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Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol 2018; 29:287-298. [DOI: 10.1007/s00330-018-5564-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/20/2018] [Accepted: 05/24/2018] [Indexed: 02/05/2023]
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202
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203
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Phytobezoar: A Brief Report with Surgical and Radiological Correlation. Case Rep Surg 2018; 2018:5253162. [PMID: 29780655 PMCID: PMC5892293 DOI: 10.1155/2018/5253162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 12/01/2022] Open
Abstract
Gastrointestinal bezoars, collections of incompletely digested material within the alimentary tract, can present as a diagnostic challenge and should be considered in the differential diagnosis and management of small bowel obstruction, ischemic bowel, or bowel perforation. We present a case of a 37-year-old man with a distant history of laparotomy for superior mesenteric artery thrombosis requiring partial small bowel resection of the jejunum who presented with worsening abdominal pain, nausea, vomiting, and hematemesis. An abdominal computed tomography revealed dilated loops of small bowel with a transition point at the ileum, distal to his prior bowel anastomosis. He was managed initially nonoperatively, but persistent vomiting and worsening distention necessitated urgent exploratory laparotomy. During the procedure, a 4 cm by 3 cm phytobezoar was discovered at the midjejunum. The patient had an unremarkable postoperative course with no further symptoms at 1-year follow-up. Timely diagnosis and treatment of bezoar is essential to minimize patient complications.
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Abstract
CLINICAL/METHODICAL ISSUE In the treatment of the benign prostatic hyperplasia (BPH) medical and surgical therapies have been established. STANDARD RADIOLOGICAL METHODS Prostate artery embolization (PAE) is an innovative endovascular technique that might close the gap between both these procedures. PERFORMANCE The PAE procedure is safe and has a low incidence of side effects. The efficacy of PAE has been proven for medium sized and large sized glands as well as for intravesical protrusions. ACHIEVEMENTS The complex mechanism of PAE carries the potential to cure lower urinary tract symptoms as well as to retard the progression of the hyperplasia. PRACTICAL RECOMMENDATIONS Data concerning the long-term efficacy are missing at present.
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Affiliation(s)
- A Kovács
- Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, MediClin Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Deutschland.
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206
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Petrillo M, Pesapane F, Fumarola EM, Emili I, Acquasanta M, Patella F, Angileri SA, Rossi UG, Piacentini I, Granata AM, Ierardi AM, Carrafiello G. State of the art of prostatic arterial embolization for benign prostatic hyperplasia. Gland Surg 2018; 7:188-199. [PMID: 29770312 PMCID: PMC5938262 DOI: 10.21037/gs.2018.03.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/25/2018] [Indexed: 12/15/2022]
Abstract
Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). Several patients present contraindication for standard approach, individuals older than 60 years with urinary tract infection, strictures, post-operative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are not good candidates for surgery. Prostatic artery embolization (PAE) is emerging as a viable method for patients unsuitable for surgery. In this article, we report results about technical and clinical success and safety of the procedure to define the current status.
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Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Filippo Pesapane
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Marzia Acquasanta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Igor Piacentini
- Interventional Radiology Unit, E.O. Ospedale Galliera, Genova, Italy
| | | | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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207
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Gupta NK, Gange SN, McVary KT. New and Emerging Technologies in Treatment of Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia. Sex Med Rev 2018; 7:491-498. [PMID: 29606553 DOI: 10.1016/j.sxmr.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) from bladder outlet obstruction from benign prostatic hyperplasia (BPH) occur in a large percentage of urologic patients. Treatment of this condition with medical and surgical therapy provides symptom relief but has serious adverse effects and causes sexual dysfunction. New technologies to treat BPH-associated LUTS aim to effectively treat urinary symptoms and minimize side effects and sexual dysfunction. AIM To review the efficacy of new and emerging therapies for treatment of LUTS from BPH. METHODS A literature search was performed to identify therapies for LUTS from BPH with early outcomes data within the past 5 years. MAIN OUTCOME MEASURES Improvement in International Prostate Symptom Score (IPSS) and effect on sexual functions such as erectile and ejaculatory functions as measured on the International Index of Erectile Function and the Male Sexual Health Questionnaire. RESULTS Technologies introduced within the past 5 years include techniques using intraprostatic injectables, mechanical devices, and prostatic tissue ablation. Most technologies remain in the development phase and have only phase I and II studies available that show promising alleviation of urinary symptoms. Injectables have not typically surpassed placebo or sham effects, although special cohorts could be exceptions. Thus far, convective water vapor ablation therapy and prostatic urethral lift have shown the most promise, with short- and medium-term data available on phase III studies demonstrating significant improvement in IPSS with minimal impact on sexual function. Many of these technologies are limited in their potential treatment population by prostate size and conformation, whereas other therapies might be more generalizable. CONCLUSION Many new technologies aim to treat LUTS from BPH and minimize sexual side effects. Most therapies remain experimental, although prostatic urethral lift and water vapor ablation therapy have been brought to market and show promise. Long-term durability of symptom relief remains to be demonstrated. Gupta NK, Gange SN, McVary KT. New and Emerging Technologies in Treatment of Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia. Sex Med Rev 2018;7:491-498.
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Affiliation(s)
- Nikhil K Gupta
- Division of Urology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
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208
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Pancreaticoduodenectomy for an Ampullary Region Carcinoma Occurred in Annular Pancreas Coexistent with Replaced Common Hepatic Artery. Case Rep Med 2018; 2018:3258141. [PMID: 29560005 PMCID: PMC5838470 DOI: 10.1155/2018/3258141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/23/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue surrounding the descending portion of the duodenum. Annular pancreas coexisting with replaced common hepatic artery which is also a rare anatomical variation has not been reported previously. Case Presentation A 53-year-old man visited our hospital complaining of epigastric pain. Based on radiological examinations, he was diagnosed as having pancreatitis, annular pancreas, and hepatomesenteric trunk. One month later, obstructive jaundice developed. Endoscopic examination revealed ampullary region carcinoma. We performed pancreaticoduodenectomy using the "artery-first" approach. Discussion Both annular pancreas and common hepatic artery anomaly are rare. High-quality preoperative imaging and awareness of such rare conditions are necessary for operative safety. Although the embryological relationship between these anomalies is uncertain, the present case may suggest some relevance between the two. Conclusion The "artery-first" approach may be a useful method for pancreaticoduodenectomy in patients who have an anatomical abnormality.
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209
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Prostatic artery embolization for benign prostatic obstruction: assessment of safety and efficacy. World J Urol 2018; 36:575-584. [PMID: 29445846 DOI: 10.1007/s00345-018-2220-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Prostatic artery embolization (PAE) has seen a recent increase in interest as a treatment for men with benign prostatic obstruction (BPO). The appeal of this intervention lies in reported reduction in morbidity and its minimally invasive nature. The purpose of this review is to assess the safety and efficacy of PAE as a new treatment in BPO and explore risks surrounding its performance. METHODS A review of the literature was performed. Medical databases searched included PubMed, EMBASE, and Cochrane databases, limited to English, peer-reviewed articles. Search terms included prostatic artery embolization, lower urinary tracts symptoms, minimally invasive therapies, interventional radiology prostate, and benign prostatic hyperplasia. Articles were screened by two independent reviewers for content on development, methods, outcomes, and complications of PAE. RESULTS Suitability of patients to undergo PAE depends on review of patient history, pre-procedure visualisation of appropriate vascular anatomy and clinical parameters. Despite this selection of candidates favourable for procedural success, PAE is not without risk of complications, some of which can significantly affect patient quality of life. CONCLUSIONS Although initial findings show promise regarding safety and efficacy of PAE in improving symptom and quality-of-life scores, further investigation is required to establish durability of effect and the appropriate use of this experimental modality. There is currently limited robust evidence for the beneficial outcomes of PAE. Long-term follow-up studies will add to the evidence base to help further assess the feasibility of this procedure as an alternative to TURP.
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210
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Napal Lecumberri S, Insausti Gorbea I, Sáez de Ocáriz García A, Solchaga Álvarez S, Cebrián Lostal JL, Monreal Beortegui R, Giral Villalta PJ, Urtasun Grijalba F. Prostatic artery embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: protocol for a non-inferiority clinical trial. Res Rep Urol 2018; 10:17-22. [PMID: 29492398 PMCID: PMC5815502 DOI: 10.2147/rru.s139086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Benign prostatic hyperplasia (BPH) is a prevalent disease associated with lower urinary tract symptoms (LUTS). The standard of care for moderate-to-severe LUTS unresponsive to pharmacological treatment is the transurethral resection of the prostate (TURP). However, this intervention is not exempt from complications. Prostatic artery embolization (PAE) has been described as a new, effective and safe procedure for the treatment of LUTS secondary to BPH. To date, only one clinical trial has been published on the use of PAE for LUTS, but the study was methodologically flawed in terms of safety monitoring. Therefore, well-designed clinical studies are required to compare the efficacy and safety of both techniques in the treatment of LUTS secondary to BPH. Methods and design This was a prospective, randomized, non-inferiority clinical trial comparing efficacy and safety of PAE and TURP in the treatment of BPH-related LUTS. A total of 60 patients diagnosed with BPH with obstructive moderate or severe LUTS refractory to medical therapy and candidates for TURP were randomized to either PAE or TURP. The presence and severity of LUTS were assessed using the validated Spanish version of the International Prostate Symptom Score (IPSS). Primary end points included improvement in maximum urinary flow rate (Qmax) as measured at baseline and 1 year after the intervention. Improvement in IPSS as measured at baseline and after the intervention, reduction in prostate volume, no deterioration or improvement of sexual function (International Index of Erectile Function [IIEF]), reduction in PSA and PVR, satisfaction of the patient with the operation and adverse events occurring during the study were secondary outcome measures. Discussion The aim of this clinical study was to investigate whether PAE is a valid therapeutic option for LUTS that is not inferior to TURP in terms of efficacy and safety. This study also helped to define the profile of candidates for PAE and analyzed the benefits and complications associated with this new technique.
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Affiliation(s)
| | - Iñigo Insausti Gorbea
- Sección de Radiología Vascular Intervencionista, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Ana Sáez de Ocáriz García
- Sección de Radiología Vascular Intervencionista, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Saioa Solchaga Álvarez
- Sección de Radiología Vascular Intervencionista, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Raquel Monreal Beortegui
- Sección de Radiología Vascular Intervencionista, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Fermín Urtasun Grijalba
- Sección de Radiología Vascular Intervencionista, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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211
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Brasil IRC, de Araujo IF, Lima AALDA, Melo ELA, Esmeraldo RDM. Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients. Radiol Bras 2018. [PMID: 29540943 PMCID: PMC5844440 DOI: 10.1590/0100-3984.2016.0179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective To describe the main anatomical variations of the celiac trunk and the
hepatic artery at their origins. Materials and Methods This was a prospective analysis of 100 consecutive computed tomography
angiography studies of the abdomen performed during a one-year period. The
findings were stratified according to classification systems devised by
Sureka et al. and Michels. Results The celiac trunk was "normal" (i.e., the hepatogastrosplenic trunk and
superior mesenteric artery originating separately from the abdominal aorta)
in 43 patients. In our sample, we identified four types of variations of the
celiac trunk. Regarding the hepatic artery, a normal anatomical pattern
(i.e., the proper hepatic artery being a continuation of the common hepatic
artery and bifurcating into the right and left hepatic arteries) was seen in
82 patients. We observed six types of variations of the hepatic artery. Conclusion We found rates of variations of the hepatic artery that are different from
those reported in the literature. Our findings underscore the need for
proper knowledge and awareness of these anatomical variations, which can
facilitate their recognition and inform decisions regarding the planning of
surgical procedures, in order to avoid iatrogenic intraoperative injuries,
which could lead to complications.
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Affiliation(s)
- Ivelise Regina Canito Brasil
- PhD, Adjunct Professor of Clinical Surgery, School of Medicine, Universidade Estadual do Ceará (UECE), Head of the Liver Transplant Program at the Hospital Geral de Fortaleza (HGF), Fortaleza, CE, Brazil
| | | | | | - Ernesto Lima Araujo Melo
- PhD, Adjunct Professor of Diagnostic Imaging, School of Medicine, Universidade Estadual do Ceará (UECE), Fortaleza, CE, Brazil
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212
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McClure TD, Ricke J. What Is New in Prostate Artery Embolization for Lower Urinary Tract Symptoms? Eur Urol Focus 2018; 4:46-48. [DOI: 10.1016/j.euf.2018.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
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213
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Clinical evaluation of embolization of the superior vesical prostatic artery for treatment of benign prostatic hyperplasia: a single-center retrospective study. Wideochir Inne Tech Maloinwazyjne 2017; 12:409-416. [PMID: 29362657 PMCID: PMC5776490 DOI: 10.5114/wiitm.2017.72324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/17/2017] [Indexed: 01/02/2023] Open
Abstract
Introduction Non-surgical minimally invasive treatments are greatly needed for patients with symptomatic benign prostatic hyperplasia (BPH), for whom medical treatment has failed and surgery is contraindicated. This study retrospectively evaluated the efficacy and safety of super-selective prostatic artery embolization (PAE) for BPH, relative to transurethral resection of the prostate (TURP). Aim To clinically evaluate the efficacy and safety of super-selective PAE for BPH, relative to TURP. Material and methods From February 2012 to March 2015, patients with BPH underwent selective PAE (n = 17) or TURP (control group; n = 40). Prostate volume, maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and quality of life (QoL) score were evaluated at baseline and postoperative 3, 6, and 12 months. Complications were also recorded. Results All the procedures were technically successfully. At postoperative 1 year, patients given PAE had significantly greater prostate volume (64.6 ±10.2 ml), IPSS (23.9 ±4.9), and QoL (4.1 ±0.7) compared with the control patients (42.0 ±7.5 ml, 13.1 ±3.5, and 2.1 ±0.7, respectively). The Qmax of the PAE group (9.5 ±3.7 ml/s) was significantly lower than that of the control (21.8 ±4.2 ml/s). The changes in parameters of the TURP patients relative to the preoperative baseline were significantly greater than those of the PAE group. No severe complications occurred. Conclusions Prostatic artery embolization was demonstrated as safe and effective and may be considered an alternative treatment for BPH patients, especially for those who are not candidates for or refuse surgery.
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214
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Zhang N, Li Z, Bai F, Ji N, Zheng Y, Li Y, Chen J, Mao X. MicroRNA expression profiles in benign prostatic hyperplasia. Mol Med Rep 2017; 17:3853-3858. [PMID: 29359788 DOI: 10.3892/mmr.2017.8318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/17/2017] [Indexed: 11/06/2022] Open
Abstract
Although alterations in microRNA (miRNA) expression have been previously investigated prostate cancer, the expression of miRNAs specifically in benign prostate hyperplasia (BPH) of the prostatic stroma remains to be fully elucidated. In the present study, miRNAs and gene expression profiles were investigated using microarray analysis and reverse transcription quantitative‑polymerase chain reaction (RT‑qPCR) in BPH tissue to clarify the associations between miRNA expression and target genes. Prostate tissue samples from five patients with BPH and five healthy men were analyzed using human Affymetrix miRNA and mRNA microarrays and differentially expressed miRNAs were validated using RT‑qPCR with 30 BPH and 5 healthy control samples. A total of 8 miRNAs, including miRNA (miR)‑96‑5p, miR‑1271‑5p, miR‑21‑3p, miR‑96‑5p, miR‑181a‑5p, miR‑143‑3p, miR‑4428 and miR‑106a‑5p were upregulated and 8 miRNAs (miR‑16‑5p, miR‑19b‑5p, miR‑940, miR‑25, miR‑486‑3p, miR‑30a‑3p, let‑7c and miR‑191) were downregulated. Additionally, miR‑96‑5p was demonstrated to have an inhibitory effect on the mRNA expression levels of the following genes: Mechanistic target of rapamycin (MTOR), RPTOR independent companion of MTOR complex 2, syntaxin 10, autophagy‑related protein 9A, zinc finger E‑box binding homeobox 1, caspase 2 and protein kinase c ε. Additionally, 16 differentially expressed miRNAs were identified using RT‑qPCR analysis. This preliminary study provides a solid basis for a further functional study to investigate the underlying regulatory mechanisms of BPH.
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Affiliation(s)
- Nan Zhang
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Zhongyi Li
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Fuding Bai
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Na Ji
- Department of Anesthesia, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yichun Zheng
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yi Li
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jimin Chen
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiawa Mao
- Department of Urology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Peterson J, Hage AN, Diljak S, Long BD, Marcusa DP, Stribley JM, Brzezinski DW, Eliason J. Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with 'Nutcracker Phenomenon,' or Compression of the Left Renal Vein. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1334-1342. [PMID: 29242494 PMCID: PMC5742474 DOI: 10.12659/ajcr.906283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Female, 91 Final Diagnosis: Nutcracker syndrome • celiacomesenteric trunk Symptoms: Dyspepsia • dysphagia Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
| | - Anthony N Hage
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephan Diljak
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - John M Stribley
- Division of Anatomy, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David W Brzezinski
- Division of Anatomy, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jonathan Eliason
- Section of Vascular Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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216
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Magistro G, Chapple CR, Elhilali M, Gilling P, McVary KT, Roehrborn CG, Stief CG, Woo HH, Gratzke C. Emerging Minimally Invasive Treatment Options for Male Lower Urinary Tract Symptoms. Eur Urol 2017; 72:986-997. [DOI: 10.1016/j.eururo.2017.07.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/04/2017] [Indexed: 01/20/2023]
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217
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Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
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Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
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218
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Le Pommellet HM, Scansen BA, Mathys DA, Mollenkopf DF, Reeves L, Skinas ML, Patel M. Arterial anomalies of the celiac trunk and median arcuate ligament compression in dogs and cats assessed by computed tomography angiography. Vet Surg 2017; 47:252-260. [DOI: 10.1111/vsu.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/22/2017] [Accepted: 07/06/2017] [Indexed: 12/31/2022]
Affiliation(s)
| | - Brian A. Scansen
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus Ohio
- Department of Clinical Sciences; Colorado State University; Fort Collins Colorado
| | - Dimitria A. Mathys
- Department of Veterinary Preventive Medicine; The Ohio State University; Columbus Ohio
| | - Dixie F. Mollenkopf
- Department of Veterinary Preventive Medicine; The Ohio State University; Columbus Ohio
| | - Lauren Reeves
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus Ohio
| | - Melissa L. Skinas
- Department of Clinical Sciences; Colorado State University; Fort Collins Colorado
| | - Mira Patel
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus Ohio
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219
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Qu L, Li J, Wang B. MR Imaging Features of Intestinal Phytobezoar. J Gastrointest Surg 2017; 21:1954-1956. [PMID: 28616857 DOI: 10.1007/s11605-017-3456-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/13/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study is to explore MR features and imaging mechanism of intestinal phytobezoar and to deepen the understanding of intestinal phytobezoar. METHODS Eighteen cases of intestinal phytobezoar (including 15 cases in small intestine and 3 cases in colon) underwent MR examinations. Summing-up and analyzing MR features combinded with intraoperative findings. RESULTS All 18 cases of intestinal phytobezoar showed irregular shape low signal on T2-weighted image, which was named coke sign in this study. And on T1-weighted image showed as follows: (i) 12 cases of intestinal phytobezoar (11 in small intestine and 1 in ascending colon) showed internal low signal and peripheral ring-like high signal, which was named empty shell sign in this study, (ii) 4 cases of intestinal phytobezoar (3 in jejunum and 1 in ileum) showed mixed slightly higher signal, and (iii) 2 cases of intestinal phytobezoar (both in colon) showed slightly low signal. CONCLUSIONS Intestinal phytobezoar presented coke sign on T2-weighted image and complicated signal, more often empty shell sign on T1-weighted image. Correct diagnosis of an intestinal phytobezoar has an instructive value in selection of treatment strategy.
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Affiliation(s)
- Lintao Qu
- Department of Radiology, Yantai Municipal Laiyang Central Hospital, Yantai, Shandong, 265200, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, Shandong, 264100, China.
| | - Bin Wang
- Medical Imaging Research Institute, Binzhou Medical University, Yantai, Shandong, 264003, China
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A Review of Adverse Events Related to Prostatic Artery Embolization for Treatment of Bladder Outlet Obstruction Due to BPH. Cardiovasc Intervent Radiol 2017; 40:1490-1500. [DOI: 10.1007/s00270-017-1765-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
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221
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Maclean D, Maher B, Modi S, Harris M, Dyer J, Somani B, Hacking N, Bryant T. Prostate artery embolization: a new, minimally invasive treatment for lower urinary tract symptoms secondary to prostate enlargement. Ther Adv Urol 2017; 9:209-216. [PMID: 29662545 DOI: 10.1177/1756287217717889] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/07/2017] [Indexed: 01/12/2023] Open
Abstract
Prostate artery embolization (PAE) is emerging as a safe and efficacious treatment which approaches benign prostatic obstruction (BPO) from a unique perspective. This brings with it distinct advantages and solutions, which we discuss along with cost, evidence, complications and disadvantages.
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Affiliation(s)
- Drew Maclean
- University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Ben Maher
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Mark Harris
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Jonathan Dyer
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Nigel Hacking
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Timothy Bryant
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
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Young S, Golzarian J. Prostate Arterial Embolization is a Viable Option for Treating Symptoms of Benign Prostatic Hyperplasia. J Urol 2017; 198:9-11. [DOI: 10.1016/j.juro.2017.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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Christidis D, McGrath S, Perera M, Manning T, Bolton D, Lawrentschuk N. Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies. Prostate Int 2017; 5:41-46. [PMID: 28593165 PMCID: PMC5448728 DOI: 10.1016/j.prnil.2017.01.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/27/2022] Open
Abstract
The prevalence of benign prostatic hypertrophy (BPH) causing bothersome lower urinary tract symptoms increases with our ageing population. Treatment of BPH traditionally begins with medical therapy and surgical intervention is then considered for those whose symptoms progress despite treatment. Minimally invasive surgical therapies have been developed as an intermediary in the treatment of BPH with the aim of decreasing the invasiveness of interventions. These therapies also aim to reduce morbidity and dysfunction related to invasive surgical procedures. Multiple treatment options exist in this group including mechanical and thermo-ablative strategies. Emerging therapies utilizing differing technologies range from the established to the experimental. We review the current literature related to these minimally invasive therapies and the evidence of their effectiveness in treating BPH. The role of minimally invasive surgical therapies in the treatment of BPH is still yet to be strongly defined. Given the experimental nature of many of the modalities, further study is required prior to their recommendation as alternatives to invasive surgical therapy. More mature evidence is required for the analysis of durability of effect of these therapies to make robust conclusions of their effectiveness.
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Affiliation(s)
- Daniel Christidis
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
- Young Urology Researchers Organization (YURO), Melbourne, Australia
| | - Shannon McGrath
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
- Young Urology Researchers Organization (YURO), Melbourne, Australia
| | - Marlon Perera
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
- Young Urology Researchers Organization (YURO), Melbourne, Australia
| | - Todd Manning
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
- Young Urology Researchers Organization (YURO), Melbourne, Australia
| | - Damien Bolton
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Bagla S, Smirniotopoulos J, Orlando J, Piechowiak R. Cost Analysis of Prostate Artery Embolization (PAE) and Transurethral Resection of the Prostate (TURP) in the Treatment of Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2017; 40:1694-1697. [PMID: 28560549 DOI: 10.1007/s00270-017-1700-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Prostatic arterial embolization (PAE) has emerged as a minimally invasive alternative to TURP; however, there are limited cost comparisons reported. The purpose of this study was to compare in-hospital direct costs of elective PAE and TURP in a hospital setting. MATERIALS AND METHODS Institutional Review Board-approved retrospective review was performed on patients undergoing PAE and TURP from January to December 2014. Inclusion criteria included male patients greater than 40 years of age who presented for ambulatory TURP or PAE with no history of prior surgical intervention for BPH. Direct costs were categorized into the following categories: nursing and operating room or interventional room staffing, operating room or interventional supply costs, anesthesia supplies, anesthesia staffing, hospital room cost, radiology, and laboratory costs. Additionally, length of stay was evaluated for both groups. RESULTS The mean patient age for the TURP (n = 86) and PAE (n = 70) cohorts was 71.3 and 64.4 years, respectively (p < 0.0001). Intra-procedural supplies for PAE were significantly more costly than TURP ($1472.77 vs $1080.84, p < 0.0001). When including anesthesia supplies and nursing/staffing, costs were significantly more expensive for TURP than PAE ($2153.64 vs $1667.10 p < 0.0001). The average length of stay for the TURP group was longer at 1.38 versus 0.125 days for the PAE group. Total in-hospital costs for the TURP group ($5338.31, SD $3521.17) were significantly higher than for PAE ($1678.14, SD $442.0, p < 0.0001). CONCLUSIONS When compared to TURP, PAE was associated with significantly lower direct in-hospital costs and shorter hospital stay.
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Affiliation(s)
- Sandeep Bagla
- Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA. .,University of North Carolina, Chapel Hill, NC, USA.
| | | | - Julie Orlando
- Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA
| | - Rachel Piechowiak
- Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA
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Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay. Cardiovasc Intervent Radiol 2017; 40:1321-1337. [PMID: 28508252 DOI: 10.1007/s00270-017-1687-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
Prostate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.
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Affiliation(s)
- Francisco Cesar Carnevale
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil.
| | - Guilherme Rebello Soares
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Andre Moreira de Assis
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Airton Mota Moreira
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | | | - Giovanni Guido Cerri
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
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Role of Coil Embolization during Prostatic Artery Embolization: Incidence, Indications, and Safety Profile ☆. J Vasc Interv Radiol 2017; 28:656-664.e3. [DOI: 10.1016/j.jvir.2017.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/31/2022] Open
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Emerging techniques in ‘truly’ minimal-invasive treatment options of benign prostatic obstruction. Curr Opin Urol 2017; 27:287-292. [DOI: 10.1097/mou.0000000000000386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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229
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Bhatia S, Harward SH, Sinha VK, Narayanan G. Prostate Artery Embolization via Transradial or Transulnar versus Transfemoral Arterial Access: Technical Results. J Vasc Interv Radiol 2017; 28:898-905. [PMID: 28396191 DOI: 10.1016/j.jvir.2017.02.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare safety and feasibility of prostate artery embolization (PAE) via transradial/transulnar access (TR/UA) and transfemoral access (TFA). MATERIALS AND METHODS A retrospective analysis was conducted for 3 cohorts: the first 32 consecutive PAE procedures performed via TFA (initial TFA, January 2014 to August 2015), the following 32 procedures performed via TFA (advanced TFA, August 2015 to February 2016), and the first 32 procedures performed via TR/UA (February 2016 to July 2016). Indications included lower urinary tract symptoms (n = 68), urinary retention (n = 24), and preoperative embolization before prostatectomy (n = 4). A single operator performed all procedures at a single institution. RESULTS Technical success was achieved in 29/32 (90.6%) initial TFA procedures, 31/32 (96.9%) advanced TFA procedures, and 30/32 (93.8%) TR/UA procedures. Mean procedure time was 110.0 minutes in TR/UA group, 155.1 min in initial TFA group, and 131.3 minutes in advanced TFA group (P < .01 and P = .03 relative to TR/UA); mean fluoroscopy time was 38.8 minutes in TR/UA group, 56.5 minutes in initial TFA group, and 48.0 minutes in advanced TFA group (P < .01 and P = .02 relative to TR/UA). Access site-related and overall adverse events did not vary significantly among study cohorts (P > .15 and P > .05, respectively). CONCLUSIONS TR/UA represents a safe and feasible approach to PAE with a comparable safety profile to TFA. Reduced procedure and fluoroscopy times might be attributable to the learning curve or method of arterial access.
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Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, R-109, PO Box 016960, Miami, FL 33101.
| | - Sardis H Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Vishal K Sinha
- University of Miami Miller School of Medicine, R-109, PO Box 016960, Miami, FL 33101
| | - Govindarajan Narayanan
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, R-109, PO Box 016960, Miami, FL 33101
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Andrade G, Khoury HJ, Garzón WJ, Dubourcq F, Bredow MF, Monsignore LM, Abud DG. Radiation Exposure of Patients and Interventional Radiologists during Prostatic Artery Embolization: A Prospective Single-Operator Study. J Vasc Interv Radiol 2017; 28:517-521. [PMID: 28259503 DOI: 10.1016/j.jvir.2017.01.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To prospectively analyze the radiation exposure of patients and interventional radiologists during prostatic artery embolization (PAE). MATERIALS AND METHODS Twenty-five consecutive PAE procedures performed with an Artis zee system in a single center by an interventional radiologist were prospectively monitored. The mean age, weight, and prostate volume of the patients were 65.7 year (range, 43-85 y), 71.4 kg (range, 54-88 kg), and 79 cm3 (range, 36-157 cm3), respectively. In addition to Digital Imaging and Communications in Medicine radiation data, direct measures were also obtained. Radiochromic film was used to evaluate peak skin dose (PSD). The radiologist wore a protective apron and a thyroid collar, and a ceiling-suspended screen and a table curtain were used. To estimate the absorbed doses, nine pairs of dosimeters were attached to the operator's body. RESULTS The average fluoroscopy time was 30.9 minutes (range, 15.5-48.3 min). The mean total dose-area product (DAP) was 450.7 Gy·cm2 (range, 248.3-791.73 Gy·cm2) per procedure. Digital subtraction angiography was responsible for 71.5% of the total DAP, followed by fluoroscopy and cone-beam computed tomography. The mean PSD was 2,420.3 mGy (range, 1,390-3,616 mGy). The average effective dose for the interventional radiologist was 17 μSv (range, 4-47 μSv); values for the eyes, hands, and feet were obtained, and were all greater on the left side. CONCLUSIONS PAE may lead to high x-ray exposures to patients and interventional radiologists.
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Affiliation(s)
- Gustavo Andrade
- AngioRad-Interventional Radiology, Ribeirão Preto, Brazil; Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Helen J Khoury
- Nuclear Energy Department, Universidade Federal de Pernambuco, Ribeirão Preto, Brazil
| | - William J Garzón
- Nuclear Energy Department, Universidade Federal de Pernambuco, Ribeirão Preto, Brazil
| | | | | | | | - Daniel G Abud
- Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, Brazil
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Leite LC, de Assis AM, Moreira AM, Harward SH, Antunes AA, Carnevale FC. Prostatic Tissue Elimination After Prostatic Artery Embolization (PAE): A Report of Three Cases. Cardiovasc Intervent Radiol 2017; 40:937-941. [PMID: 28175975 DOI: 10.1007/s00270-017-1584-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE We report three cases of spontaneous prostatic tissue elimination through the urethra while voiding following technically successful prostatic artery embolization (PAE) as a treatment for lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHODS All patients were embolized with 100- to 300-μm microspheres alone or in combination with 300- to 500-μm microspheres. RESULTS During follow-up prior to eliminating the tissue fragments, the three patients all presented with intermittent periods of LUTS improvement and aggravation. After expelling the prostatic tissue between 1 and 5 months of follow-up, significant improvements in LUTS and urodynamic parameters were observed in all patients. CONCLUSIONS Urethral obstruction after PAE caused by sloughing prostate tissue is a potential complication of the procedure and should be considered in patients with recurrent LUTS in order to avoid inappropriate management.
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Affiliation(s)
- Leandro Cardarelli Leite
- Department of Radiology, University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Andre Moreira de Assis
- Department of Radiology, University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Airton Mota Moreira
- Department of Radiology, University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | | | | | - Francisco Cesar Carnevale
- Department of Radiology, University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil.
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Multidetector Computed Tomographic Angiography for Optimal Cartography of the Visceral Abdominal Arterial Network: An Extensive Pictorial Review with Emphasis on Common and Uncommon Collateral Pathways, Complications and some Specific Syndromes. J Belg Soc Radiol 2017; 101:6. [PMID: 30038999 PMCID: PMC5854326 DOI: 10.5334/jbr-btr.1203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D global cartography of all abdominal arteries and that with only a limited amount of contrast media. MDCTA allows the optimal diagnosis of single or multiple arterial stenosis and easily analyses sometimes very complex collateral pathways. It constitutes a major advance to plan the arterial visceral safety of major commonly performed abdominal surgical procedures such as aorto-iliac surgery, endovascular aneurysm repair (EVAR), but also complex pancreatic and gastrointestinal or colonic surgery. It also allows to plan the most optimal strategy for revascularization of the mesenteric system through percutaneous angioplasty, stent placement or surgical bypass. This extensive pictorial review illustrates a large variety of situations which may be found during clinical practise. Single compression or stenosis of each digestive artery, combined and/or complex associations of stenosis and/or compressions of several arteries, secondary complications like aneurysms and classical but also sometimes unusual patterns of collateralization are richly illustrated. Specific syndromes comprising the median arcuate ligament syndrome (MALS) and the Leriche’s syndrome are also discussed.
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233
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Efficacy and Safety of Prostatic Arterial Embolization: Systematic Review with Meta-Analysis and Meta-Regression. J Urol 2017; 197:465-479. [DOI: 10.1016/j.juro.2016.08.100] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 02/06/2023]
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234
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Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques. Cardiovasc Intervent Radiol 2017; 40:366-374. [DOI: 10.1007/s00270-017-1569-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022]
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Kuang M, Vu A, Athreya S. A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2016; 40:655-663. [PMID: 28032133 DOI: 10.1007/s00270-016-1539-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To summarize current evidence on outcomes and complications of prostatic artery embolization as a treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. METHODS AND MATERIALS A database search of MEDLINE, Embase, Web of Science, and Cochrane Library was performed for published literature up to August 2015 concerning PAE in the treatment of BPH. Inclusion and exclusion criteria were applied by two independent reviewers, and disagreements were resolved by consensus. Peer-reviewed studies concerning PAE with BPH with a sample size >10 and at least one measured parameter were included. RESULTS The search yielded 193 articles, of which ten studies representing 788 patients, with a mean age of 66.97 years, were included. Patients had LUTS ranging from moderate to severe. At 6 months following procedure, PV, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05), while for PSA there was no significant change. At 12 and 24 months, PV, PSA, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05). IIEF was unchanged at 6 and 12 months but was significantly reduced at 24 months. CONCLUSION This suggests that PAE is effective in treating LUTS in the short and intermediate term.
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Affiliation(s)
- Michelle Kuang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anthony Vu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sriharsha Athreya
- St. Joseph's Healthcare, Hamilton, ON, Canada. .,McMaster University Faculty of Health Sciences, Centre for Interventional Radiology and Oncology, Josephs Healthcare Hamilton, Rm. T0112, 50 Charlton Ave. E., Hamilton, ON, L8N 4A6, Canada.
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237
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Teoh JYC, Chiu PKF, Yee CH, Wong HM, Chan CK, Chan ESY, Hou SSM, Ng CF. Prostatic artery embolization in treating benign prostatic hyperplasia: a systematic review. Int Urol Nephrol 2016; 49:197-203. [DOI: 10.1007/s11255-016-1461-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 11/24/2022]
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238
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Mirakhur A, McWilliams JP. Prostate Artery Embolization for Benign Prostatic Hyperplasia: Current Status. Can Assoc Radiol J 2016; 68:84-89. [PMID: 27887933 DOI: 10.1016/j.carj.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
Prostate artery embolization has garnered much attention as a promising treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. We aim to provide an up-to-date review of this minimally invasive technique, including discussion of potential benefits and technical challenges. Current evidence suggests it is a safe and effective option for patients with medication-refractory urinary obstructive symptoms who are poor surgical candidates or refuse surgical therapy. Larger, randomized studies with long-term follow-up data are needed for this technique to be formally established in the treatment paradigm for benign prostatic hyperplasia.
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Affiliation(s)
- Anirudh Mirakhur
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA.
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239
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Feng S, Tian Y, Liu W, Li Z, Deng T, Li H, Wang K. Prostatic Arterial Embolization Treating Moderate-to-Severe Lower Urinary Tract Symptoms Related to Benign Prostate Hyperplasia: A Meta-Analysis. Cardiovasc Intervent Radiol 2016; 40:22-32. [DOI: 10.1007/s00270-016-1516-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/15/2016] [Indexed: 12/12/2022]
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Bagla S, Smirniotopoulos J, Orlando JC, Piechowiak R. Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis. Cardiovasc Intervent Radiol 2016; 40:360-365. [PMID: 27872983 DOI: 10.1007/s00270-016-1514-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Prostatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH. MATERIALS AND METHODS IRB-approved retrospective study of 40 consecutive patients 49-81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months. RESULTS No significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm2 vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred. CONCLUSIONS Robotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.
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Affiliation(s)
- Sandeep Bagla
- Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA.
| | | | - Julie C Orlando
- Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA
| | - Rachel Piechowiak
- Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA
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Pyo JS, Cho WJ. Systematic review and meta-analysis of prostatic artery embolisation for lower urinary tract symptoms related to benign prostatic hyperplasia. Clin Radiol 2016; 72:16-22. [PMID: 27863699 DOI: 10.1016/j.crad.2016.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/23/2016] [Accepted: 10/13/2016] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the efficacy of prostatic artery embolisation (PAE) in lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) at short- and mid-term follow-up. MATERIALS AND METHODS The current study included 484 BPH patients from seven eligible studies. A meta-analysis was performed to determine the mean differences in parameters associated with LUTS, including the international prostate symptom score (IPSS), peak urinary flow (Qmax), post-void residual volume (PVR), quality of life score (QoL), prostate-specific antigen level (PSA), and prostatic volume (PV), between baseline and follow-up periods. RESULTS Nearly all parameters at follow-up of 3-24 months were significantly improved compared to the baseline. Mean differences in IPSS at 3, 6, 12, and 24 months were -14.06 (95% confidence interval [CI]: -16.47 to -11.64), -12.32 (95% CI: -15.57 to -9.08), -16.41 (95% CI: -19.81 to -13.02), and -17 (95% CI: -17.91 to -16.09), respectively. In addition, mean differences of Qmax, PVR, PV, and QoL between the follow-up period and baseline were improved significantly; however, there were no significant differences in PSA at 24 months. CONCLUSION The present data shows that PAE could improve LUTS by BPH after short- and mid-term follow-up; however, more cumulative studies for long-term follow-up and comparison with other therapeutic modalities will be needed.
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Affiliation(s)
- J-S Pyo
- Department of Pathology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - W J Cho
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Republic of Korea.
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Wang XY, Zong HT, Zhang Y. Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis. Clin Interv Aging 2016; 11:1609-1622. [PMID: 27956827 PMCID: PMC5113931 DOI: 10.2147/cia.s119241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Prostate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The purpose of this article was to evaluate the efficacy and safety of PAE on LUTS related to BPH. Materials and methods A literature review was performed to identify all published articles of PAE for BPH. The sources included MEDLINE, EMBASE and Cochrane Library from 1980 to 2016. A systematic review and meta-analysis was conducted. The outcome measurements were combined by calculating the mean difference with 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.0. Results Twelve studies involving 840 participants were included. Compared with baseline, the International Index of Erectile Function (IIEF-5; International Prostate Symptom Score) scores, the quality of life scores, peak urinary flow rate (Qmax) and postvoid residual volume all had significant improvements during the 24-month follow-up (all P<0.00001). Both prostate volume (PV) and prostate-specific antigen had significant decrease during the 12-month follow-up (P<0.00001 and P=0.005, respectively), except postoperative 24 months (P=0.47 and P=0.32, respectively). The IIEF-5 short form scores had significant increase at postoperative 6 months (P=0.002) and 12 months (P<0.0001), except postoperative 1 month (P=0.23) and 24 months (P=0.21). For large volume (PV ≥80 mL) BPH, the results were similar. There were no life-threatening complications. Conclusion PAE is an effective, safe and well-tolerable treatment for LUTS related to BPH, including large volume (PV ≥80 mL) BPH, with a good short-term follow-up. Studies with large number of cases and longer follow-up time are needed to validate our results.
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Affiliation(s)
- Xiao-Yan Wang
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huan-Tao Zong
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yong Zhang
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
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Loehr JA, Stinnett GR, Hernández-Rivera M, Roten WT, Wilson LJ, Pautler RG, Rodney GG. Eliminating Nox2 reactive oxygen species production protects dystrophic skeletal muscle from pathological calcium influx assessed in vivo by manganese-enhanced magnetic resonance imaging. J Physiol 2016; 594:6395-6405. [PMID: 27555555 PMCID: PMC5088246 DOI: 10.1113/jp272907] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/12/2016] [Indexed: 01/18/2023] Open
Abstract
KEY POINTS Inhibiting Nox2 reactive oxygen species (ROS) production reduced in vivo calcium influx in dystrophic muscle. The lack of Nox2 ROS production protected against decreased in vivo muscle function in dystrophic mice. Manganese-enhanced magnetic resonance imaging (MEMRI) was able to detect alterations in basal calcium levels in skeletal muscle and differentiate disease status. Administration of Mn2+ did not affect muscle function or the health of the animal, and Mn2+ was cleared from skeletal muscle rapidly. We conclude that MEMRI may be a viable, non-invasive technique to monitor molecular alterations in disease progression and evaluate the effectiveness of potential therapies for Duchenne muscular dystrophy. ABSTRACT Duchenne muscular dystrophy (DMD) is an X-linked progressive degenerative disease resulting from a mutation in the gene that encodes dystrophin, leading to decreased muscle mechanical stability and force production. Increased Nox2 reactive oxygen species (ROS) production and sarcolemmal Ca2+ influx are early indicators of disease pathology, and eliminating Nox2 ROS production reduces aberrant Ca2+ influx in young mdx mice, a model of DMD. Various imaging modalities have been used to study dystrophic muscle in vivo; however, they are based upon alterations in muscle morphology or inflammation. Manganese has been used for indirect monitoring of calcium influx across the sarcolemma and may allow detection of molecular alterations in disease progression in vivo using manganese-enhanced magnetic resonance imaging (MEMRI). Therefore, we hypothesized that eliminating Nox2 ROS production would decrease calcium influx in adult mdx mice and that MEMRI would be able to monitor and differentiate disease status in dystrophic muscle. Both in vitro and in vivo data demonstrate that eliminating Nox2 ROS protected against aberrant Ca2+ influx and improved muscle function in dystrophic muscle. MEMRI was able to differentiate between different pathological states in vivo, with no long-term effects on animal health or muscle function. We conclude that MEMRI is a viable, non-invasive technique to differentiate disease status and might provide a means to monitor and evaluate the effectiveness of potential therapies in dystrophic muscle.
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Affiliation(s)
- James A Loehr
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Gary R Stinnett
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | | | - Wesley T Roten
- SMART Program, Baylor College of Medicine, Houston, TX, USA
- Department of Biology, University of North Carolina, Chapel Hill, NC, USA
| | - Lon J Wilson
- Department of Chemistry, Rice University, Houston, TX, USA
| | - Robia G Pautler
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - George G Rodney
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA.
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Uflacker A, Haskal ZJ, Bilhim T, Patrie J, Huber T, Pisco JM. Meta-Analysis of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2016; 27:1686-1697.e8. [DOI: 10.1016/j.jvir.2016.08.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/02/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022] Open
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Short- to Midterm Safety and Efficacy of Prostatic Artery Embolization: A Systematic Review. J Vasc Interv Radiol 2016; 27:1487-1493.e1. [DOI: 10.1016/j.jvir.2016.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 12/28/2022] Open
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246
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Yu H, Isaacson AJ, Burke CT. Review of Current Literature for Prostatic Artery Embolization. Semin Intervent Radiol 2016; 33:231-5. [PMID: 27582611 DOI: 10.1055/s-0036-1586141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prostatic artery embolization (PAE) is an emerging, novel interventional technique in the management of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is a common clinical condition in middle-aged and elderly men resulting in LUTS, including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Traditionally, LUTSs have been managed by medical or surgical therapies. Since the initial incidental discovery that selective PAE performed for uncontrolled bleeding secondary to BPH resulted in improved LUTS, the technique has continually evolved with a growing body of evidence supporting its safety and efficacy. However, despite the available data, PAE has yet to be established as a standard-of-care treatment option for patients with LUTS/BPH. In this article, the authors review the history and current state of PAE, including published data from case reports, animal studies, retrospective/prospective cohort studies, and prospective randomized controlled trials.
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Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Amouyal G, Chague P, Pellerin O, Pereira H, Del Giudice C, Dean C, Thiounn N, Sapoval M. Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH. Cardiovasc Intervent Radiol 2016; 39:1245-55. [DOI: 10.1007/s00270-016-1412-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 06/25/2016] [Indexed: 12/28/2022]
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Garzón WJ, Andrade G, Dubourcq F, Abud DG, Bredow M, Khoury HJ, Kramer R. Prostatic artery embolization: radiation exposure to patients and staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:246-254. [PMID: 27025551 DOI: 10.1088/0952-4746/36/2/246] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the radiation doses to patients and staff received from the first cases of prostatic artery embolization (PAE) conducted in a public hospital in Recife, Brazil. Five PAE procedures for 5 men diagnosed with benign prostatic hyperplasia were investigated. In order to characterize patient exposure, dosimetric quantities, such as the air kerma-area product (P KA), the cumulative air kerma at the interventional reference point (Ka,r), the number of images, etc, were registered. To evaluate the possibility for deterministic effects, the peak skin dose (PSD) was measured using radiochromic films. For evaluation of personal dose equivalent and effective dose to the medical staff, thermoluminescent dosemeters (TLD-100) were used. The effective dose was estimated using the double dosimetry alghoritm of von Boetticher. The results showed that the mean patient's PSD per procedure was 2674.2 mGy. With regard to the medical staff, the mean, minimum and maximum effective doses estimated per procedure were: 18 μSv, 12 μSv and 21 μSv respectively. High personal equivalent doses were found for the feet, hands and lens of the eye, due to the use of multiple left anterior oblique projections and the improper use of the suspended lead screen and the lead curtain during procedures.
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Affiliation(s)
- W J Garzón
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
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Bilhim T, Pisco J, Pereira JA, Costa NV, Fernandes L, Campos Pinheiro L, Duarte M, Oliveira AG. Predictors of Clinical Outcome after Prostate Artery Embolization with Spherical and Nonspherical Polyvinyl Alcohol Particles in Patients with Benign Prostatic Hyperplasia. Radiology 2016; 281:289-300. [PMID: 27223621 DOI: 10.1148/radiol.2016152292] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess predictors of outcome after prostate artery embolization (PAE) for benign prostatic hyperplasia with spherical particle polyvinyl alcohol (sPVA) and compare outcomes with the use of nonspherical particle polyvinyl alcohol (nsPVA). Materials and Methods This was a single-center retrospective institutional review board-approved study conducted from 2009 to 2015 in patients undergoing PAE with sPVA (n = 186; mean age ± standard deviation, 65.5 years ± 7.7) and nsPVA (n = 300; mean age, 65.3 years ± 7.6). The two cohorts were compared and analyzed for predictors of outcome with a Cox proportional hazards model and linear regression. Post-PAE prostate ischemia was measured with contrast material-enhanced magnetic resonance (MR) imaging in 23 patients with nsPVA and 25 patients with sPVA. The 24-hour post-PAE prostate-specific antigen (PSA) level was registered in 133 patients with sPVA. Prognostic values of MR imaging and PSA levels 24 hours after PAE were assessed with Cox and random-effects regressions. Results Predictors of clinical failure were older age (age over 65 years, P = .002), unilateral procedure (P = .002), and higher baseline International Prostate Symptom Score (IPSS, P = .033). Adjusted hazard ratio for clinical failure of sPVA was 1.273 (P = .16). Acute urinary retention was a predictor of lower IPSS after PAE (P = .002). The mean proportion of prostate ischemia was 11% with sPVA and 10% with nsPVA (P = .65). Lower IPSS after PAE was associated with a higher proportion of prostate ischemia (P = .009). Patients with a PSA level of at least 75 ng/mL (75 μg/L) 24 hours after PAE had a greater decrease in IPSS (P = .01). Prostate ischemic volume and PSA level 24 hours after PAE were correlated (Pearson r = 0.64, P = .014). Conclusion Clinical outcome was similar after PAE with sPVA and nsPVA. Younger age (up to 65 years), bilateral PAE, lower baseline IPSS, and acute urinary retention were predictors of better clinical outcome. The PSA level 24 hours after PAE correlated with prostate ischemia, and both correlated with clinical outcome. (©) RSNA, 2016.
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Affiliation(s)
- Tiago Bilhim
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - João Pisco
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - José A Pereira
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Nuno Vasco Costa
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Lúcia Fernandes
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Luís Campos Pinheiro
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Marisa Duarte
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - António G Oliveira
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
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250
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Abdel-Aal AK, Moustafa AS. Incidentally Discovered Middle Mesenteric Artery In A Renal Donor. J Radiol Case Rep 2016; 9:15-20. [PMID: 27200172 DOI: 10.3941/jrcr.v9i12.2493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The middle mesenteric artery is a very rare anomalous artery originating from the ventral surface of the abdominal aorta in-between the superior mesenteric artery and inferior mesenteric artery. We identified a middle mesenteric artery during abdominal computed tomographic angiography in a renal donor patient as a part of his work up. The middle mesenteric artery branched out into ileal and ileocolic arteries, supplying the terminal ileal loops as well as the cecum. The anomalous artery had no effect on patient's eligibility as a renal donor candidate.
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Affiliation(s)
- Ahmed Kamel Abdel-Aal
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
| | - Amr Soliman Moustafa
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
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