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Boschheidgen M, Ullrich T, Al-Monajjed R, Ziayee F, Michalski R, Steuwe A, Minko P, Albers P, Antoch G, Schimmöller L. Value of magnetic resonance angiography before prostatic artery embolization for intervention planning. Sci Rep 2024; 14:7758. [PMID: 38565890 PMCID: PMC10987590 DOI: 10.1038/s41598-024-58207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
Knowledge about anatomical details seems to facilitate the procedure and planning of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPS). The aim of our study was the pre-interventional visualization of the prostatic artery (PA) with MRA and the correlation of iliac elongation and bifurcation angles with technical success of PAE and technical parameters. MRA data of patients with PAE were analysed retrospectively regarding PA visibility, PA type, vessel elongation, and defined angles were correlated with intervention time, fluoroscopy time, dose area product (DAP), cumulative air kerma (CAK), contrast media (CM) dose and technical success of embolization. T-test, ANOVA, Pearson correlation, and Kruskal-Wallis test was applied for statistical analysis. Between April 2018 and March 2021, a total of 78 patients were included. MRA identified the PA origin in 126 of 147 cases (accuracy 86%). Vessel elongation affected time for catheterization of right PA (p = 0.02), fluoroscopy time (p = 0.05), and CM dose (p = 0.02) significantly. Moderate correlation was observed for iliac bifurcation angles with DAP (r = 0.30 left; r = 0.34 right; p = 0.01) and CAK (r = 0.32 left; r = 0.36 right; p = 0.01) on both sides. Comparing the first half and second half of patients, median intervention time (125 vs. 105 min.) and number of iliac CBCT could be reduced (p < 0.001). We conclude that MRA could depict exact pelvic artery configuration, identify PA origin, and might obviate iliac CBCT. Vessel elongation of pelvic arteries increased intervention time and contrast media dose while the PA origin had no significant influence on intervention time and/or technical success.
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Affiliation(s)
- Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Rouvier Al-Monajjed
- Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Farid Ziayee
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Rene Michalski
- Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Peter Albers
- Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
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Ngov D, Self SC, Schammel CM, Devane AM. Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review. HEALTH PHYSICS 2023; 124:200-207. [PMID: 36719935 DOI: 10.1097/hp.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT Prostate artery embolization is a minimally invasive treatment for benign prostatic hyperplasia, and imaging is indispensable for the technical success of this procedure; however, imaging is a major source of radiation exposure for patients and healthcare providers. Radiation emission during prostate artery embolization procedures at a single institution was evaluated to determine radiation exposure with the goal to work toward minimizing exposure. All patients at a single institution that underwent outpatient unilateral/bilateral prostate artery embolization between 4 January 2019 and 16 November 2021 were retrospectively evaluated; data collected included body mass index, prostate volume, and indications for prostate artery embolization. Technical parameters recorded were air kerma, procedure time, fluoroscopy time, number of acquisitions, and intra-procedural imaging modalities. Fisher's t-test, ANOVA, and chi-square analyses were used as appropriate for statistical analysis (P < 0.05). Overall, 56 patients were included in the study. Body mass index (obesity; P = 0.0017) was a significant predictor of increased air kerma; prostate size and bilateral vs. unilateral prostate artery embolization were not significantly associated with increased air kerma despite the number of acquisitions being significantly different between bilateral and unilateral embolization (P = 0.0064). When evaluating radiation exposure during prostate artery embolization, increased body mass index significantly predicted increased air kerma. Contrary to the literature, the extent of embolization (bilateral vs. unilateral) was not associated with increased air kerma regardless of higher acquisitions and procedure time associated with bilateral prostate artery embolization. Increased radiation protection efforts should be considered for patients with higher body mass index to protect patients and practitioners.Health Phys. 124(0):000-000; 2023.
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Affiliation(s)
- Daniel Ngov
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Stella Cw Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
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Review of Sexual Health-Friendly BPH Therapies. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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Wang K, Chen M, Liu Y, Xiao W, Qian Y, Liu X. Efficacy and Safety of Prostatic Artery Embolization in the Treatment of High Risk Benign Prostatic Hyperplasia and its Influence on Postoperative Life Quality of Patients. Front Surg 2022; 9:905394. [PMID: 35656089 PMCID: PMC9152163 DOI: 10.3389/fsurg.2022.905394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the efficacy, safety and postoperative quality of life of high risk benign prostatic hyperplasia (BPH) patients treated with prostatic artery embolization. Methods 34 patients with high-risk BPH were selectedfrom January 2020 to June 2021 in our hospital. All patients were treated with prostatic artery embolization. The changes of international prostate symptom score (IPSS), prostate volume (PV), remaining urine (RU), maximum urine flow rate (Qmax), quality of life scale -74(GQOLI-74), time to sleep without disturbance (HUS) judgment, self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) were compared before operation, 1 month and 6 months after operation. Results Prostatic artery embolization was successful in all 34 patients, including unilateral embolization in 15 patients and bilateral embolization in 19 patients. No severe complications occurred in the postoperative patients. The IPSS, PV and RU levels of the patient one month and six months after surgery were lower than those before surgery, while the Qmax level was higher than that before surgery. Besides, the IPSS, PV and RU levels six months after surgery were significantly lower than those one month after surgery, and the Qmax level was significantly higher than that one month after surgery (p < 0.05). The GQOLI-74 score six months after surgery was significantly higher than that before surgery (p < 0.05). The HUS of the patient six months after surgery was significantly increased, and the SAS and SDS scores were significantly decreased as compared with those before surgery (p < 0.05). Conclusion For high-risk patients with BPH, prostate embolization is an effective and safe method, which can significantly improve the quality of life of patients after surgery and has good application prospects.
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Affiliation(s)
- Kun Wang
- Department of Urology, The First Chinese Traditional Hospital of Changde, Changde City, China
| | - Ming Chen
- Vascular intervention department, The First Chinese Traditional Hospital of Changde, Changde City, China
| | - Yiqing Liu
- Department of Urology, The First Chinese Traditional Hospital of Changde, Changde City, China
| | - Weiren Xiao
- Department of Urology, The First Chinese Traditional Hospital of Changde, Changde City, China
| | - Yonghong Qian
- Department of Urology, The First Chinese Traditional Hospital of Changde, Changde City, China
| | - Xu Liu
- Department of Internal Medicine, Changde Geriatric Hospital, Changde City, China
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Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization. Diagnostics (Basel) 2022; 12:diagnostics12030585. [PMID: 35328138 PMCID: PMC8946889 DOI: 10.3390/diagnostics12030585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: To assess the treatment response of benign prostatic syndrome (BPS) following prostatic artery embolization (PAE) using a semi-automatic software analysis of magnetic resonance imaging (MRI) features and clinical indexes. (2) Methods: Prospective, monocenter study of MRI and clinical data of n = 27 patients with symptomatic BPS before and (1, 6, 12 months) after PAE. MRI analysis was performed using a dedicated semi-automatic software for segmentation of the central and the total gland (CG, TG), respectively; signal intensities (SIs) of T1-weighted (T1w), T2-weighted (T2w), and diffusion-weighted images (DWI), as well as intravesical prostatic protrusion (IPP) and prostatic volumes (CGV, TGV), were evaluated at each time point. The semi-automatic assessed TGV was compared to conventional TGV by an ellipse formula. International prostate symptom score (IPSS) and international consultation on incontinence questionnaire−urinary incontinence short form (ICIQ-UI SF) questionnaires were used as clinical indexes. Statistical testing in the form of ANOVA, pairwise comparisons using Bonferroni correction, and multiple linear correlations, were conducted using SPSS. (3) Results: TGV was significantly reduced one, six, and 12 months after PAE as assessed by the semi-automatic approach and conventional ellipse formula (p = 0.005; p = 0.025). CGV significantly decreased after one month (p = 0.038), but showed no significant differences six and 12 months after PAE (p = 0.191; p = 0.283). IPP at baseline was demonstrated by 25/27 patients (92.6%) with a significant decrease one, six, and 12 months after treatment (p = 0.028; p = 0.010; p = 0.008). Significant improvement in IPSS and ICIQ-UI SF (p = 0.002; p = 0.016) after one month correlated moderately with TGV reduction (p = 0.031; p = 0.05, correlation coefficients 0.52; 0.69). Apparent diffusion coefficient (ADC) values of CG significantly decreased one month after embolization (p < 0.001), while there were no significant differences in T1w and T2w SIs before and after treatment at each time point. (4) Conclusions: The semi-automatic approach is appropriate for the assessment of volumetric and morphological changes in prostate MRI following PAE, able to identify significantly different ADC values post-treatment without the need for manual identification of infarct areas. Semi-automatic measured TGV reduction is significant and comparable to the TGV calculated by the conventional ellipse formula, confirming the clinical response after PAE.
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Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis. J Vasc Interv Radiol 2021; 33:359-367.e8. [PMID: 34968671 DOI: 10.1016/j.jvir.2021.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
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Herrmann TRW, Misrai V, Sancha FG, Bach T. TURPxit or not: contemporary management options for benign prostatic obstruction. World J Urol 2021; 39:2251-2254. [PMID: 34283282 PMCID: PMC8332635 DOI: 10.1007/s00345-021-03780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Thomas R. W. Herrmann
- Urology Spital Thurgau AG, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
- Hannover Medical Scholl MHH, Carl Neuberg Str. 1, 30625 Hannover, Germany
- Stellenbosch University Western Cape, Stellenbosch, South Africa
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, Toulouse, France
| | - Fernando Gómez Sancha
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Ventisquero de la Condesa 42, 28035 Madrid, Spain
- Urology Department, Hill Clinic, Sofia, Bulgaria
| | - Thorsten Bach
- Department of Urology, AsklepiosWestklinikumHamburg, Suurheid 20, 22559 Hamburg, Germany
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