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Saha P, Rachapalli KR, Bhat B R, Ansari WA, Ansari A, Desai H. Subacute duodenal obstruction caused by Common Celiaco-Mesenteric Trunk anomaly-A case report. Int J Surg Case Rep 2021; 83:106043. [PMID: 34118527 PMCID: PMC8193349 DOI: 10.1016/j.ijscr.2021.106043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance The origin of the mesenteric vasculature is highly variable. One such variation is the common celiaco-mesenteric trunk (CMT). To our knowledge, this is the first reported case of subacute duodenal obstruction caused by common CMT. The awareness of this anomaly helps keep a high index of suspicion for varied presentations, prompts appropriate investigations, timely intervention, and avoids iatrogenic injury. Patient profile A 15-year-old boy presented with a history of repeated attacks of colicky abdominal pain with bilious vomiting. Computed tomography of the abdomen with intravenous contrast revealed subacute duodenal obstruction caused by an acute angulation of common CMT with the abdominal aorta. To relieve the obstruction, the patient underwent a side-to-side duodenojejunostomy. Discussion A common CMT, where the coeliac artery (CA) and superior mesenteric artery (SMA) have a common origin from the aorta, accounts for less than 1% of all splanchnic artery anomalies. Most CMTs are incidental findings, but aneurysm or dissection of the common trunk commonly accompany this anatomical aberrancy. Intestinal obstruction due to CMT anomaly is a rare occurrence. Conclusion There should be a high index of suspicion concerning vascular anomalies in patients, especially children presenting with repeated episodes of subacute intestinal obstruction. This knowledge of vascular aberrations prevents disastrous iatrogenic complications. Rarity of the occurrence of common celiacomesenteric trunk As per our knowledge this is the first reported case of CMT presenting with duodenal obstruction. Its similarity to Wilkie's syndrome in terms of patient and management Different presentations of CMT Knowledge of this variations important in other surgeries and endovascular procedures to avoid dreadful complications.
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Affiliation(s)
- Priyanka Saha
- Department of General Surgery, Grant Government Medical College and Sir J&J Group of Hospitals, Mumbai, India
| | - Keerthika Reddy Rachapalli
- Department of General Surgery, Grant Government Medical College and Sir J&J Group of Hospitals, Mumbai, India
| | - Rajeshwari Bhat B
- Department of General Surgery, Grant Government Medical College and Sir J&J Group of Hospitals, Mumbai, India.
| | - Waqar Ahmed Ansari
- Department of General Surgery, Grant Government Medical College and Sir J&J Group of Hospitals, Mumbai, India
| | - Asif Ansari
- Department of General Surgery, Grant Government Medical College and Sir J&J Group of Hospitals, Mumbai, India
| | - Hridayanath Desai
- Department of General Surgery, Grant Government Medical College and Sir J&J Group of Hospitals, Mumbai, India
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Marcondes GB, Tenorio ER, Lima GB, Mendes B, Saqib N, Khan S, Macedo TA, Lee H, Oderich GS. Incorporation of Celiomesenteric Trunk With Double Kissing Directional Branches During Fenestrated-Branched Endovascular Aortic Repair. J Endovasc Ther 2021; 28:636-641. [PMID: 33998350 DOI: 10.1177/15266028211016430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Common celiomesenteric trunk (CMT) is a rare anatomical variation that occurs in 0.5% to 3.4% of the general population. Its presence may complicate planning and implantation of fenestrated and branched stent-grafts because the wide diameter and short length of the CMT to its bifurcation does not allow sufficient sealing for placement of bridging stents. CASE REPORT We report a patient with thoracoabdominal aortic aneurysm (TAAA) and CMT treated by fenestrated-branched endovascular aortic repair (FB-EVAR) using double kissing directional branches to incorporate the celiac axis and superior mesenteric artery. Pitfalls of stent design and implantation are outlined. CONCLUSION Double kissing directional branches should be considered as an alternative to incorporate vessels with early bifurcation such as a CMT.
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Affiliation(s)
- Giulianna B Marcondes
- Advanced Aortic Research Program, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Emanuel R Tenorio
- Advanced Aortic Research Program, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Guilherme B Lima
- Advanced Aortic Research Program, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Bernardo Mendes
- Division of Vascular and Endovascular Surgery Mayo Clinic, Rochester, MN, USA
| | - Naveed Saqib
- Advanced Aortic Research Program, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Sophia Khan
- Advanced Aortic Research Program, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Thanila A Macedo
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Hansoo Lee
- Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Gustavo S Oderich
- Advanced Aortic Research Program, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
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Xu C, Zhang G, Wang JJ, Zhou CX, Jiang MJ. Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients. J Int Med Res 2021; 49:300060520986284. [PMID: 33499701 PMCID: PMC7844465 DOI: 10.1177/0300060520986284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia. Methods Twenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level. Results Selective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%. Conclusions PAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.
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Affiliation(s)
- Chen Xu
- Department of Urology, the Ninth People's Hospital of Suzhou City, Suzhou, China
| | - Gang Zhang
- Department of Intervention, the Ninth People's Hospital of Suzhou City, Suzhou, China
| | - Jin-Jin Wang
- Department of Radiology, the Ninth People's Hospital of Suzhou City, Suzhou, China
| | - Chun-Xian Zhou
- Department of Intervention, the Ninth People's Hospital of Suzhou City, Suzhou, China
| | - Min-Jun Jiang
- Department of Urology, the Ninth People's Hospital of Suzhou City, Suzhou, China
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Ishida H, Ishikawa Y, Akahoshi K, Ueda H, Morimoto K, Yamashita H, Ogawa K, Ono H, Kudo A, Tanaka S, Tanabe M. Laparoscopic distal pancreatectomy in a patient with aberrant splenic artery originating from the superior mesenteric artery: A case report. Medicine (Baltimore) 2021; 100:e25704. [PMID: 33950952 PMCID: PMC8104267 DOI: 10.1097/md.0000000000025704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery. PATIENT CONCERNS A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass. DIAGNOSES The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery. INTERVENTIONS The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion. OUTCOMES The postoperative course was uneventful. LESSONS Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.
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Affiliation(s)
| | | | | | - Hiroki Ueda
- Department of Hepatobiliary and Pancreatic Surgery
| | | | | | - Kosuke Ogawa
- Department of Hepatobiliary and Pancreatic Surgery
| | - Hiroaki Ono
- Department of Hepatobiliary and Pancreatic Surgery
| | - Atsushi Kudo
- Department of Hepatobiliary and Pancreatic Surgery
| | - Shinji Tanaka
- Department of Molecular Oncology, Tokyo Medical and Dental University, Tokyo, Japan
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Tang Y, Zhang JH, Zhu YB, Wu SJ, Cai SL, Zhou YF, Qian X, Luo JW, Fang ZT. Effect of superselective prostatic artery embolization on benign prostatic hyperplasia. Abdom Radiol (NY) 2021; 46:1726-1736. [PMID: 33025152 DOI: 10.1007/s00261-020-02782-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/16/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the safety and effectiveness of superselective prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). METHODS Sixty-five patients diagnosed with BPH in Fujian Provincial Hospital between December 2014 and July 2019 were included. Patients with ineffective drug treatment after 6 months, who refused surgery, or who were unsuitable for surgery were included. We observed postoperative complications, followed up at 1, 3, and 6 months, compared clinical symptoms, and monitored changes in prostate-specific antigen (PSA) and prostatic volume (PV) before and after treatment. RESULTS Of the 65 patients, 58 (89.23%) successfully received PAE; 44 and 14 bilateral and unilateral embolization, respectively. Clinical efficacy was 94.83% (55/58) after the 6-month follow-up. Postoperative PV, International Prostate Symptom Score, quality of life, maximum flow rate, and post-void residual significantly improved after 6 months (P < 0.05). One month after PAE, the serum total PSA increased by 1.47 (10.84/7.37) times and dropped 3 months later to a level lower than that before surgery (P < 0.05). Six months after PAE, the degree of relief from obstructive symptoms was more apparent than that of irritative symptoms. No serious complications were observed after PAE. CONCLUSION PAE was safe and effective for the treatment of BPH. The efficacy of bilateral PAE was better than that of unilateral PAE.
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Affiliation(s)
- Yi Tang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Jian-Hui Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Yao-Bin Zhu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Shao-Jie Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Sen-Lin Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yan-Feng Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Xin Qian
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Jie-Wei Luo
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, 350001, China.
| | - Zhu-Ting Fang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China.
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Peacock J, Sikaria D, Maun-Garcia L, Javedan K, Yamoah K, Parikh N. A Proof-of-Concept Study on the Use of Prostate Artery Embolization Before Definitive Radiation Therapy in Prostate Cancer. Adv Radiat Oncol 2021; 6:100619. [PMID: 33748542 PMCID: PMC7966837 DOI: 10.1016/j.adro.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 10/28/2022] Open
Abstract
Purpose Prostatic artery embolization (PAE) is an effective therapy for alleviating lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia; however, is not well studied in patients with concurrent prostate cancer (PCa). We demonstrate a proof of concept for PAE before definitive radiation therapy (RT) in patients with PCa. Methods and Materials From December 2017 to July 2019, 9 patients with PCa underwent PAE for the indication of LUTS from benign prostatic hyperplasia with concurrent PCa. Five received radiation and all follow-ups at our institution and were therefore included in the analysis. Median follow-up was 18 months from the time of PAE. Side effects during radiation were quantified using the Common Terminology Criteria for Adverse Events scoring system. Pre- and post-PAE plans were compared in the 5 patients by performing an isovolumetric expansion of the post-PAE plan (treated plan) equivalent to the measured volume reduction after PAE. Patient 1 (PT-01) and PT-02 had prostate RT alone whereas PT-03, PT-04, and PT-05 had prostate with elective nodal coverage RT. Mean doses to organs at risk were compared between the 2 plans. Results The mean International Prostate Symptom Score reduction after PAE was 13.8 (5.0-30.0; P = .02). The mean prostatic volume reduction after PAE was 23.1% (7.2%-47.7%). There were no Common Terminology Criteria for Adverse Events grade 3 (severe) or higher during radiation. Post-PAE plans in PT-01 and PT-02 had on average 23.2%, 39.8%, and 22.9% decrease in mean dose across the bladder, rectum, and penile bulb, respectively, compared with the pre-PAE plans. There were no appreciable differences in dosimetry in PT03, PT-04, and PT-05 who had nodal coverage. There was no biochemical failure in any of the patients. Conclusions We demonstrate a proof of concept that PAE is a clinically significant adjunctive therapy for alleviating LUTS and achieving significant volume reduction before RT, resulting in decreased radiation-related toxicity from RT for PCa.
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Affiliation(s)
| | | | | | | | - Kosj Yamoah
- Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Nainesh Parikh
- Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
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Holm A, Lindgren H, Bläckberg M, Augutis M, Jakobsson P, Tell M, Wallinder J, Lundström KJ, Styrke J. Patients' perspective on prostatic artery embolization: A qualitative study. SAGE Open Med 2021; 9:20503121211000908. [PMID: 33786178 PMCID: PMC7958185 DOI: 10.1177/20503121211000908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim was to describe the patients' experience of undergoing prostatic artery embolization. Methods A retrospective qualitative interview study was undertaken with 15 patients of mean age 73 years who had undergone prostatic artery embolization with a median duration of 210 min at two medium sized hospitals in Sweden. The reasons for conducting prostatic artery embolization were clean intermittent catheterization (n = 4), lower urinary tract symptoms (n = 10) or haematuria (n = 1). Data were collected through individual, semi-structured telephone interviews 1-12 months after treatment and analysed using qualitative content analysis. Results Four categories with sub-categories were formulated to describe the results: a diverse experience; ability to control the situation; resumption of everyday activities and range of opinions regarding efficacy of outcomes. Overall, the patients described the procedure as painless, easy and interesting and reported that while the procedure can be stressful, a calm atmosphere contributed to achieving a good experience. Limitations on access to reliable information before, during and after the procedure were highlighted as a major issue. Practical ideas for improving patient comfort during the procedure were suggested. Improved communications between treatment staff and patients were also highlighted. Most patients could resume everyday activities, some felt tired and bruising caused unnecessary worry for a few. Regarding functional outcome, some patients described substantial improvement in urine flow while others were satisfied with regaining undisturbed night sleep. Those with less effect were considering transurethral resection of the prostate as a future option. Self-enrolment to the treatment and long median operation time may have influenced the results. Conclusions From the patients' perspective, prostatic artery embolization is a well-tolerated method for treating benign prostate hyperplacia.
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Affiliation(s)
- Alexander Holm
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Hans Lindgren
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Interventional Radiology and Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Mats Bläckberg
- Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Marika Augutis
- Department of Research and Development, Sundsvalls Hospital, Sundsvall, Sweden
| | - Peter Jakobsson
- Department of Radiology, Östersunds Hospital, Östersund, Sweden
| | - Mattias Tell
- Department of Surgery, Sundsvalls Hospital, Sundsvall, Sweden
| | - Jonas Wallinder
- Department of Surgery, Sundsvalls Hospital, Sundsvall, Sweden
| | - Karl-Johan Lundström
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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Dahm P, MacDonald R, McKenzie L, Jung JH, Greer N, Wilt T. Newer Minimally Invasive Treatment Modalities to Treat Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia. EUR UROL SUPPL 2021; 26:72-82. [PMID: 34337510 PMCID: PMC8317814 DOI: 10.1016/j.euros.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
Context Several newer device-based procedures have recently become available for treating men with lower urinary tract symptoms attributed to benign prostatic hyperplasia, but their effectiveness remains uncertain. Objective To assess the longer-term comparative effectiveness (defined as >12 mo of follow-up) of the newer treatment modalities prostatic urethral lift (PUL), transurethral prostate convective radiofrequency water vapor (Rezūm), Aquablation, and prostatic arterial embolization (PAE). Evidence acquisition Ovid Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Agency for Healthcare Research and Quality databases were searched through September 30, 2019; hand searches of references of relevant studies were also performed. Eligible studies were randomized controlled trials (RCTs) published in English language. We excluded observational studies. Evidence synthesis One RCT (n = 91) found that patients undergoing PUL may be less likely to respond (risk ratio [RR] 0.8; 95% confidence interval [CI] 0.7-1.0; low certainty of evidence [CoE]) and have a higher mean International Prostate Symptom Score (IPSS; mean difference 6.1; 95% CI 2.2-10.0; low CoE) than those undergoing transurethral resection of the prostate (TURP). Among patients undergoing PAE, one small RCT (n = 30) reported similar IPSS response rates (RR 0.9; 95% CI 0.7-1.1; low CoE) and one trial (n = 107) found similar mean IPSS (-0.7; 95% CI -1.3 to 2.7; moderate CoE) scores to those among patients undergoing TURP. A single study on Aquablation reported 12 mo of follow-up only, and a single 3-mo trial compared Rezūm with sham treatment. Conclusions The current best evidence underlying these newer therapies is limited to few trials (PUL and PAE), short-term follow-up of 12 mo (Aquablation and Rezūm), or sham comparison only (Rezūm). Patient summary Evidence for four of the newer surgical treatments for men with an enlarged prostate is limited to few small trials with short-term follow-up; only one trial compared a new treatment modality with sham surgery.
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Affiliation(s)
- Philipp Dahm
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | | | | | - Jae Hung Jung
- Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Nancy Greer
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Timothy Wilt
- Minneapolis VA Health Care System, Minneapolis, MN, USA
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Abstract
Superior mesenteric artery (SMA) syndrome is an uncommon entity leading to compression of the duodenum between the aorta and the SMA. Normally the coeliac trunk and the superior mesenteric arteries have distinct origins from the abdominal aorta. The celiacomesenteric trunk (CMT) is the least frequently reported anatomic variation of all abdominal vascular anomalies. CMT denotes a common trunk of origin of the coeliac and superior mesenteric arteries. The coexistence of these anomalies has never been reported in the literature. We present a case of a 59-year-old man presenting with duodenal obstruction due to SMA syndrome with CMT. The aortomesenteric angle was 13 degrees and SMA-aorta distance was 8 mm. Patient underwent a gastrojejunostomy. After an uneventful recovery, the patient has been symptom free for 1-year follow-up.
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Affiliation(s)
| | - Jenny Thomas
- General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Roshan Chiranjeev
- General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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Abstract
PURPOSE Prostatic artery embolization (PAE) has emerged as a truly minimally invasive treatment option for patients with lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) over the last few years and is now supported by evidence-based international guidelines. Here, we provide an overview on the profile of PAE based on the most relevant and recent literature. METHODS A comprehensive review of literature on PAE was conducted on PubMed-Medline. The most relevant literature was summarized narratively. RESULTS While there is still a lack of long-term data, efficacy and safety data have been published for the short to mid-term. As with any minimally invasive technique, relief of bladder outlet obstruction is less pronounced after PAE compared to more invasive resective techniques. This is likely to be associated with higher re-intervention rates during the longer term. However, due to its beneficial safety profile, PAE represents an interesting option for many patients and could fill a niche between pharmacotherapy and formal surgical intervention. Given its unique treatment approach, i.e. endovascular instead of transurethral, PAE has a clearly different profile compared to other minimally invasive treatments. Performance with local anesthesia with possible continuation of anticoagulant drugs and no upper prostate size limit are the most important advantages of PAE. CONCLUSION PAE represents a valuable supplement in the treatment armamentarium of LUTS/BPH if patients are selected appropriately.
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Affiliation(s)
- Dominik Abt
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Mark J Speakman
- Department of Urology, Musgrove Park Hospital, Somerset Foundation Trust, Taunton, UK
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Neymark AI, Karpenko AA, Neymark BA, Tachalov MA, Arzamastsev DD, Torbik DV, Gameeva EV, Bobrov BY, Spivak LG, Korolev DO, Tsarichenko DG, Rapoport LM. Superselective prostatic artery embolization in the treatment of large benign prostatic hyperplasia. Urologia 2021; 88:374-381. [PMID: 33550913 DOI: 10.1177/0391560321993598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the use of prostatic artery embolization (PAE) as a treatment option for patients with symptomatic benign prostatic hyperplasia (BPH) with prostate volumes of 80 cc and more. MATERIALS AND METHODS The study included 75 patients with high anesthesia-related risks for conventional surgery (TURP). All patients were surveyed for symptom burden, using IPSS and quality of life score. The prostate volume was determined by transrectal ultrasonography (TRUS). At baseline, prostate-specific antigen (PSA) level was obtained in all patients. Urodynamics was evaluated using uroflowmetry. Clinical outcomes were assessed at follow-up 1, 3, 6, 12, and 24 months after PAE. RESULTS The prostate volume decreased significantly at months 1 and 3 post-treatment; the prostate continued shrinking until month 12, and the size was then stabilized. At month 24, prostate volume decreased by 40.82%, from 134.0 ± 8.3 mL at baseline to 79.3 ± 6.6 mL. Postvoid residual (PVR) urine volume was significantly decreased from 55.9 ± 5.3 mL to 22.0 ± 1.8 mL 1 month after PAE (p < 0.001). Qmax increased from 9.2 ± 0.3 mL/s to 15.7 ± 0.4 mL/s. IPSS score following PAE decreased from 28.2 ± 0.7 to 9.7 ± 0.8 (p < 0.001). QoL improvement was observed from 4.8 ± 0.2 at baseline to 1.8 ± 0.2 at month 24 (p < 0.001). Decreased activity and density of adenomatous tissue resulted in decreased total PSA levels: from 5.9 ± 1.1 ng/mL to 2.6 ± 0.2 ng/mL (p < 0.001). TURP became feasible in 35 patients due to reduction of prostate volumes below 80 mL after PAE. CONCLUSIONS PAE was effective in relieving LUTS and reducing prostate size, and may be considered as a preoperative approach for patients with large prostate.
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Affiliation(s)
- Alexander Izrailevich Neymark
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Andrey Anatoljevich Karpenko
- E. Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Boris Alexandrovich Neymark
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Mikhail Alexandrovich Tachalov
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Denis Dmitrievich Arzamastsev
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Demid Vjacheslavovich Torbik
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Elena Vladimirovn Gameeva
- Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia
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Young S. Prostate artery embolization for benign prostatic hyperplasia: The hunt for the ideal patient population. Diagn Interv Imaging 2021; 102:119-120. [PMID: 33518450 DOI: 10.1016/j.diii.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shamar Young
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420, Delaware ST SE, MMC 292, 55455 Minneapolis, MN, USA.
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Abstract
Interventional therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures. To date, IT are considered experimental, though they are evolving rapidly and starting to challenge established surgical strategies. With gradually increasing evidence for the benefits of IT in BPH, several techniques are moving out of the realm of research and into everyday clinical practice. As such, IT provides encouraging mid-term functional outcomes with improved health-related quality of life (QoL), particularly in terms of better preservation of ejaculation. The distinct role IT could play as a bridge between exhausted drug-based treatment options and surgery is yet to be defined. Further studies are required before IT can be recommended as alternatives to invasive therapies. Systematic trials are needed to identify subgroups of patients who can benefit particularly from IT in comparison to other treatments, to identify features of the prostate particularly suited to a specific IT, and to analyze the durability of success for each technique.
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114
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Elterman D, Li W, Hatiboglu G, Relle J, Zorn KC, Bhojani N, Chin J. Relief of Lower Urinary Tract Symptoms After MRI-Guided Transurethral Ultrasound Ablation for Localized Prostate Cancer: Subgroup Analyses in Patients with Concurrent Cancer and Benign Prostatic Hyperplasia. J Endourol 2021; 35:497-505. [PMID: 32935575 DOI: 10.1089/end.2020.0511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: MRI-guided transurethral ultrasound ablation (TULSA) offers minimally invasive thermal ablation of benign and malignant prostate tissue, using directional high-intensity ultrasound and real-time, magnetic resonance thermometry feedback control. Feasibility of TULSA for alleviating lower urinary tract symptoms (LUTSs) associated with benign prostatic hyperplasia (BPH) is retrospectively assessed in a subgroup of men from a localized prostate cancer study who also had LUTSs. Patients and Methods: TULSA was used to ablate 90% of the prostate gland in 30 men with localized prostate cancer, without plans to spare ejaculatory ducts. Mean ± standard deviation treatment time was 37 ± 10 minutes. Retrospective analysis was conducted on a subpopulation of nine patients who also suffered from LUTSs (International Prostate Symptom Score [IPSS] ≥ 12 at baseline) as well as a smaller subgroup of five patients with IPSS >12 and peak urinary flow (Qmax) <15 mL/second. Urinary symptom relief, continence, and erectile function were assessed using IPSS, International Index of Erectile Function (IIEF), and uroflowmetry. Results: At 12 months post-TULSA, IPSS improved significantly by 58% to 6.3 ± 5.0 (p = 0.003), with at least a moderate (≥6 points) reduction in eight of nine patients. IPSS quality of life improved in eight of nine patients. Erectile function (IIEF-EF) remained stable from 14.6 ± 9.3 at baseline to 15.7 ± 9.0 at 12 months. The proportion of patients with erections sufficient for penetration (IIEF Q2 ≥2) was unchanged. Full urinary continence (pad free and leak free) was achieved at 12 months in all patients. In five men who suffered from more severe symptoms, Qmax increased from 11.6 ± 2.6 mL/second to 22.5 ± 14.2 mL/second at 12 months (p = 0.126). Perfused prostate volume, measured on MRI, decreased 70% to 13.6 ± 4.6 mL (p = 0.003) at 12 months. All adverse events were mild to moderate (Common Terminology Criteria for Adverse Events [CTCAE] Grade 1-2) with no serious events reported. Conclusions: This retrospective analysis demonstrates promising safety and feasibility of TULSA to relieve LUTSs, with improvement in IPSS comparable with modern, minimally invasive surgical therapies. Larger controlled studies with BPH-specific ablation plans in men seeking treatment for LUTSs are warranted.
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Affiliation(s)
- Dean Elterman
- University Health Network, University of Toronto, Toronto, Canada
| | | | - Gencay Hatiboglu
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - James Relle
- Beaumont Health System, Royal Oak, Michigan, USA
| | - Kevin C Zorn
- Department of Urology, University of Montreal, Montreal, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal, Montreal, Canada
| | - Joseph Chin
- London Health Sciences Center, Western University, London, Canada
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Lebdai S, Chevrot A, Doizi S, Pradère B, Barry Delongchamps N, Baumert H, Benchikh A, Della Negra E, Fourmarier M, Gas J, Misraï V, Rouscoff Y, Theveniaud PE, Vincendeau S, Wilisch J, Descazeaud A, Robert G. [Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. Prog Urol 2021; 31:249-265. [PMID: 33478868 DOI: 10.1016/j.purol.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France.
| | - A Chevrot
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - S Doizi
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France
| | - B Pradère
- Service d'urologie, CHU de Tours, Tours, France
| | | | - H Baumert
- Service d'urologie, hôpital Ambroise-Paré, Paris, France
| | - A Benchikh
- Service d'urologie, Clinique les Martinets, Versailles, France
| | - E Della Negra
- Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France
| | - M Fourmarier
- Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France
| | - J Gas
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - V Misraï
- Service d'urologie, clinique Pasteur, Toulouse, France
| | - Y Rouscoff
- Service d'urologie, polyclinique Saint-Georges, Nice, France
| | - P E Theveniaud
- Service d'urologie, CHR de Metz Thionville, Metz, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Wilisch
- Service d'urologie, hôpital privé Natecia, Lyon, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
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116
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Xiang P, Guan D, Du Z, Hao Y, Yan W, Wang Y, Liu Y, Liu D, Ping H. Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Eur Radiol 2021; 31:4929-46. [PMID: 33449181 DOI: 10.1007/s00330-020-07663-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of the prostate (TURP) in patients affected by benign prostatic hyperplasia (BPH). We also reviewed mean changes from baseline in PAE at selected follow-up points. METHODS PubMed, Web of Science, and Embase were searched up to May 1, 2020. Randomized controlled trials on PAE were collected according to specific inclusion and exclusion criteria. Meta-analyses were performed using RevMan 5.3, STATA 14, and GraphPad Prism 8. Pooled patient-reported scores and functional outcomes were calculated by using a fixed or random-effect model. RESULTS Eleven articles met our selection criteria and ten independent patient series were included in the final analysis. Pooled estimates suggested no significant difference between TURP and PAE for patient-reported outcomes including International Prostate Symptom Score (2.32 (- 0.44 to 5.09)) and quality of life (0.18 (- 0.41 to 0.77)) at 12 months. PAE was less effective regarding improvements in most functional outcomes such as maximum flow rate, prostate volume, and prostate-specific antigen. Moreover, PAE may be associated with relatively fewer complications, lower cost, and shorter hospitalization. After the PAE procedure, the overall weighted mean differences for all outcomes except sexual health scores were significantly improved from baseline during follow-up to 24 months. CONCLUSION PAE is non-inferior to TURP with regard to improving patient-reported outcomes, though most functional parameters undergo more changes after TURP than after PAE. Moreover, PAE can significantly continue to relieve symptoms for 24 months without causing serious complications. KEY POINTS • PAE is as effective as TURP in improving subjective symptom scores, with fewer complications and shorter hospitalization times. • PAE is inferior to TURP in the improvement of most functional outcomes. • Improvements due to PAE are durable during follow-up to 24 months.
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117
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Kim JH, Dodd S, Ye FQ, Knutsen AK, Nguyen D, Wu H, Su S, Mastrogiacomo S, Esparza TJ, Swenson RE, Brody DL. Sensitive detection of extremely small iron oxide nanoparticles in living mice using MP2RAGE with advanced image co-registration. Sci Rep 2021; 11:106. [PMID: 33420210 PMCID: PMC7794370 DOI: 10.1038/s41598-020-80181-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/15/2020] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a widely used non-invasive methodology for both preclinical and clinical studies. However, MRI lacks molecular specificity. Molecular contrast agents for MRI would be highly beneficial for detecting specific pathological lesions and quantitatively evaluating therapeutic efficacy in vivo. In this study, an optimized Magnetization Prepared—RApid Gradient Echo (MP-RAGE) with 2 inversion times called MP2RAGE combined with advanced image co-registration is presented as an effective non-invasive methodology to quantitatively detect T1 MR contrast agents. The optimized MP2RAGE produced high quality in vivo mouse brain T1 (or R1 = 1/T1) map with high spatial resolution, 160 × 160 × 160 µm3 voxel at 9.4 T. Test–retest signal to noise was > 20 for most voxels. Extremely small iron oxide nanoparticles (ESIONPs) having 3 nm core size and 11 nm hydrodynamic radius after polyethylene glycol (PEG) coating were intracranially injected into mouse brain and detected as a proof-of-concept. Two independent MP2RAGE MR scans were performed pre- and post-injection of ESIONPs followed by advanced image co-registration. The comparison of two T1 (or R1) maps after image co-registration provided precise and quantitative assessment of the effects of the injected ESIONPs at each voxel. The proposed MR protocol has potential for future use in the detection of T1 molecular contrast agents.
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Affiliation(s)
- Joong H Kim
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD, USA.,Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Stephen Dodd
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Frank Q Ye
- Neurophysiology Imaging Facility, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, and National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew K Knutsen
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Duong Nguyen
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Haitao Wu
- Chemistry and Synthesis Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shiran Su
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Simone Mastrogiacomo
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Thomas J Esparza
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD, USA.,Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Rolf E Swenson
- Chemistry and Synthesis Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - David L Brody
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD, USA. .,Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA. .,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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118
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Boeken T, Di Gaeta A, Moussa N, Del Giudice C, Dean C, Pellerin O, Sapoval M. Association between intravesical prostatic protrusion and clinical outcomes in prostatic artery embolization. Diagn Interv Imaging 2021; 102:141-145. [PMID: 33423975 DOI: 10.1016/j.diii.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the influence of intravesical prostatic protrusion (IPP) on clinical outcomes after prostatic artery embolization (PAE) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS All consecutive patients who underwent PAE for lower urinary tract symptoms between January 2017 and January 2019 were retrospectively included. IPP was evaluated on pre-treatment magnetic resonance imaging examination and symptoms were assessed at follow-up consultations using the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. IPPs were classified as grade 1 (<5mm), grade 2 (5-10mm), or grade 3 (>10mm). RESULTS A total of 160 consecutive men (mean age 65±7.8 [SD] years; range: 45-89 years), underwent PAE. The mean IPSS was 21±7.3 (SD) (range: 5-35) and prostate volume 87±38 (SD) mL (range: 30-200mL). The IPP grade was 1 for 28 (28/160; 18%), 2 for 52 (52/160; 33%), and 3 for 80 (80/160; 50%) patients. There were no significant differences in IPSS at baseline between the three IPP grades. Patients with severe (grade 3) IPP had a significantly higher reduction in IPSS than those with non-severe IPP (grade 1 or 2), with estimated mean reductions of 12±2.5 (SD) (range: -4-28) and 8.3±1.9 (SD) (range: -8-21) (P=0.02), respectively. The mean reduction in the QOL score was 3.0 for grade 3 and 2.0 for grade 1 or 2 IPP (P=0.02). CONCLUSIONS The degree of IPP does not limit the efficacy of PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.
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Affiliation(s)
- Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France.
| | - Alessandro Di Gaeta
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Nadia Moussa
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Constantino Del Giudice
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Carole Dean
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Olivier Pellerin
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France; INSERM URM 970 équipe 2 Imagerie de l'Angiogenèse, 75015 Paris, France
| | - Marc Sapoval
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France; INSERM URM 970 équipe 2 Imagerie de l'Angiogenèse, 75015 Paris, France
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119
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Pascoe J, Fontaine C, Hashim H. Modern advancements in minimally invasive surgical treatments for benign prostatic obstruction. Ther Adv Urol 2021; 13:17562872211030832. [PMID: 34349840 PMCID: PMC8287272 DOI: 10.1177/17562872211030832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
A wide variety of minimally invasive surgical techniques are now being offered for treating voiding lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). These options offer an alternative to both medical therapy and traditional surgical options. Minimally invasive surgical treatments in LUTS/BPO boast both day case and local anaesthetic options, with a potentially reduced side effect profile compared to traditional surgical interventions matching the needs for a range of patients. We provide a narrative review of minimally invasive surgical treatments available for BPO in terms of the technology, efficacy, safety, institutional recommendations, cost and potential future developments.
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Affiliation(s)
- John Pascoe
- Specialist Registrar in Urology, University Hospitals Plymouth, Derriford Rd, Devon PL6 8DH, UK
| | - Christina Fontaine
- Specialist Registrar in Urology, University Hospitals Plymouth, Devon, UK
| | - Hashim Hashim
- Consultant Urological Surgeon and Honorary Professor in Urology, Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
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120
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Ng BHS, Chung E. A state-of-art review on the preservation of sexual function among various minimally invasive surgical treatments for benign prostatic hyperplasia: Impact on erectile and ejaculatory domains. Investig Clin Urol 2021; 62:148-158. [PMID: 33660441 PMCID: PMC7940857 DOI: 10.4111/icu.20200392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/11/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022] Open
Abstract
There is a strong association between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction. While transurethral resection of the prostate (TURP) is considered the standard BPH treatment, it is however associated with a high rate of erectile and ejaculatory dysfunctions. Over the past decade, new and novel minimally invasive BPH therapies have been shown to improve various parameters of voiding domains while minimizing adverse sexual effects. These minimally invasive BPH therapies can be largely be divided into those with cavitating technology (Rezum, Histotripsy, Aquablation), intra-prostatic injections (Botulinum neurotoxin Type A, Fexapotide Triflutate, prostate specific antigen-activated protoxin PRX-302), and mechanical devices which include intraprostatic stents (Urospinal 2™, Memotherm™, Memokath™, and Allium triangular prostatic stent™) and intraprostatic devices (iTIND™, Urolift™), as well as prostatic artery embolization. Published literature on these technologies showed reasonable preservation of erectile function with limited data reported on ejaculatory domain. Further validation of the performance of these novel minimally invasive treatment options for LUTS due to BPH in well-designed and multi-centre studies are desired, to evaluate their role (or lack of such a role) in clinical practice and whether these BPH therapies can provide equivalent standard or better than TURP.
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Affiliation(s)
- Brian Hung Shin Ng
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.,AndroUroloogy Centre, Brisbane, QLD, Australia.,Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
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121
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Rusu MC, Jianu AM, Dincă D, Manta BA. Quadrifurcation Variants of the Celiac Trunk. Ann Vasc Surg 2020; 73:303-313. [PMID: 33359689 DOI: 10.1016/j.avsg.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The celiac trunk (CT) commonly trifurcates into the left gastric artery, common hepatic artery (CHA), and splenic artery (SA). The CHA then sends off the proper hepatic artery and gastroduodenal artery (GDA). The arcades of the head of the pancreas are celiacomesenteric anastomoses between branches of the GDA and the superior mesenteric artery. A quadrifurcation of the CT commonly occurs when a different branch is added to the 3 normal ones. An uncommon quadrifurcation of the CT occurs when only one or 2 of the normal branches of the CT participate. METHODS The CT quadrifurcations were documented on 112 computed tomography angiograms. RESULTS Five different types of CT quadrifurcation-3 uncommon (types 1-3) and 2 common (types 4-5)-were found in 15/112 cases (13.39%). A marginal significant association was found between the presence of quadrifurcations and male gender (P = 0.05; Fisher's exact test). Type 1 showed a hepatogastric trunk+SA + right hepatic artery+GDA pattern, type 2 had an HGT + right inferior phrenic artery + CHA + SA pattern, type 3 had a gastrophrenic trunk + left inferior phrenic artery+CHA + SA pattern, type 4 showed an left gastric artery + CHA + SA + left inferior phrenic artery combination, and type 5 had an additional common inferior phrenic trunk. One of the type 4 cases showed a buildup of a mesentericomesenteric anastomotic pancreatic arcade between the inferior pancreaticoduodenal arteries, rather than a celiacomesenteric one. CONCLUSIONS Anatomic variation of the celiacomesenteric axis is important during hepatobiliary and duodenopancreatic approaches. Therefore, preoperative evaluation is essential because theoretical anatomic possibilities could be real arterial variants.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Adelina Maria Jianu
- Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dănuţ Dincă
- Department II of Surgical Clinical Divisions, Faculty of Medicine, "Ovidius" University, Constanţa, Romania
| | - Bogdan Adrian Manta
- Division of Anatomy, Department 1, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Jung JH, McCutcheon KA, Borofsky M, Young S, Golzarian J, Reddy B, Shin TY, Kim MH, Narayan V, Dahm P. Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2020; 12:CD012867. [PMID: 33368143 PMCID: PMC8728637 DOI: 10.1002/14651858.cd012867.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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 using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020. 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 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, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT 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 (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) 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. While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.71, 95% CI 0.16 to 3.10; 250 participants; 4 RCTs; I² = 26%; very low-certainty evidence), PAE may increase re-treatments (RR 3.64, 95% CI 1.02 to 12.98; 204 participants; 3 RCTs; I² = 0%; low-certainty evidence). Based on 18 re-treatments per 1000 men in the TURP group, this corresponds to 47 more (0 more to 214 more) per 1000 men undergoing PAE. We are very uncertain about the effects on erectile function (MD -0.03, 95% CI -6.35 to 6.29; 129 participants; 2 RCTs; I² = 78%; very low-certainty evidence) measured by the International Index of Erectile Function at 5 on a scale from 1 to 25, with higher scores indicating better function. NRS evidence when available yielded similar results. Based on evidence from NRS, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 260 participants; 1 NRS; low-certainty evidence). Longer-term follow-up: based on RCT evidence, we are very uncertain about the effects of PAE on urologic symptom scores (MD 0.30, 95% CI -3.17 to 3.77; 95 participants; very low-certainty evidence) compared to TURP. Quality of life may be similar (MD 0.20, 95% CI -0.49 to 0.89; 95 participants; low-certainty evidence). We are also very uncertain about major adverse events (RR 1.96, 95% CI 0.63 to 6.13; 107 participants; very low-certainty evidence). We did not find evidence on erectile function and ejaculatory disorders. Based on evidence from NRS, PAE may increase re-treatment rates (RR 1.51, 95% CI 0.43 to 5.29; 305 participants; low-certainty evidence); based on 56 re-treatments per 1000 men in the TURP group. this corresponds to 143 more (25 more to 430 more) per 1000 men in the PAE group. AUTHORS' CONCLUSIONS: Compared to TURP up to 12 months (short-term follow-up), PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE may increase re-treatment rates. We are uncertain about erectile function, but PAE may reduce ejaculatory disorders. Longer term (follow-up of 13 to 24 months), we are very uncertain as to how both procedures compare with regard to urologic symptom scores, but quality of life appears to be similar. We are very uncertain about major adverse events but PAE may increase re-treatments. We did not find longer term evidence on erectile function and ejaculatory disorders. Certainty of evidence for the main outcomes of this review was low or very low, signalling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.
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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, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jafar Golzarian
- Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Balaji Reddy
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tae Young Shin
- Department of Urology, Ewha Womans University, Seoul, Korea, South
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Vikram 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
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Bekki T, Fukuda T, Moriuchi T, Namba Y, Okimoto S, Mukai S, Saito Y, Oishi K, Tanabe K, Ohdan H. Branching form of celiac artery to be aware of in laparoscopic surgery: A case report using MDCT angiography. Radiol Case Rep 2021; 16:476-9. [PMID: 33363686 DOI: 10.1016/j.radcr.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022] Open
Abstract
The anomalies of the celiac artery have been reported and reviewed in literature. Hence, it is not uncommon to clinically encounter its various types. This report presents the case of a 76-year-old male who underwent laparoscopic distal gastrectomy. Preoperative abdominal contrast-enhanced computed tomography showed an anomaly of the celiac artery, which was extremely rare, with various other anomalies of the artery.
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Frandon J, Bey E, Hamard A, Mohammad H, Gonzalez S, Greffier J, Chevallier T, de Forges H, Beregi JP, Droupy S. Early Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study. J Vasc Interv Radiol 2021; 32:247-55. [PMID: 33248919 DOI: 10.1016/j.jvir.2020.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the feasibility of prostatic artery embolization in patients with low-risk prostate cancer (PC) under active surveillance (AS). METHODS This monocentric prospective pilot study, running from June 2018 to June 2019, included 10 patients with low-risk PC under AS, median age 72 years (range, 62-77 years), with a unilateral focal lesion visible on magnetic resonance (MR) imaging, with Prostate Imaging Reporting and Data System v2 score ≥3/5 confirmed by multiparametric MR imaging-targeted biopsy and Gleason score 6. The patients underwent unilateral prostatic artery embolization with 300-500 μm Embospheres in the affected prostatic lobe. The primary endpoint was technical feasibility (prostate and no off-target ischemia in the imaging). The secondary endpoints included safety, negative biopsies/MR imaging response/functional outcomes at 6 months, and oncologic efficacy at 1 year. RESULTS Embolization was successfully achieved in all patients; prostate ischemia was confirmed on multiparametric MR imaging, and no off-target ischemia was reported. No major complications were reported. Four patients (40%) presented with both negative targeted and systematic biopsies at 6 months. No lesions were seen on the MR imaging in 30% of patients. The mean International Prostate Symptom Score and International Index of Erectile Function score were 7 and 19 and 5 and 20 at baseline and 6 months, respectively, with no significant difference. Nine patients (90%) were still under AS at 1 year. One patient (10%) had PC progression outside the target lesion and was switched over to curative radiotherapy. CONCLUSIONS Prostatic artery embolization is feasible and appears safe for prostate cancer patients under AS, with no impact on erectile function or continence status. These results justify the pursuit of further studies.
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Boeken T, Gautier A, Moussa N, Del Giudice C, Abed A, Dean C, Pellerin O, Sapoval M. Impact of anatomy type of prostatic artery on the number of catheters needed for prostatic artery embolization. Diagn Interv Imaging 2021; 102:147-52. [PMID: 33129753 DOI: 10.1016/j.diii.2020.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/26/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to assess the relationship between the number of microcatheters required for prostatic artery embolization (PAE) and the anatomy of the prostatic artery (PA). MATERIALS AND METHODS All consecutive patients who underwent PAE between May 2017 and December 2018 were included. The anatomical description of the PAs was assessed by both global cone beam computed tomography and selective angiography and data on the resources used, in terms of microcatheters, were prospectively collected. RESULTS A total of 215 consecutive patients (mean age, 66±8.7 [SD] years; range: 45-93 years), with a mean International Prostate Symptom Score of 21±7.4 (SD) and a mean prostate volume on magnetic resonance imaging of 88±38 (SD) mL (range: 30-200mL) underwent PAE. A single PA was observed in 347 hemipelvises (347/411; 84.4%) and double PAs in 64 (64/411; 15.6%). Eighty percent (173/215 patients) of PAEs were performed using a single microcatheter. Type I PA anatomy required significantly more microcatheters (1.15±0.39 [SD]; range: 1-3), than type II (1.04±0.19 [SD]; range: 1-2), type III (1.09±0.34 [SD]; range: 1-3) and type IV (1.06±0.27 [SD]; range: 1-2) (P=0.01 for all). CONCLUSION PAE is feasible with limited per-intervention changes in devices for all types of PA anatomy encountered. This could help in the design of appropriate reimbursement policies in various healthcare settings.
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Parikh N, Keshishian E, Sharma A, Roca M, Manley B, Poch M, Grass GD, Torres-Roca J, Boulware D, Johnstone P, Montejo M, Smith J, Pow-Sang J, Yamoah K. Prostatic Artery Embolization Is Safe and Effective for Medically Recalcitrant Radiation-Induced Prostatitis. Adv Radiat Oncol 2020; 5:905-9. [PMID: 33083652 DOI: 10.1016/j.adro.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) represents 90% of all chronic prostatitis cases and may occur after radiation therapy (RT) for localized prostate cancer. Medical therapy is effective in approximately 50% of cases, with no therapy demonstrating consistent efficacy in refractory cases. Prostatic artery embolization (PAE) is effective in men with lower urinary tract symptoms and benign prostatic hyperplasia. We report clinical improvement after PAE in a case series of men with CP/CPPS after RT. Methods and Materials Nine men (median age 72 years; range, 61-83 years) with CP/CPPS after RT for prostate cancer underwent PAE. Baseline International Prostate Symptom Score was recorded in 5 patients (median 23; range, 4-26), Chronic Prostatitis Symptom Index score in 6 patients (median 22.5; range, 6-34), and quality of life (QoL) score in 8 patients (median 5; range, 2-6). Median baseline prostate volume was 49 cm3 (range, 22-123 cm3). Patients were followed up at 6 and 12 weeks with QoL, International Prostate Symptom Score, and/or Chronic Prostatitis Symptom Index score and magnetic resonance imaging. Results Technical success (ie, bilateral embolization) was achieved in 78% (n = 7) of patients with the other 2 patients having undergone unilateral embolization with no major complications. Clinical success was seen in 89% (n = 8) of patients and QoL improved in 78% (n = 7) during the follow-up period. Conclusion CP/CPPS after RT for localized prostate cancer is a highly morbid condition, with medical therapy successful in only 50% of cases. PAE may be a successful therapy for medically recalcitrant CP/CPPS, and further studies are necessary to understand the best patient selection and scenario for PAE in the setting of CP/CPPS.
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Knight GM, Talwar A, Salem R, Mouli S. Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2021; 44:183-93. [PMID: 33078236 DOI: 10.1007/s00270-020-02657-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS A multi-database search for relevant literature was conducted on 15 July 2020 to include studies published on or before that date. Search terms used were: (prostate embolization OR prostatic embolization OR prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction). Risk of bias was assessed using Cochrane Collaboration and ROBINS-I criteria. Random-effects meta-analysis was performed using RevMan 5.3. RESULTS Six studies with 598 patients were included. TURP was associated with significantly more improvement in maximum urinary flow rate (Qmax) (mean difference = 5.02 mL/s; 95% CI [2.66,7.38]; p < 0.0001; I2 = 89%), prostate volume (mean difference = 15.59 mL; 95% CI [7.93,23.25]; p < 0.00001; I2 = 88%), and prostate-specific antigen (PSA) (mean difference = 1.02 ng/mL; 95% CI [0.14,1.89]; p = 0.02; I2 = 71%) compared to PAE. No significant difference between PAE and TURP was observed for changes in International Prostate Symptoms Score (IPSS), IPSS quality of life (IPSS-QoL), International Index of Erectile Function (IIEF-5), and post-void residual (PVR). PAE was associated with fewer adverse events (AEs) (39.0% vs. 77.7%; p < 0.00001) and shorter hospitalization times (mean difference = -1.94 days; p < 0.00001), but longer procedural times (mean difference = 51.43 min; p = 0.004). CONCLUSION Subjective symptom improvement was equivalent between TURP and PAE. While TURP demonstrated larger improvements for some objective parameters, PAE was associated with fewer AEs and shorter hospitalization times. LEVEL OF EVIDENCE II Level 2a, Systematic Review.
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Lin YX, Wang SJ, Liang HS, Lin S, Bian LY, Ding J, Li D. Clinical Analysis of the Curative Effect of a Transnasal Ileus Tube in the Treatment of Small Bowel Obstruction Caused by a Phytobezoar. Gastroenterol Res Pract 2020; 2020:4295024. [PMID: 33061959 DOI: 10.1155/2020/4295024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
Objective To investigate the curative effect of a transnasal ileus tube in the treatment of small bowel obstruction caused by a phytobezoar. Methods Seventy-one patients with small bowel obstruction caused by a phytobezoar who underwent treatment in three provincial tertiary grade A hospitals in Fujian Province from March 2011 to February 2020 were included in this study. Patients were divided into the following two groups according to the treatment received: (1) conservative group, comprising patients who received medical conservative treatment, and (2) combined group, including patients who received combined medical conservative treatment and transnasal ileus tube placement. The clinical symptoms, changes in abdominal imaging, tube depth of the first day, reduction of pressure volume on the first day after catheterization, length of hospital stay, and nonsurgical rate were compared between the combined and conservative groups. Results There was no significant difference in age, sex, history of previous abdominal surgery and abdominal radiotherapy, symptoms at admission, duration of symptoms before admission, signs at admission, laboratory data, and obstruction position between the combined and conservative groups. There was a statistically significant difference in the nonsurgical rate (19/24 vs. 23/47, P = 0.014) between the combined and conservative groups. Logistic analysis showed that the duration of symptoms before admission, albumin level, and use of a transnasal ileus tube might be independent factors affecting the transition to surgery for patients with small bowel obstruction caused by a phytobezoar (P < 0.05). Conclusion Timely conservative medical treatment with transnasal ileus tube placement can effectively improve the nonsurgical rate of small bowel obstruction caused by a phytobezoar. The duration of symptoms before admission, albumin level, and use of a transnasal ileus tube were closely related to whether patients with small bowel obstruction caused by phytobezoar were transferred to surgery.
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Kearns DJ, Boardman P, Tapping CR. Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2020; 44:95-101. [PMID: 33037455 DOI: 10.1007/s00270-020-02671-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. MATERIALS AND METHODS We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical follow-up occurred at a minimum of 3 months. RESULTS 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p < 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). CONCLUSION We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery.
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Affiliation(s)
- Daniel J Kearns
- Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK.
| | - Philip Boardman
- Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Charles R Tapping
- Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK
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Abstract
As prostate artery embolization (PAE) for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia becomes more commonly performed, operator knowledge of the adverse events is essential to inform patient selection, patient preparation, and postprocedural management. The aim of this article is to discuss the incidence, presentation, and management of adverse effects after PAE.
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Jackson J, Schmitt V. Paper 2. Epigallocatechin Gallate and Tannic Acid Based Formulations of Finasteride for Dermal Administration and Chemoembolization. J Pharm Sci 2021; 110:807-14. [PMID: 33035538 DOI: 10.1016/j.xphs.2020.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022]
Abstract
Finasteride is used to treat benign prostatic hyperplasia (BPH) and pattern hair loss (androgenetic alopecia or APA). The local administration of formulations with increased solubility and controlled release of finasteride are proposed using gallate-containing compositions within embolic microparticles or paste. Finasteride solubility in either epigallocatechin gallate (EGCG) or tannic acid (TA) solutions was assessed using HPLC. Poly(dl-lactide-co-glycolide) (PLGA) or poly(methylmethacrylate) (PMMA) microspheres (100-400 μm) containing finasteride and EGCG or TA were effectively manufactured. Embolic particles were loaded with finasteride/EGCG/TA. Dermal uptake of TA/EGCG/finasteride topical compositions was measured in pig skin. The solubility of finasteride was dramatically increased using EGCG- or TA-based compositions. Finasteride loaded microspheres released over two months which was increased by EGCG or TA inclusion. Embolic particles soaked up finasteride and EGCG or TA and released the encapsulated drug over two weeks. Dermal uptake of finasteride from EGCG- or TA-based formulations was enhanced between 10 and 50 fold in layers as deep as 500 μm when compared to a generic control formulation. Gallate-based formulations of finasteride increase drug solubility and allow for effective release of the drug from embolic formulations. Paste or powder EGCG- or TA-based formulations of finasteride greatly increase dermal penetration of the drug.
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Abstract
Medically refractory benign prostatic hyperplasia induced lower urinary tract symptoms is an extremely prevalent issue in older men. The current gold standard therapy transurethral resection of the prostate does produce urologic improvements but is also associated with higher than desired morbidity. This has led to the need to develop new minimally invasive means to treat this disease; prostate artery embolization (PAE) has emerged as one minimally invasive treatment option for these patients. The body of evidence which supports the use of PAE has grown quickly and substantially over the last decade. The goal of this review is to introduce and summarize the published urologic outcomes for PAE when utilized to treat benign prostatic hyperplasia induced lower urinary tract symptoms as well as document the established complication profile. Finally, the paper reviews current societal recommendations as they relate to PAE.
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Affiliation(s)
- Shamar Young
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN.
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN
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Young S, Gasparetto A, Jalaeian H, Golzarian J. Biomarkers in the setting of benign prostatic hyperplasia-induced lower urinary tract symptoms: what an interventional radiologist needs to know. Br J Radiol 2020; 93:20200484. [PMID: 32706988 DOI: 10.1259/bjr.20200484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With increasing evidence to support prostate artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS), Interventional Radiologists have begun to play an important role in the management of these patients. One area of knowledge needed when developing a PAE practice is knowledge of prostate-specific antigen (PSA) and other biomarkers utilized to detect prostate cancer in this population and what role they should play in the work up and follow-up of patients presenting with presumed BPH-induced LUTS. Furthermore, understanding how to evaluate presumed BPH-induced LUTS and stratify the risk of prostate cancer is an important skill to develop. The goal of this review is to provide Interventional Radiologists who have begun or aim to begin a PAE practice with the information they need to know regarding PSA levels and prostate cancer risk stratification for this patient population.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
| | - Alessandro Gasparetto
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami 1115 NW 14 St, Miami, FL, 33136, United States
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
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Li X, Li B, Ullah MW, Panday R, Cao J, Li Q, Zhang Y, Wang L, Yang G. Water-stable and finasteride-loaded polyvinyl alcohol nanofibrous particles with sustained drug release for improved prostatic artery embolization — In vitro and in vivo evaluation. Materials Science and Engineering: C 2020; 115:111107. [DOI: 10.1016/j.msec.2020.111107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/18/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
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Pandolfi M, Liguori A, Gurgitano M, Arrichiello A, Di Meglio L, Rodà GM, Guadagni A, Angileri SA, Ierardi AM, Buccimazza G, Donat D, Paolucci A, Carrafiello G. Prostatic artery embolization in patients with benign prostatic hyperplasia: perfusion cone-beam CT to evaluate planning and treatment response. Acta Biomed 2020; 91:e2020013. [PMID: 33245070 PMCID: PMC8023075 DOI: 10.23750/abm.v91i10-s.10260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
This proof of concept is to evaluate the utility of perfusion cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia (BPH) with moderate or severe-grade lower urinary tract symptoms (LUTS). PAE is a novel minimally invasive therapy and is both safe and effective procedure with low risks and high technical successes, making this procedure as the best alternative to surgery. A lot of technical changes would compromise clinical outcomes after procedure, including a variable prostate vascular anatomy, thin PA, and extensive atherosclerotic disease. The purpose of our study is to exploit the advantages of Perfusion Cone Beam Computed Tomography (CBCT) that could impact treatment and help interventional radiologists for treatment planning, diagnosis and for assessing the technical feasibility during PAE, mitigating the risk of nontarget embolization and suggesting clinical outcomes. Qualitative and quantitative clinical pre- and post-treatment values will be compared, to reach the best possible results.
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Affiliation(s)
- Marco Pandolfi
- Radiology Unit, Istituto Clinico Città Studi Milano, via Niccolò Jommelli, 17, 20131 Milano, Italy.
| | - Alessandro Liguori
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Martina Gurgitano
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
| | - Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Giovanni Maria Rodà
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Alice Guadagni
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Anna Maria Ierardi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Giorgio Buccimazza
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Daniela Donat
- Clinical Center od Vojvodina, Center for Radiology, Serbia, Novi Sad, Hajduk Veljkova 1.
| | - Aldo Paolucci
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy; Department of Health Sciences, Università degli Studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
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Radwan A, Farouk A, Higazy A, Samir YR, Tawfeek AM, Gamal MA. Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia. Prostate Int 2020; 8:130-133. [PMID: 33102395 PMCID: PMC7557197 DOI: 10.1016/j.prnil.2020.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is considered the gold standard surgical intervention for prostate size less than 80 g. Prostatic artery embolization (PAE) has been suggested as a minimally invasive interventional radiological procedure in the management of benign prostatic hyperplasia (BPH), especially by using the PErFecTED technique. We aim through our study to evaluate the efficacy and safety of PAE compared with those of monopolar transurethral resection of prostate (M-TURP) and bipolar transurethral resection of prostate (B-TURP) in treating lower urinary tract symptoms (LUTSs) secondary to BPH. METHODS We randomized 60 patients into 3 equal groups representing M-TURP, B-TURP, and PAE. Patients were followed up at 1 and 6 months postoperatively with regard to the International prostate symptom score (IPSS) score; uroflowmetry; prostate volume by transrectal ultrasound; and postvoid residual urine. RESULTS The mean operative time was 59, 68, and 89 minutes for the M-TURP group, the B-TURP group, and the PAE group, respectively; only one patient, who represented 5% of the M-TURP group and 1.7% of the whole study population, developed transurethral resection syndrome. Four patients of the PAE group complained of postembolization syndrome, which represented 20% of the cases. Only two patients in our study, both belonging to the PAE group, developed acute urinary retention after catheter removal, representing 10% of the PAE group and 3.33% of the whole study population. The improvement in the IPSS score, the average uroflowmetry (Q-average) score, postvoid residual urine, and prostate volume reduction was noted in all groups, with more statistically significant improvement in each of the M-TURP and the B-TURP groups than in the PAE group. CONCLUSION PErFecTED technique is a novel way of embolization, with statistically significant improvement for patients complaining of LUTSs due to BPH in terms of improvement of IPSS, uroflowmetry, prostate size, and amount of postvoid residual urine, yet these results are still not comparable with either the results of M-TURP or B-TURP that still show more effective improvement.
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Svarc P, Taudorf M, Nielsen MB, Stroomberg HV, Røder MA, Lönn L. Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10090659. [PMID: 32878325 PMCID: PMC7555179 DOI: 10.3390/diagnostics10090659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Postembolization syndrome (PES) is the most common side effect of vascular embolization of solid organs. The aim of this review was to determine the incidence of PES and its individual components after prostatic artery embolization (PAE). A systematic review with a pre-specified search strategy for PubMed, Embase, Web of Science and Cochrane Library was performed according to PRISMA guidelines. Studies in English regarding PAE in humans with 10 or more participants were eligible for inclusion. No restrictions on participant demographics or PAE technique were imposed. The search returned 378 references, of which 32 studies with a total of 2116 patients met the inclusion criteria. The results for overall PES frequency and individual PES components were presented as median (interquartile range, (IQR)). Overall median PES frequency was 25.5% (12.5–45.8). The two most frequent individual PES components were dysuria/urethral burning and local pain, with a median frequency of 21.7% (13.8–33.3) and 20% (5.4–29.4), respectively. Most outcome measures were characterized by a marked lack of uniformity and inconsistency in reporting across studies. Development of a uniform reporting system would help the clinicians recognize and treat PES accordingly.
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Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
- Correspondence: ; Tel.: +45-91-87-06-18
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
| | - Hein Vincent Stroomberg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (H.V.S.); (M.A.R.)
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (H.V.S.); (M.A.R.)
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
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Liu W, Shi MQ, Ge YS, Wang PY, Wang X. Multisection spiral CT in the diagnosis of adhesive small bowel obstruction: the value of CT signs in strangulation. Clin Radiol 2020; 76:75.e5-75.e11. [PMID: 32859383 DOI: 10.1016/j.crad.2020.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- W Liu
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, No 774 Jinbu Road, Yantai, 264100, PR China
| | - M Q Shi
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, No 774 Jinbu Road, Yantai, 264100, PR China
| | - Y S Ge
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, No 774 Jinbu Road, Yantai, 264100, PR China
| | - P Y Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, No 774 Jinbu Road, Yantai, 264100, PR China; Binzhou Medical University, No 346 Guanhai Road, 264003, Yantai, Shandong, PR China.
| | - X Wang
- Binzhou Medical University, No 346 Guanhai Road, 264003, Yantai, Shandong, PR China.
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Hashem E, Elsobky S, Khalifa M. Prostate Artery Embolization for Benign Prostate Hyperplasia Review: Patient Selection, Outcomes, and Technique. Semin Ultrasound CT MR 2020; 41:357-365. [DOI: 10.1053/j.sult.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Yalçın S, Tunç L. Indications, techniques, and role of new minimally invasive benign prostate hyperplasia surgical options. Turk J Urol 2020; 46:S79-S91. [PMID: 32707030 DOI: 10.5152/tud.2020.20204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
Novel emerging techniques for the surgical treatment of benign prostate hyperplasia (BPH) related to lower urinary tract symptoms are being investigated very seriously to help search for a better method, and the studies are getting their place in the literature. In this review article, UroLift® system, (i)TIND®, Aquablation®, Rezūm® system, and prostatic artery embolization have been discussed according to the literature and both European and American urological guidelines. All related randomized controlled trials are discussed under the appropriate headings. Indications, technique, and the role of these minimally invasive surgical options for BPH are assessed. These methods, which are still being studied, are promising for the future. As the studies get completed, the indications will become clearer, and these techniques will find their respective places as the personalized treatment options.
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Affiliation(s)
- Serdar Yalçın
- Department of Urology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Lütfi Tunç
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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Kovács A, Bücker A, Grimm MO, Habermann CR, Katoh M, Massmann A, Mahnken AH, Meyer BC, Moche M, Reimer P, Teichgräber U, Wacker FK. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. ROFO-FORTSCHR RONTG 2020; 192:835-846. [PMID: 32615637 DOI: 10.1055/a-1183-5438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In recent years prostate artery embolization (PAE) evolved into a clinically established minimally invasive endovascular treatment option for lower urinary tract symptoms caused by benign prostate syndrome (BPS). METHODS In this interdisciplinary position paper, initiated by the steering group for research of the German Society for Interventional Radiology (IR), the method of PAE is presented and discussed in the context of current evidence. RESULTS PAE is a safe IR procedure for the treatment of BPS. In terms of symptom relief, measured with the IPSS (International Prostate Symptom Score), the PAE has comparable effect, similar to the historic gold standard, transurethral resection (TUR) of the prostate. With regard to reducing subvesical obstruction PAE is inferior to TUR, but does not limit subsequent surgery. Based on current evidence, PAE is recommended by the British National Institute for Health and Care Excellence as an alternative therapy. The feasibility under local anaesthesia and the preservation of sexual function are important arguments for patients in favour of interventional therapy. Patient selection and therapy concepts require close interdisciplinary collaboration between urologists and radiologists. CONCLUSION Effectiveness and safety of PAE for the treatment of BPS are proven. Further randomized trials should focus on long term outcome and help to identify most suitable indications for PAE. KEY POINTS · PAE, an endovascular procedure, is a patient-friendly, minimally invasive, alternative therapy option of the BPS. · PAE can reduce the symptoms of the lower urinary tract (LUTS), comparable to transurethral resection (TUR). The deobstructive and volume-reducing potential of the PAE is inferior to that of the TUR. · The main advantages of PAE are use of local anesthesia (no general anesthesia required), short patient recovery and maintenance of sexual function, including antegrade ejaculation.. · Based on current evidence PAE should be considered after conservative drug therapy and before TUR.. · The role of PAE in the context of other minimally invasive procedures (MIST) requires further evaluation with an open minded approach towards PAE.. · PAE is carried out by interventional radiologists, usually on a referral basis from urologists, and requires close interdisciplinary cooperation.. CITATION FORMAT · Kovacs A, Bücker A, Grimm M et al. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. Fortschr Röntgenstr 2020; 192: 835 - 846.
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Affiliation(s)
- Attila Kovács
- MediClin Robert Janker Clinic, Clinic of Diagnostic and Interventional Radiology and Neuroradiology, Bonn, Germany
| | - Arno Bücker
- Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany
| | | | - Christian R Habermann
- Kath. Marienhospital Hamburg, Department of Diagnostic and Interventional Radiology, Hamburg, Germany
| | - Marcus Katoh
- Helios-Hospital Krefeld, Diagnostic and Interventional Radiology, Krefeld, Germany
| | - Alexander Massmann
- Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany
| | - Andreas H Mahnken
- Marburg University Hospital, Clinic of Diagnostic and Interventional Radiology, Marburg, Germany
| | - Bernhard C Meyer
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Michael Moche
- Helios-Park-Klinikum Leipzig, Department of Interventional Radiology, Leipzig, Germany
| | - Peter Reimer
- Städtisches Klinikum Karlsruhe, Academic teaching hospital of the University of Freiburg, Institute of Diagnostic and Interventional Radiology, Karlsruhe, Germany
| | - Ulf Teichgräber
- Jena University Hospital, Department of Radiology, Jena, Germany
| | - Frank K Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
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Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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Bortnick E, Brown C, Simma-Chiang V, Kaplan SA. Modern best practice in the management of benign prostatic hyperplasia in the elderly. Ther Adv Urol 2020; 12:1756287220929486. [PMID: 32547642 PMCID: PMC7273551 DOI: 10.1177/1756287220929486] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/03/2020] [Indexed: 11/17/2022] Open
Abstract
Benign prostatic hyperplasia (BPH), with its associated lower urinary tract symptoms (LUTS), can be a debilitating disease in the elderly male. Transurethral resection of the prostate (TURP) remains the gold standard; however, many patients will choose to avoid surgery if possible. Medical therapy is an effective alternative, however, new studies are showing that there may be more side effects than previously realized in the elderly male. Newer, novel minimally invasive techniques, including UroLift® and Rezūm™, are gaining favor as alternative office-based procedural techniques that do not require general anesthesia and may better preserve ejaculatory function. Though promising, at this point, these techniques are not approved for all patients. With a range of medical, procedural, and surgical options for treatment of BPH with LUTS, it is important to have a discussion with your patient regarding the short- and long-term risks and benefits, as well as alternatives, before deciding on a treatment plan for your patient with BPH.
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Affiliation(s)
- Eric Bortnick
- Department of Urology, Mount Sinai Hospital, 1245 Madison Avenue, New York, NY 10029, USA
| | - Conner Brown
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | | | - Steven A Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
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Carnevale FC, Moreira AM, de Assis AM, Antunes AA, Cristina de Paula Rodrigues V, Srougi M, Cerri GG. Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years' Experience. Radiology 2020; 296:444-451. [PMID: 32484416 DOI: 10.1148/radiol.2020191249] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Long-term experience with prostatic artery embolization (PAE) for benign prostatic hyperplasia remains limited. Purpose To evaluate the efficacy, safety, and long-term results of PAE for benign prostatic hyperplasia. Materials and Methods This retrospective single-center study was conducted from June 2008 to June 2018 in patients with moderate to severe benign prostatic hyperplasia-related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed. PAE was performed with 100-500-μm embolic microspheres. Mixed-model analysis of variance and Kaplan-Meyer method was accessed, as appropriate. Results A total of 317 consecutive men (mean age ± standard deviation, 65 years ± 8) were treated. Follow-up ranged from 3 months to 96 months (mean, 27 months). Bilateral and unilateral PAE was performed in 298 (94%) and 19 (6%) men, respectively. Early clinical failure occurred in six (1.9%) and symptom recurrence in 72 (23%) men at a median follow-up of 72 months. Mean maximum improvement was as follows: IPSS, 16 points ± 7; quality-of-life score, 4 points ± 1; prostatic volume reduction, 39 cm3 ± 39 (39% ± 29); maximum urinary flow rate, 6 mL/sec ± 10 (155% ± 293); and postvoid residual volume, 70 mL ± 121 (48% ± 81) (P < .05 for all). Unilateral PAE was associated with higher recurrence (42% vs 21%; P = .04). Baseline PSA was inversely related with recurrence (hazard ratio, 0.9 per nanograms per milliliter of PSA; 95% confidence interval [CI], 0.8, 0.9; P < .001). Embolization with combined particle sizes (100-500 μm) did not relate to symptom recurrence (hazard ratio, 0.4; 95% CI: 0.2, 1.1 for 100-500-μm group vs 300-500-μm group and hazard ratio, 0.4; 95% CI: 0.1, 1.5 for 100-500-μm group vs 100-300-μm group; P = .19).None of the patients presented with urinary incontinence or erectile dysfunction. Conclusion Prostatic artery embolization was a safe and effective procedure for benign prostatic hyperplasia with good long-term results for lower urinary tract symptoms. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Francisco Cesar Carnevale
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Airton Mota Moreira
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Andre Moreira de Assis
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Alberto Azoubel Antunes
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Vanessa Cristina de Paula Rodrigues
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Miguel Srougi
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Giovanni Guido Cerri
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
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Insausti I, Sáez de Ocáriz A, Galbete A, Capdevila F, Solchaga S, Giral P, Bilhim T, Isaacson A, Urtasun F, Napal S. Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2020; 31:882-90. [DOI: 10.1016/j.jvir.2019.12.810] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
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Barat M, Boeken T, Moussa N, Di Gaeta A, Déan C, Thioun N, Del Giudice C, Pellerin O, Sapoval M. Contrast-Enhanced Ultrasonography for the Early Evaluation of Prostate Artery Embolization. Cardiovasc Intervent Radiol 2020; 43:1498-1504. [PMID: 32435835 DOI: 10.1007/s00270-020-02518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
AIM To prospectively evaluate the feasibility and reproducibility of the semiquantitative measurement of the unenhanced area of the prostate by trans-abdominal contrast-enhanced ultrasound (CEUS) performed immediately after prostate artery embolization (PAE) as a prognostic factor of success. METHODS Thirty-nine patients with PAE were prospectively included. They all underwent pre- and post-PAE trans-abdominal prostate CEUS. Two readers independently evaluated the pre- and post-PAE unenhanced area using a semiquantitative method: unenhanced areas were measured on 3 different slices (basis, middle, and apex) and reported to the whole prostate area. The mean of the three measures was reported semiquantitatively in classes of ten percent and quartiles. We evaluated correlation with clinical success, at 3 months after PAE, defined as a > 25% reduction in the International Prostatic Symptoms Score and a Quality of life < 3. RESULTS Twenty-three patients who had bilateral PAE were analyzed. Pre-PAE trans-abdominal prostate CEUS showed visible early and marked enhancement of the entire prostate in all patients. After PAE, all patients had a semiquantitatively measured unenhanced area > 25%. The semiquantitative measurement was found to be highly reproducible, with an interclass correlation > 0.8. No correlation was found between the area of unenhanced tissue and clinical success evaluated at 3 months. CONCLUSION Trans-abdominal prostate CEUS performed early after PAE provides reproducible results and is a valuable tool to evaluate unenhanced areas of the prostate. LEVEL OF EVIDENCE 3, local non random sample.
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Affiliation(s)
- Maxime Barat
- Department of Body and Interventional Radiology, Hôpital Cochin, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75014, France.
- Department of Radiology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France.
| | - Tom Boeken
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - Nadia Moussa
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - Alessandro Di Gaeta
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - Carole Déan
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - Nicolas Thioun
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - C Del Giudice
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - Olivier Pellerin
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
| | - Marc Sapoval
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris-Descartes Paris 5, Paris, 75015, France
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Monreal R, Robles C, Sánchez-Casado M, Ciampi J, López-Guerrero M, Ruíz-Salmerón R, Lanciego C. Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. Radiología (English Edition) 2020. [DOI: 10.1016/j.rxeng.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Uflacker AB, Haskal ZJ, Baerlocher MO, Bhatia SS, Carnevale FC, Dariushnia SR, Faintuch S, Gaba RC, Golzarian J, Midia M, Nikolic B, Sapoval MR, Walker TG. Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization. J Vasc Interv Radiol 2020; 31:891-898.e1. [PMID: 32340862 DOI: 10.1016/j.jvir.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andre B Uflacker
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ziv J Haskal
- Department of Radiology and Medical Imaging/Interventional Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mark O Baerlocher
- Department of Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada
| | - Shivank S Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Mehran Midia
- Department of Radiology, McMaster University, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Boris Nikolic
- Department of Interventional Radiology, Cooley Dickinson Hospital, Massachusetts General Hospital Affiliate, Northampton, Massachusetts
| | - Marc R Sapoval
- Department of Interventional Vascular and Oncologic Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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149
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Patel K, Zha N, Neumann S, Tembelis MN, Juliano M, Samreen N, Hussain J, Moshiri M, Patlas MN, Katz DS. Computed Tomography of Common Bowel Emergencies. Semin Roentgenol 2020; 55:150-169. [DOI: 10.1053/j.ro.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Prostate artery embolization is a well-known and promising treatment for benign prostatic hyperplasia, with the quantum leaps of research in medicine. We aim to provide an up-to-date review of the novel technique, including large retrospective studies and randomized control trials, ends with discussions of advantages and disadvantages of this minimally invasive technique.
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Affiliation(s)
- Li Cui
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yanhua Bai
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Jinlong Zhang
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Bing Yuan
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xiuqi Wang
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yan Wang
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Feng Duan
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Maoqiang Wang
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
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