hepatic hypoperfusion. Nevertheless, despite the potential risks, planned artery resection has become acceptable in carefully selected patients. Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods. The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery. Here, we comprehensively reviewed the anatomical basis of hepatic artery variation, its incidence, and its effect on the surgical and oncological outcomes after pancreatic resection. In addition, we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion. Overall, the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.
Collapse
Affiliation(s)
- Ye-Cheng Xu
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China
| | - Feng Yang
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China
| | - De-Liang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai 200040, China
| |
Collapse
|
64
|
Diamond J, Conway AM, Carroccio A, Rosen RJ. Endovascular Interventions for the Pelvis. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
65
|
Abt D, Lyatoshinsky P, Schmid HP, Müllhaupt G. Prostatic Artery Embolisation: Do We Still Need It and for Whom? Eur Urol Focus 2022; 8:384-387. [PMID: 35484049 DOI: 10.1016/j.euf.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
Prostatic artery embolisation (PAE) is now endorsed by international evidence-based guidelines as a treatment for lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) for selected patients. PAE is a truly minimally invasive technique, with proven efficacy and safety demonstrated for the short- to mid-term. As it has a unique treatment approach (endovascular instead of transurethral), its profile and ideal application differ clearly from other treatments for LUTS/BPO, which must be considered for patient selection. This mini review examines the role of PAE in the treatment of LUTS/BPO on the basis of current evidence. PATIENT SUMMARY: For properly selected patients, prostatic artery embolisation (PAE), in which arteries feeding the prostate are blocked in a nonsurgical procedure, is one of the treatment options for obstruction of urine outflow caused by benign enlargement of the prostate. This article examines the role of PAE according to the evidence available in the literature.
Collapse
Affiliation(s)
- Dominik Abt
- Department of Urology, Spitalzentrum Biel, Centre Hospitalier Bienne, Biel, Switzerland.
| | - Pavel Lyatoshinsky
- Department of Urology, Spitalzentrum Biel, Centre Hospitalier Bienne, Biel, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
66
|
Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms: A Markov Model-Based Cost-Effectiveness Analysis. J Am Coll Radiol 2022; 19:733-743. [PMID: 35476943 DOI: 10.1016/j.jacr.2022.02.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP). METHODS The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature. A decision tree-based Markov model was created, analyzing long-term cost-effectiveness for TURP and PAE from a US health care sector perspective. Cost-effectiveness over a time frame of 5 years was estimated while assuming a willingness to pay of $50,000 per quality-adjusted life-year (QALY). The primary outcome was incremental cost-effectiveness ratio. RESULTS PAE resulted in overall cost of $6,464.92 and an expected outcome of 4.566 QALYs. In comparison, TURP cost $9,221.09 and resulted in expected outcome of 4.577 QALYs per treatment. The incremental cost-effectiveness ratio for TURP was $247,732.65 per QALY. On the basis of the willingness-to-pay threshold, PAE is cost effective compared with TURP. CONCLUSIONS On the basis of our model, PAE in comparison with TURP can be regarded as a cost-effective treatment option for patients with lower urinary tract symptoms within the US health care system.
Collapse
|
67
|
Laparoscopic Release for Median Arcuate Ligament Compression Syndrome Associated with a Celiac-Mesenteric Trunk. Case Rep Vasc Med 2022; 2022:3595603. [PMID: 35494098 PMCID: PMC9054496 DOI: 10.1155/2022/3595603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022] Open
Abstract
The median arcuate ligament compression syndrome is a rare entity that occurs in 2 per 100,000 unselected individuals. We present a case where the median arcuate ligament compression syndrome was associated with an equally uncommon anatomic variation—a celiac-mesenteric trunk, which occurs in 0.42-2.7% of unselected individuals. We could find no prior report of a celiac-mesenteric trunk being associated with the median arcuate ligament compression syndrome. This report also adds to the literature to show that a laparoscopic approach to median arcuate ligament release is feasible.
Collapse
|
68
|
Jung JH, McCutcheon KA, Borofsky M, Young S, Golzarian J, Kim MH, Narayan VM, Dahm P. Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2022; 3:CD012867. [PMID: 35349161 PMCID: PMC8962961 DOI: 10.1002/14651858.cd012867.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach. OBJECTIVES To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH. SEARCH METHODS We performed a comprehensive search the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up to 8 November 2021. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 years with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age was 66 years, International Prostate Symptom Score (IPSS) was 22.8, and prostate volume of participants was 72.8 mL. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. Prostatic arterial embolization versus transurethral resection of the prostate We included six RCTs and two NRSs with short-term (up to 12 months) follow-up, and two RCTs and one NRS with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; 6 RCTs, 360 participants; I² = 78%; low-certainty evidence). There may be little to no difference in quality of life as measured by the IPSS-quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively (MD 0.28, 95% CI -0.28 to 0.84; 5 RCTs, 300 participants; I² = 63%; low-certainty evidence). While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19 to 2.97; 4 RCTs, 250 participants; I² = 24%; very low-certainty evidence), PAE likely increases retreatments (RR 3.20, 95% CI 1.41 to 7.27; 4 RCTs, 303 participants; I² = 0%; moderate-certainty evidence). PAE may make little to no difference in erectile function measured by the International Index of Erectile Function-5 on a scale from 1 to 25, with higher scores indicating better function (MD -0.50 points, 95% CI -5.88 to 4.88; 2 RCTs, 120 participants; I² = 68%; low-certainty evidence). Based on NRS evidence, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 1 NRS, 260 participants; low-certainty evidence). Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urologic symptom scores (MD 2.58 points, 95% CI -1.54 to 6.71; 2 RCTs, 176 participants; I² = 73%; low-certainty evidence) and quality of life (MD 0.50 points, 95% CI -0.03 to 1.04; 2 RCTs, 176 participants; I² = 29%; low-certainty evidence). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20 to 4.05; 2 RCTs, 206 participants; I² = 72%; very low-certainty evidence). PAE likely increases retreatments (RR 3.80, 95% CI 1.32 to 10.93; 1 RCT, 81 participants; moderate-certainty evidence). While PAE may result in little to no difference in erectile function (MD 3.09 points, 95% CI -0.76 to 6.94; 1 RCT, 81 participants; low-certainty evidence), PAE may reduce the occurrence of ejaculatory disorders (RR 0.67, 95% CI 0.45 to 0.98; 1 RCT, 50 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to TURP, PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE likely increases retreatment rates. While erectile function may be similar, PAE may reduce ejaculatory disorders. Certainty of evidence for the outcomes of this review was low or very low except for retreatment (moderate-certainty evidence), signaling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.
Collapse
Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | | | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Vikram M Narayan
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
69
|
Mehdorn M, Gockel I, Jansen-Winkeln B, Meyer HJ. Akute Mesenterialischämie. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
70
|
Bilhim T, Costa NV, Torres D. Prostatic Artery Embolization for Benign Prostatic Hyperplasia—A Primer for Interventional Radiologists. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0041-1739302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMale patients over 50 years with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are potential candidates for prostatic artery embolization (PAE). PAE is not a perfect fit for all BPH patients. Careful pre- and postpostprocedural evaluation/consultation with correct selection of patients should be tailored on an individual basis. Evaluated parameters include the following: LUTS severity quantification with validated questionnaires as the international prostate symptom score (IPSS) and quality of life (QoL), erectile and ejaculatory evaluation with validated questionnaires, blood tests including full blood count, coagulation profile, renal function and total/free prostate-specific antigen (PSA), prostate volume measured by multiparametric magnetic resonance (mpMR) of the prostate and/or transrectal ultrasound, uroflowmetry measuring the peak urinary flowrate (Qmax), and postvoid residual urine (PVR). Correct arterial anatomy identification with either computed tomography (CT) angiography, MR angiography, or intraprocedural cone-beam CT (CBCT) are suggested for a confident procedure and avoiding potential complications. The minimally invasive nature of PAE with a faster recovery, preserving the sexual function, and comparable results to standard prostatic surgery make the procedure an attractive choice for many male patients suffering with this condition. Patients should be informed about the potential for higher retreatment rates and shorter duration of treatment effect when compared with standard prostatic surgery. In this comprehensive review, we provide an updated toolbox for all interventional radiologists interested in the PAE practice for patients with BPH. We explain how to evaluate patients during consultation before and after PAE, describe the preprocedural imaging required, explain the technique, and narrate how to optimize outcomes. Finally, we review the level of evidence of PAE for BPH.
Collapse
Affiliation(s)
- Tiago Bilhim
- Angiography Unit, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Saint Louis Hospital, Portugal and Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Nuno V. Costa
- Angiography Unit, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Saint Louis Hospital, Portugal and Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Daniel Torres
- Angiography Unit, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Saint Louis Hospital, Portugal and Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| |
Collapse
|
71
|
Haddad H, Hermani H, Bischoff P, Hanitzsch H, Heidrich A, Schaefer A, Kovács A, Pinkawa M. Permanent interstitial brachytherapy for prostate cancer implementing neoadjuvant prostatic artery embolization. Brachytherapy 2022; 21:308-316. [DOI: 10.1016/j.brachy.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 11/02/2022]
|
72
|
Xu Z, Zhou Z, Mu Y, Cai T, Gao Z, Liu L. An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia. Front Surg 2022; 8:779571. [PMID: 34977145 PMCID: PMC8715078 DOI: 10.3389/fsurg.2021.779571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH) has been introduced into clinical practice, but conclusive evidence of efficacy and safety has been lacking. Objective: To compare the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of prostate (TURP), we performed a meta-analysis of clinical trials. Methods: We searched randomized controlled trials (RCTs) from Pubmed, Embase, Wanfang, and CNKI from January 2000 to December 2020 and used RevMan 5.0 to analyze the data after five RCTs were included. Results: The reducing of prostate volume (PV) [Median mean (MD) 14.87; 95% confidence interval (CI) 7.52–22.22; P < 0.0001] and the increasing of maximum flow rate in free uroflowmetry (Qmax) (MD 3.73; 95% CI 0.19–7.27; P = 0.004) were more obvious in TURP than in PAE; however, the rate of lower sexual dysfunction [odds ratio (OR) 0.12; 95% CI 0.05–0.30; P < 0.00001] was lower in PAE compared with TURP. Meanwhile, no conspicuous difference in International Prostate Symptoms Score (IPSS) score (MD 1.42; 95% CI −0.92 to 3.75; P = 0.23), quality of life (Qol) score (MD 0.21; 95% CI −0.31 to 0.73; P = 0.43), post void residual (PVR) (MD 21.16; 95% CI −5.58 to 47.89; P = 0.12), prostate-specific antigen (PSA) (MD 0.56; 95% CI −0.15 to 1.27; P = 0.12), and complications (OR 0.90; 95% CI 0.20–4.05; P = 0.89) between PAE and TURP group was shown. Conclusion: PAE may replace TURP as an alternative treatment for Benign prostatic hyperplasia (BPH) patients who do not want to have surgery or with operational contraindications.
Collapse
Affiliation(s)
- Zhunan Xu
- Second Clinical Medical College, Binzhou Medical University, Yantai, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Yingmei Mu
- Department of Allergy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Tong Cai
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhenli Gao
- Second Clinical Medical College, Binzhou Medical University, Yantai, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Lingling Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| |
Collapse
|
73
|
Pušnik L, Šekoranja D, Plut D. A Unique Case of Multicentric Infantile Myofibromatosis with Radiologic-Pathologic Correlation. CHILDREN 2022; 9:children9010053. [PMID: 35053678 PMCID: PMC8774631 DOI: 10.3390/children9010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Infantile myofibromatosis (IM) is a rare condition with a variable clinical presentation that characteristically affects young children. Most frequently it presents as one or more benign nodules of the skin, bones, soft tissues, or, rarely, visceral organs. According to the location and number of lesions, there are three different forms: solitary, multicentric without visceral involvement, and multicentric with visceral involvement (generalised), with the latter having the least favourable prognosis. We present a unique case of severe congenital generalised IM in a new-born male who required intubation and mechanical ventilation immediately after the birth due to respiratory distress. A chest radiograph showed numerous tumours involving the entire lung, resembling a metastatic lung disease. Additionally, the neonate had multiple, bluish, papular skin nodules and a biopsy of a skin nodule ultimately led to the diagnosis of IM. Diffuse lung involvement prevented adequate ventilation which resulted in multiorgan failure and death before targeted treatment could have been initiated. The presented case is unique, as such atypical extensive involvement of the lung and leptomeninges in IM has not been reported before. In this brief report, we present the findings of radiographic and ultrasonographic examinations in correlation with autopsy and histopathology.
Collapse
Affiliation(s)
- Luka Pušnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Correspondence: ; Tel.: +386-31-573-832
| | - Daja Šekoranja
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Domen Plut
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| |
Collapse
|
74
|
Gil R, Shim DJ, Kim D, Lee DH, Kim JJ, Lee JW. Prostatic Artery Embolization for Lower Urinary Tract Symptoms via Transradial Versus Transfemoral Artery Access: Single-Center Technical Outcomes. Korean J Radiol 2022; 23:548-554. [PMID: 35506528 PMCID: PMC9081690 DOI: 10.3348/kjr.2021.0934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the safety and feasibility of prostatic artery embolization (PAE) via transradial access (TRA) compared with transfemoral access (TFA). Materials and Methods This retrospective study included 53 consecutive men with lower urinary tract symptoms (LUTS) who underwent PAE between September 2018 and September 2021. Thirty-one patients (mean age ± standard deviation: 70.6 ± 8.4 years) were treated with TFA, including 14 patients treated before adopting TRA. Since December 2019, TRA has also been attempted with the procedure’s selection criteria of patent carpal circulation and a height ≤ 172 cm, with 22 patients treated via TRA (69.1 ± 9.6 years). Parameters of technical success (defined as successful bilateral embolization), clinical success (defined as LUTS improvement), procedural time, radiation dose, and adverse events were compared between the two groups using the Fisher’s exact test, independent sample t test, Wilcoxon signed-rank test, or Mann-Whitney test. Results All patients received at least one-side PAE. Technical success of PAE was achieved in most patients (TRA, 21/22; TFA, 30/31; p > 0.999). No technical problem-related conversion from TRA to TFA occurred. The clinical success rate was 85% (11/13) in patients with TRA, and 89% (16/18) in patients with TFA for follow-up > 2 weeks post-PAE (median, 3 months) (p > 0.999). The median procedure time was similar in both groups (TRA, 81 minutes vs. TFA, 94 minutes; p = 0.570). No significant dose differences were found between the TRA and TFA groups in the dose-area product (median Gycm2, 95 [range, 44–255] for TRA and 84 [34–255] for TFA; p = 0.678) or cumulative air kerma (median mGy, 609 [236–1584] for TRA and 634 [217–1594] for TFA; p = 0.551). No major adverse events occurred in either of the groups. Conclusion PAE via TRA is a safe and feasible method comparable to conventional TFA. It can be safely implemented by selecting patients with patent carpal circulation and adequate height.
Collapse
Affiliation(s)
- Ryun Gil
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Doyoung Kim
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hwan Lee
- Department of Urology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Jun Kim
- Department of Urology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Whee Lee
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
75
|
Young S, Moran P, Golzarian J. Ejaculatory dysfunction following prostate artery embolization: A retrospective study utilizing the male sexual health questionnaire-ejaculation dysfunction questionnaire. Diagn Interv Imaging 2022; 103:310-315. [DOI: 10.1016/j.diii.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/28/2022]
|
76
|
Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis. J Vasc Interv Radiol 2021; 33:359-367.e8. [PMID: 34968671 DOI: 10.1016/j.jvir.2021.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
Collapse
|
77
|
Malviya KK, Verma A, Nayak AK, Mishra A, More RS. Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region. Diagnostics (Basel) 2021; 11:2262. [PMID: 34943499 PMCID: PMC8700197 DOI: 10.3390/diagnostics11122262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022] Open
Abstract
Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.
Collapse
Affiliation(s)
- Kapil Kumar Malviya
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India;
| | - Amit Kumar Nayak
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Anand Mishra
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Raghunath Shahaji More
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| |
Collapse
|
78
|
Rare anastomosis between a replaced right hepatic artery and left branch of the proper hepatic artery. Surg Radiol Anat 2021; 44:137-141. [PMID: 34837499 DOI: 10.1007/s00276-021-02863-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/19/2021] [Indexed: 01/26/2023]
Abstract
Appreciation of the potential anatomical variation of the hepatic arterial supply and branches of the abdominal aorta is of paramount importance in pancreatic and hepatobiliary surgery. Here we describe a hitherto un-reported coelio-mesenteric anastomotic connection between a replaced right hepatic artery, originating from the superior mesenteric artery, and the left hepatic branch of the proper hepatic artery. The embryological origins of the variant anatomy as well as its potential surgical implications are discussed with a view to encourage thorough pre-operative interrogation of available imaging by radiologists and surgeons to successfully identify such variants and take advantage of their potentially useful functionality.
Collapse
|
79
|
Franco JVA, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, Young S, Golzarian J, Veroniki AA, Garegnani L, Dahm P. Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU Int 2021; 130:142-156. [PMID: 34820997 DOI: 10.1111/bju.15653] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezūm); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. RESULTS We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. CONCLUSIONS Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.
Collapse
Affiliation(s)
- Juan Victor Ariel Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, South Korea
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands.,Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, MN, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, MN, USA
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
80
|
Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
Collapse
Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
| |
Collapse
|
81
|
Svarc P, Stroomberg HV, Juhl Jensen R, Frevert S, Håkan Lindh M, Taudorf M, Brasso K, Lönn L, Røder MA. Efficacy of dexamethasone in reducing the postembolisation syndrome in men undergoing prostatic artery embolisation for benign prostatic hyperplasia: protocol for a single-centre, randomised, double-blind, placebo-controlled trial-the 'DEXAPAE' study. BMJ Open 2021; 11:e047878. [PMID: 34725072 PMCID: PMC8562514 DOI: 10.1136/bmjopen-2020-047878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Postembolisation syndrome (PES) is the most common side effect of vascular embolisation of solid organs. Although prophylactic corticosteroids are known to reduce the incidence and severity of PES, no trials investigating their efficacy have been conducted in men undergoing prostatic artery embolisation (PAE). We postulate that steroids can have a similar effect in reducing PES after PAE. This paper describes the rationale and detailed protocol for a randomised controlled trial evaluating the efficacy of dexamethasone (DEXA) in reducing PES after PAE. METHODS AND ANALYSIS In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 60 individuals undergoing PAE for benign prostatic hyperplasia. Participants will be randomised to receive IV DEXA (24 mg) or placebo (saline). The primary outcomes will be postprocedural fever, pain and quality of life. The secondary outcomes will include postprocedural nausea, postprocedural medicine usage, laboratory parameters (C reactive protein, prostate-specific antigen) and early PAE results. ETHICS AND DISSEMINATION Ethics approval was obtained from the Danish Committee on Health Research Ethics in the Capital Region (H-20025910). The results from this trial will be disseminated through publication in peer-reviewed journals and national and international presentations. TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier: NCT04588857; EudraCT number: 2020-000915-53.
Collapse
Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Vincent Stroomberg
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | | | - Susanne Frevert
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
82
|
Prostate Artery Embolization-Review of Indications, Patient Selection, Techniques and Results. J Clin Med 2021; 10:jcm10215139. [PMID: 34768659 PMCID: PMC8584630 DOI: 10.3390/jcm10215139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.
Collapse
|
83
|
Cunha B, Kuroedov D, Conceição C. Imaging of pediatric nasal masses: A review. J Neuroimaging 2021; 32:230-244. [PMID: 34705308 DOI: 10.1111/jon.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022] Open
Abstract
Several conditions may present as nasal masses in pediatric age, including congenital and developmental disorders, inflammatory and infectious conditions, neoplastic and neoplastic-like lesions, and other miscellaneous disorders. A confident presurgical diagnosis can be challenging and imaging is often key in the management of these lesions. We provide a pictorial review of pediatric nasal masses and discuss a location-based approach to the diagnosis of these lesions on imaging studies. Acquaintance with the most common pathologies and awareness for its characteristic imaging features can aid the physician in the differential diagnosis. Location and extension of the lesion can be particularly helpful. Midline masses raise suspicion for developmental nasal midline lesions, including frontoethmoidal cephalocele, dermoid/epidermoid cyst, and neuroglial heterotopia. In case of trauma, nasal septum hematoma/abscess should be considered. Developmental or odontogenic cystic lesions and osseous neoplasms and neoplasm-like lesions can originate from the maxilla and palate. Although most nasal tumors show overlapping imaging characteristics, some have suggestive features, such as nasopharyngeal angiofibroma and esthesioneuroblastoma. Malignant tumors tend to be locally aggressive, demonstrating invasive features, bony erosion, intermediate signal on T2-weighted images, and restricted diffusion on diffusion-weighted imaging. In certain cases, a definite diagnosis can only be made histologically. Nonetheless, detailed characterization of the lesion is crucial prior to invasive procedures in order to avoid complications.
Collapse
Affiliation(s)
- Bruno Cunha
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Danila Kuroedov
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carla Conceição
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| |
Collapse
|
84
|
Szczerepa D, Gallagher M, Fluss G, Trocha K, Finlay D. Nutcracker Phenomenon as a Result of Celiomesenteric Trunk Aneurysm. Ann Vasc Surg 2021; 79:441.e1-441.e8. [PMID: 34653637 DOI: 10.1016/j.avsg.2021.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/24/2021] [Accepted: 07/22/2021] [Indexed: 11/01/2022]
Abstract
A common origin of the celiac trunk and superior mesenteric artery is exceedingly rare, and aneurysms of this common trunk are even rarer. According to our literature search, there are no reported cases of nutcracker syndrome or phenomenon involving this rare aneurysmal anomaly. Repair of such anomalies is standardly via open surgical approach with few reported cases of endovascular repair. We describe a patient with an aneurysm of the celiomesenteric trunk resulting in nutcracker phenomenon of the left renal vein. The celiomesenteric trunk aneurysm was repaired endovascularly, resulting in decreased surrounding inflammation and improvement of the left renal vein compression.
Collapse
Affiliation(s)
| | - Margaret Gallagher
- Department of Surgery, New York Medical College at Metropolitan Hospital Center, New York, NY
| | - Gabriella Fluss
- Department of Surgery, New York Medical College at Metropolitan Hospital Center, New York, NY
| | - Kaspar Trocha
- Department of Surgery, New York Medical College at Metropolitan Hospital Center, New York, NY
| | - David Finlay
- Division of Vascular Surgery, Department of Surgery, The Mount Sinai Medical Center, New York, NY.
| |
Collapse
|
85
|
New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes. EUR UROL SUPPL 2021; 33:28-41. [PMID: 34604814 PMCID: PMC8473553 DOI: 10.1016/j.euros.2021.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Context Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr. Objective To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection. Evidence acquisition A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses. Evidence synthesis The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; −9.81 points, 95% confidence interval [CI] −11.37 to −8.25 at 1 mo; −13.13 points, 95% CI −14.98 to −11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8–4.5 to +4.14 ml/s, 95% CI 0.72–7.56 at 12 mo), and postvoid residual volume (−10.10 ml, 95% CI −27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34–2.42 at the start of follow-up; and 1.04, 95% CI 0.28–1.8 after 1 yr), or the IPSS-Quality of Life questionnaire. Conclusions Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients’ sexual function with respect to baseline, especially regarding preservation of ejaculation. Patient summary We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function. Take Home Message Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient’s quality of life.
Collapse
|
86
|
Dias US, de Moura MRL, Viana PCC, de Assis AM, Marcelino ASZ, Moreira AM, Leite CC, Cerri GG, Carnevale FC, Horvat N. Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications. Radiographics 2021; 41:1509-1530. [PMID: 34415807 DOI: 10.1148/rg.2021200144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as α-blockers and 5α-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. ©RSNA, 2021.
Collapse
Affiliation(s)
- Ubenicio Silveira Dias
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Maurício Ruettimann Liberato de Moura
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Publio Cesar Cavalcante Viana
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - André Moreira de Assis
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Antônio Sérgio Zanfred Marcelino
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Airton Mota Moreira
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Claudia Costa Leite
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Natally Horvat
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| |
Collapse
|
87
|
Laparotomy with suture repair is the most common treatment for obturator hernia: a scoping review. Langenbecks Arch Surg 2021; 406:1733-1738. [PMID: 34410482 DOI: 10.1007/s00423-021-02293-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obturator hernias are rare and associated with high mortality. However, the optimal surgical approach remains unknown. We aimed to investigate the available evidence and examine the surgical details regarding obturator hernia defect closure as well as the recurrence rates of the different approaches. METHODS We reported this scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews) and registered the protocol online. A comprehensive literature search in five different databases was conducted. The population was patients undergoing surgery for obturator hernia. Articles were included for data charting if the management of the hernia defect was reported. Data regarding surgical details, and hernia recurrence were extracted. RESULTS A total of 1299 patients from 313 articles were included. In total, 937 patients underwent open obturator hernia repair, in which 992 hernias were repaired (including some bilateral obturator hernias). A total of 295 patients underwent laparoscopic repair for 341 obturator hernias, and for the remaining 67 patients, type of surgery was not reported. For open surgery, suture repair was the most common method of repair (n = 508, 51%) with a recurrence rate of 10%. For laparoscopic surgery, the most common repair of the defect was mesh repair (n = 299, 88%) with no reported recurrences. CONCLUSION Open surgery with primary suture repair is the most common method of repair for obturator hernia but is associated with a recurrence rate of 10%. Laparoscopic mesh repair is becoming more common and have seemingly very low recurrence rates and may be a better method of repair.
Collapse
|
88
|
Carnevale FC, McClure T, Cadour F, Vidal V, de Assis AM, Moreira AM, Rocha ADD, Rebet A, Nutting C. Advanced image guidance for prostatic artery embolization - a multicenter technical note. CVIR Endovasc 2021; 4:63. [PMID: 34374875 PMCID: PMC8355292 DOI: 10.1186/s42155-021-00249-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. MAIN TEXT This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. CONCLUSIONS This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.
Collapse
Affiliation(s)
- Francisco Cesar Carnevale
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil.
| | | | | | | | - André Moreira de Assis
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Airton Mota Moreira
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Arthur Diego Dias Rocha
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | | | - Charles Nutting
- Endovascular Consultants of Colorado Lone Tree, Lone Tree, Colorado, USA
| |
Collapse
|
89
|
de Assis AM, Moreira AM, Carnevale FC, Lanz-Luces JR. Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience. Radiol Bras 2021; 54:219-224. [PMID: 34393287 PMCID: PMC8354184 DOI: 10.1590/0100-3984.2020.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 08/30/2023] Open
Abstract
Objective To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.
Collapse
Affiliation(s)
- André Moreira de Assis
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Airton Mota Moreira
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - José Ramón Lanz-Luces
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| |
Collapse
|
90
|
Li X, Zhang W, Zhou M, Ding Y, Wang Y, Xie T, Zhou Z, Cai L, Shi Z. A new classification and strategies for endovascular treatment of celiac artery aneurysms. Vascular 2021; 30:834-841. [PMID: 34263673 DOI: 10.1177/17085381211032768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endovascular treatment is being increasingly used for celiac artery aneurysms (CAAs), but systematic endovascular treatment strategies have not been defined yet. This study intended to investigate the strategies of endovascular management of CAAs according to a single-center experience. METHODS Anatomically, CAAs were classified into two types: Type I CAAs located in the main trunk of celiac artery. Type II CAAs located on the branches of the celiac artery. Type I and Type II CAAs can be further divided into two different subtypes according to fusiform (a) or saccular or (b) morphology: type Ia, type Ib, type IIa, and type IIb. Patient demographics, clinical manifestations, aneurysm characteristics, endovascular intervention procedures, and perioperative and follow-up outcomes were reviewed and analyzed. RESULTS Between August 2012 and August 2020, 18 consecutive patients (12 men; mean age, 56.8 ± 14.5 years) with CAAs were identified and treated with endovascular procedures. There were seven patients with type Ia, three patients with type Ib, four patients with type IIa, and four patients with type IIb CAAs. One patient died of hemorrhagic shock due to a ruptured aneurysm. Technical success was achieved in 16 patients (88.9%). The mean follow-up period was 51.7 ± 19.4 months. No hepatic or intestinal ischemia or death developed perioperatively or during the follow-up period. No aneurysmal expansion was detected on CTA surveillance, except for one patient who was diagnosed with an endoleak during the follow-up and received reintervention. CONCLUSIONS The endovascular strategy based on the novel classification of CAAs was safe and effective, with a favorable mid-term clinical outcome.
Collapse
Affiliation(s)
- Xu Li
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Wan Zhang
- Department of Vascular Surgery, 159396Huadong Hospital Fudan University, Shanghai, China
| | - Min Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Yong Ding
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Yonggang Wang
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Tianchen Xie
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Zhenyu Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Liang Cai
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| |
Collapse
|
91
|
Franco JV, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, Young S, Golzarian J, Veroniki AA, Garegnani L, Dahm P. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database Syst Rev 2021; 7:CD013656. [PMID: 34693990 PMCID: PMC8543673 DOI: 10.1002/14651858.cd013656.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A variety of minimally invasive treatments are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). However, it is unclear which treatments provide better results. OBJECTIVES Our primary objective was to assess the comparative effectiveness of minimally invasive treatments for lower urinary tract symptoms in men with BPH through a network meta-analysis. Our secondary objective was to obtain an estimate of relative ranking of these minimally invasive treatments, according to their effects. SEARCH METHODS We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Scopus, Web of Science and LILACS), trials registries, other sources of grey literature, and conference proceedings, up to 24 February 2021. We had no restrictions on language of publication or publication status. SELECTION CRITERIA We included parallel-group randomized controlled trials assessing the effects of the following minimally invasive treatments, compared to TURP or sham treatment, on men with moderate to severe LUTS due to BPH: convective radiofrequency water vapor therapy (CRFWVT); prostatic arterial embolization (PAE); prostatic urethral lift (PUL); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT). DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model for pair-wise comparisons and a frequentist network meta-analysis for combined estimates. We interpreted them according to Cochrane methods. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used risk ratios (RRs) with 95% confidence intervals (CIs) to express dichotomous data and mean differences (MDs) with 95% CIs to express continuous data. We used the GRADE approach to rate the certainty of evidence. MAIN RESULTS We included 27 trials involving 3017 men, mostly over age 50, with severe LUTS due to BPH. The overall certainty of evidence was low to very low due to concerns regarding bias, imprecision, inconsistency (heterogeneity), and incoherence. Based on the network meta-analysis, results for our main outcomes were as follows. Urologic symptoms (19 studies, 1847 participants): PUL and PAE may result in little to no difference in urologic symptoms scores (MD of International Prostate Symptoms Score [IPSS]) compared to TURP (3 to 12 months; MD range 0 to 35; higher scores indicate worse symptoms; PUL: 1.47, 95% CI -4.00 to 6.93; PAE: 1.55, 95% CI -1.23 to 4.33; low-certainty evidence). CRFWVT, TUMT, and TIND may result in worse urologic symptoms scores compared to TURP at short-term follow-up, but the CIs include little to no difference (CRFWVT: 3.6, 95% CI -4.25 to 11.46; TUMT: 3.98, 95% CI 0.85 to 7.10; TIND: 7.5, 95% CI -0.68 to 15.69; low-certainty evidence). Quality of life (QoL) (13 studies, 1459 participants): All interventions may result in little to no difference in the QoL scores, compared to TURP (3 to 12 months; MD of IPSS-QoL score; MD range 0 to 6; higher scores indicate worse symptoms; PUL: 0.06, 95% CI -1.17 to 1.30; PAE: 0.09, 95% CI -0.57 to 0.75; CRFWVT: 0.37, 95% CI -1.45 to 2.20; TUMT: 0.65, 95% CI -0.48 to 1.78; TIND: 0.87, 95% CI -1.04 to 2.79; low-certainty evidence). Major adverse events (15 studies, 1573 participants): TUMT probably results in a large reduction of major adverse events compared to TURP (RR 0.20, 95% CI 0.09 to 0.43; moderate-certainty evidence). PUL, CRFWVT, TIND and PAE may also result in a large reduction in major adverse events, but CIs include substantial benefits and harms at three months to 36 months; PUL: RR 0.30, 95% CI 0.04 to 2.22; CRFWVT: RR 0.37, 95% CI 0.01 to 18.62; TIND: RR 0.52, 95% CI 0.01 to 24.46; PAE: RR 0.65, 95% CI 0.25 to 1.68; low-certainty evidence). Retreatment (10 studies, 799 participants): We are uncertain about the effects of PAE and PUL on retreatment compared to TURP (12 to 60 months; PUL: RR 2.39, 95% CI 0.51 to 11.1; PAE: RR 4.39, 95% CI 1.25 to 15.44; very low-certainty evidence). TUMT may result in higher retreatment rates (RR 9.71, 95% CI 2.35 to 40.13; low-certainty evidence). Erectile function (six studies, 640 participants): We are very uncertain of the effects of minimally invasive treatments on erectile function (MD of International Index of Erectile Function [IIEF-5]; range 5 to 25; higher scores indicates better function; CRFWVT: 6.49, 95% CI -8.13 to 21.12; TIND: 5.19, 95% CI -9.36 to 19.74; PUL: 3.00, 95% CI -5.45 to 11.44; PAE: -0.03, 95% CI -6.38, 6.32; very low-certainty evidence). Ejaculatory dysfunction (eight studies, 461 participants): We are uncertain of the effects of PUL, PAE and TUMT on ejaculatory dysfunction compared to TURP (3 to 12 months; PUL: RR 0.05, 95 % CI 0.00 to 1.06; PAE: RR 0.35, 95% CI 0.13 to 0.92; TUMT: RR 0.34, 95% CI 0.17 to 0.68; low-certainty evidence). TURP is the reference treatment with the highest likelihood of being the most efficacious for urinary symptoms, QoL and retreatment, but the least favorable in terms of major adverse events, erectile function and ejaculatory function. Among minimally invasive procedures, PUL and PAE have the highest likelihood of being the most efficacious for urinary symptoms and QoL, TUMT for major adverse events, PUL for retreatment, CRFWVT and TIND for erectile function and PUL for ejaculatory function. AUTHORS' CONCLUSIONS Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and QoL compared to TURP at short-term follow-up. They may result in fewer major adverse events, especially in the case of PUL and PAE; resulting in better rankings for symptoms scores. PUL may result in fewer retreatments compared to other interventions, especially TUMT, which had the highest retreatment rates at long-term follow-up. We are very uncertain about the effects of these interventions on erectile function. There was limited long-term data, especially for CRFWVT and TIND. Future high-quality studies with more extended follow-up, comparing different, active treatment modalities, and adequately reporting critical outcomes relevant to patients, including those related to sexual function, could provide more information on the relative effectiveness of these interventions.
Collapse
Affiliation(s)
- Juan Va Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
92
|
Ataka R, Ikeno Y, Doi R. Celiacomesenteric Trunk: a Rare Variation that Must Be Known Before Pancreatic Surgery. J Gastrointest Surg 2021; 25:1917-1919. [PMID: 33532982 DOI: 10.1007/s11605-021-04929-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Ryo Ataka
- Department of Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu City, Shiga, Japan
| | - Yoshinobu Ikeno
- Department of Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu City, Shiga, Japan.
| | - Ryuichiro Doi
- Department of Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu City, Shiga, Japan
| |
Collapse
|
93
|
Wang R, Pan T, Huang L, Liao C, Li Q, Jiang H, Yang J. Photoacoustic imaging in evaluating early intestinal ischemia injury and reperfusion injury in rat models. Quant Imaging Med Surg 2021; 11:2968-2979. [PMID: 34249627 DOI: 10.21037/qims-20-1160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/14/2021] [Indexed: 12/11/2022]
Abstract
Background It remains a challenge to distinguish whether the damaged intestine is viable in treating acute mesenteric ischemia. In this study, photoacoustic imaging (PAI) was used to observe intestinal tissue viability after ischemia and reperfusion injury in rats. Methods An in vivo study was conducted using forty male SD rats, which were randomly divided into a sham-operated (SO) group, a 1 h ischemia group, a 2 h ischemia group, and an ischemia-reperfusion (I/R) group with 10 rats in each group. In the ischemia group, the superior mesenteric artery (SMA) was isolated and clamped for 1 and 2 h, respectively, and in the I/R group, after ischemia for 1 h, the clamp was removed and reperfused for 1 h. The same time interval was used in the SO group. Immediately after establishing the animal model, a PAI examination was performed, and the small intestine was collected for histopathology. Results The levels of PAI parameters Hb, HbR, MAP 760, and MAP 840 were increased to different degrees in the ischemia groups, especially in the 2 h ischemia group, compared with the SO group (P<0.05), and with prolongation of the ischemia time, the injury was aggravated. All PAI signal levels except HbO in the I/R group were higher than those in the control group, and the increased range differed, especially in Hb and MAP 840. Using western blot, compared with the SO group, the BAX increased significantly in the 2 h ischemia group (P<0.05), and Caspase-3 in the experimental group was significantly higher than in the SO group (P<0.05). The level of HIF-1α increased in the 2 h ischemia group and I/R group (P<0.05), and TUNEL staining showed that the number of positive apoptotic nuclei in the 2 h ischemia group was significantly higher than in the SO group (P<0.05). Hematoxylin-eosin (HE) staining showed that ischemia for 2 hours was the most serious, with obvious mucosal damage, extensive epithelial injury, and bleeding. Conclusions PAI can be used as an effective tool to detect acute intestinal ischemia injury and quantitatively evaluate tissue viability.
Collapse
Affiliation(s)
- Rui Wang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital/Center, Kunming, China
| | - Teng Pan
- School of Electronic Science and Engineering, Center for Information in Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Lin Huang
- School of Electronic Science and Engineering, Center for Information in Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Chengde Liao
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital/Center, Kunming, China
| | - Qinqing Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital/Center, Kunming, China
| | - Huabei Jiang
- Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - Jun Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital/Center, Kunming, China
| |
Collapse
|
94
|
Pike JF, Abel WF, Seckel TB, Schammel CM, Flanagan W, Devane AM. Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1730083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Purpose Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for patients with prostates >80 mL and has demonstrated lower morbidity rates. We sought to evaluate PAE at a single tertiary medical center. Methods A retrospective review of all patients who underwent PAE was completed. Demographic, clinicopathologic, procedure, and outcome data were collected to include international prostatic symptom score (IPSS) and quality of life (QoL) assessments. Results The pre-PAE mean prostate-specific antigen (PSA) was 8.4 ng/mL, mean prostate volume was 146.9 mL (9% >200 mL), and mean postvoid residual (PVR) was 208.2 mL (21.9% 200–300 mL). IPSS mean was 19.8 and QoL was “mostly dissatisfied.” Following PAE, mean PSA was reduced by 3.2 ng/mL (38.1%, p = 0.3014), the mean prostate volume reduction was 59.2 mL (40.3%, n = 19, p < 0.0001), and the average PVR reduction was 150.3 mL (72.2%, n = 27, p = 0.0002). Average IPSS score was also lower (11.9; 60.1%, n = 25, p < 0.0001) and QoL was reduced to “mostly satisfied” (p < 0.0001). Technical success was 100% with 24% minor morbidities. Conclusion PAE is a successful treatment for patients with BPH resulting in large prostates that are not good candidates for simple prostatectomy, providing optimal care with less operative and postoperative complications.
Collapse
Affiliation(s)
- James F. Pike
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
| | - William F. Abel
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
| | - Tyler B. Seckel
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
| | | | - William Flanagan
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
- Department of Surgery, Division of Urology, Prisma Health Upstate, Greenville, South Carolina, United States
| | - A. Michael Devane
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
- Department of Radiology, Interventional Radiology, Prisma Health Upstate, Greenville, South Carolina, United States
| |
Collapse
|
95
|
Yang S, Cho MJ. Clinical Characteristics and Treatment Outcomes Among Patients With Gastrointestinal Phytobezoars: A Single-Institution Retrospective Cohort Study in Korea. Front Surg 2021; 8:691860. [PMID: 34250009 PMCID: PMC8263911 DOI: 10.3389/fsurg.2021.691860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To describe our experience with phytobezoars, evaluate risk factors on treatment, and analyze whether previous gastric surgery affects treatment outcomes. Methods: Medical records of 51 patients with phytobezoars between 2000 and 2019 were retrospectively evaluated. We compared endoscopic and surgical treatment groups and evaluated risk factors using multivariate logistic regression analysis. And we compared patients with and without previous gastric surgery in the surgical treatment group. Results: The median patient age was 62.9 (range: 27–89) years. The endoscopic and surgical treatment groups included 26 (51%) and 25 (49%) patients, respectively. Patients aged ≥65 years, diabetes, and small intestinal phytobezoars were more frequent in the surgical treatment group. Previous gastric surgery (n = 16, 31.4%) was the most common predisposing risk factor, but without a significant difference between the groups. Enterotomy was performed for 20 patients (80%), segmental resection was performed for five patients (20%). Five patients (20%) had postoperative complications; there was one death. There were no significant differences in age, preoperative diagnosis, operation method, operative time, or postoperative stay between patients with and without previous gastric surgery, but postoperative complications were significantly more common in patients with previous gastric surgery. Conclusions: Phytobezoar should be suspected early in patients with previous gastric surgery or a specific food intake history. Early diagnosis and treatment are important for avoiding surgical intervention and complications, especially in elderly patients. Surgery is required in most patients with small intestinal phytobezoars, safe removal can be achieved mainly via enterotomy.
Collapse
Affiliation(s)
- Songsoo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Min Jeng Cho
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| |
Collapse
|
96
|
Viitala A, Anttinen M, Wright C, Virtanen I, Mäkelä P, Hovinen T, Sainio T, Saunavaara J, Taimen P, Blanco Sequeiros R, Boström PJ. Magnetic resonance imaging-guided transurethral ultrasound ablation for benign prostatic hyperplasia: 12-month clinical outcomes of a phase I study. BJU Int 2021; 129:208-216. [PMID: 34161649 DOI: 10.1111/bju.15523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the safety and feasibility of magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) for the treatment of benign prostatic obstruction (BPO). PATIENTS AND METHODS An investigator-initiated, prospective, registered (NCT03350529), phase I study enrolled men with lower urinary tract symptoms due to benign prostatic hyperplasia in need of surgical intervention. Patients were followed for 12 months after TULSA. Uroflowmetry, prostate-specific antigen (PSA) level, and a comprehensive set of functional questionnaires including the Expanded Prostate cancer Index Composite-26, International Prostate Symptom Score (IPSS) and five-item version of the International Index of Erectile Function were obtained at baseline and every 3 months afterwards. MRI was obtained at baseline, and at 3 and 12 months after TULSA. Medication use before and after TULSA were recorded. Adverse events (AEs) were reported using the Clavien-Dindo classification. RESULTS A total of 10 men underwent TULSA with no severe AEs encountered. The baseline median (interquartile range [IQR]) age and prostate volume were 68 (63-72) years and 53 (45-66) mL, respectively. At baseline, six patients were moderately symptomatic and four patients severely symptomatic. Nine patients at baseline were on BPO medication. The median (IQR) improvement in the IPSS was 82%, from 17.5 (15.3-23.0) at baseline to 4.0 (2.3-6.3) at 12 months. Similarly, the median maximum urinary flow rate improved by 101%, from a median (IQR) of 12.4 (8.8-17.6) mL/s at baseline to 21.8 (17.6-26.5) mL/s at 12 months. Improvements were already seen at 3 months. The median prostate volume and PSA reduction at 12 months were 33% and 48%, respectively. There were no changes in continence, sexual, erectile or bowel functions. At 12 months, five out of six men with normal ejaculatory function before TULSA reported normal antegrade ejaculations. All patients taking BPO medication before TULSA discontinued medication after TULSA. CONCLUSION TULSA appears to be a safe and effective treatment for BPO, with promising 12-month follow-up outcomes. Further studies with larger cohorts are needed to confirm the observed results.
Collapse
Affiliation(s)
- Antti Viitala
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland.,Department of Diagnostic Radiology, University of Turku, Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland
| | - Cameron Wright
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland.,Department of Diagnostic Radiology, University of Turku, Turku University Hospital, Turku, Finland
| | - Ilari Virtanen
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland
| | - Pietari Mäkelä
- Department of Diagnostic Radiology, University of Turku, Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland
| | - Topi Hovinen
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
| | - Teija Sainio
- FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland.,Department of Medical Physics and Nuclear Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland.,Department of Medical Physics and Nuclear Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland.,Department of Pathology, Institute of Biomedicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku, Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre, University of Turku, Turku University Hospital, Turku, Finland
| |
Collapse
|
97
|
Shaker M, Hashem E, Abdelrahman A, Okba A. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Anatomical Aspects and Radiation Considerations from a Case Series of 210 Patients. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1729134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Context Prostatic artery embolization (PAE) has been established as a safe and effective treatment option for symptomatic benign prostatic hyperplasia (BPH). Thorough knowledge of detailed prostatic artery (PA) anatomy is essential.
Aims The aim of this study was to provide a pictorial review of PA anatomy and prevalence of related anatomical variants, in addition to other anatomical and radiation dose considerations.
Settings and Design Case series and review of literature.
Materials and Methods We performed PAE for 210 patients from November 2015 to November 2020 under local anesthesia only. Anatomy, procedure duration, fluoroscopy time, radiation dose, technical success, and complications were analyzed.
Statistical Analysis Used Descriptive statistics were analyzed using Microsoft Excel software.
Results A total of 210 patients (420 sides) were analyzed. Double arterial supply on the same side was noted in 12 patients (5.7%). In 10 patients (4.7%), only a unilateral PA was identified. In two patients (0.9%), no PA could be identified. Frequencies of PA origins were calculated. Penile, rectal, and vesical anastomoses were identified with 79 (18.8%), 54 (12.9%), and 41 (9.8%) of PAs, respectively. Median skin radiation dose, procedure time, and fluoroscopy time were 505 mGy, 73 and 38 minutes, respectively. Complications occurred in nine patients (4.3%), none of them was major.
Conclusions Knowledge of PA anatomy is essential when treating BPH by PAE for optimum results. There is no enough evidence to support routine use of preoperative computed tomography angiography and intraoperative cone-beam computed tomography as means of improving safety or efficacy.
Collapse
Affiliation(s)
- Mohamed Shaker
- Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt
| | - Essam Hashem
- Department of Department of Diagnostic and Interventional Radiology, Ain Shams University, King’s College Hospital, Cairo, Egypt
| | | | - Ahmed Okba
- Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
98
|
Dariushnia SR, Redstone EA, Heran MKS, Cramer HR, Ganguli S, Gomes AS, Hogan MJ, Himes EA, Patel S, Schiro BJ, Lewis CA. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization. J Vasc Interv Radiol 2021; 32:476.e1-476.e33. [PMID: 33640083 DOI: 10.1016/j.jvir.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303.
| | - Ellen A Redstone
- Department of Interventional Radiology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA, 18015
| | - Manraj K S Heran
- Pediatric Interventional Radiology, Diagnostic & Therapeutic Neuroradiology, British Columbia's Children's Hospital, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada
| | - Harry R Cramer
- Section of Interventional Radiology, Coastal Vascular and Interventional, PLLC, 3155 Hyde Park Place, Pensacola, FL, 32503
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH 4th Floor, Boston, MA, 02118
| | - Antoinette S Gomes
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plz Ste 2125, Los Angeles, CA, 90095-8358
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Elizabeth A Himes
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Sheena Patel
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Brian J Schiro
- Department of Vascular & Interventional Radiology, Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33156, United States
| | - Curtis A Lewis
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303
| |
Collapse
|
99
|
Kamalov A, Kapranov S, Neymark A, Kurbatov D, Neymark B, Karpov V, Shaparov B. Prostatic Artery Embolization for Benign Prostatic Hyperplasia Treatment: A Russian Multicenter Study in More Than 1,000 Treated Patients. Am J Mens Health 2021; 14:1557988320923910. [PMID: 32486959 PMCID: PMC7273342 DOI: 10.1177/1557988320923910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases of the
genitourinary system. The prevalence of BPH increases in men with advancing age.
While transurethral resection of the prostate gland entails complications such
as retrograde ejaculation, urinary incontinence, hematuria, urethral strictures,
bladder neck sclerosis, and other adverse events, it is necessary to apply
minimally invasive surgical methods such as superselective embolization of the
prostatic arteries (PAE), particularly Proximal Embolization First Then Distal
Embolization (PErFecTED). The data from 1,015 BPH patients who underwent
endovascular surgery demonstrate the benefits of PErFecTED treatment during 24
months after surgery. Both Quality of Life score and International Prostate
Symptom Score were around three times better in the PErFecTED group and remained
stable during the entire observation period. However, the technique needs to be
improved due to the high risk of postembolization syndrome.
Collapse
Affiliation(s)
- Armais Kamalov
- Urology and Andrology Department, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.,Urology Department, Moscow Research and Education Center of the Lomonosov Moscow State University, Moscow, Russia
| | - Sergei Kapranov
- Research Institute of Clinical Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Alexander Neymark
- Department of Urology and Andrology, Altai State Medical University, Barnaul, Russia
| | - Dmitry Kurbatov
- Department of Urology and Andrology, National Medical Research Center of Endocrinology, Moscow, Russia
| | - Boris Neymark
- Department of Urology and Andrology, Altai State Medical University, Barnaul, Russia
| | - Valery Karpov
- Urology and Andrology Department, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.,Urology Department, Moscow Research and Education Center of the Lomonosov Moscow State University, Moscow, Russia
| | - Boris Shaparov
- Urology and Andrology Department, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.,Urology Department, Moscow Research and Education Center of the Lomonosov Moscow State University, Moscow, Russia
| |
Collapse
|
100
|
Balasubramanian A, Nagar H, Barbieri CE, Tagawa ST, McClure TD. Re: Early Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolization, a Pilot Study. J Vasc Interv Radiol 2021; 32:1243-1244. [PMID: 34091024 DOI: 10.1016/j.jvir.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | | | - Scott T Tagawa
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York; Meyer Cancer Center, Weill Cornell Medicine/New York Presbyterian, New York, New York; Division of Hematology and Medical Oncology, Weill Cornell Medicine/New York Presbyterian, New York, New York
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York; Department of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian, New York, New York
| |
Collapse
|