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Wante M, Mathai MJ, Shetty V. Comparative Outcomes of Monopolar and Bipolar Transurethral Resection of the Prostate: An Institutional Perspective. Cureus 2024; 16:e67947. [PMID: 39347160 PMCID: PMC11436255 DOI: 10.7759/cureus.67947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/27/2024] [Indexed: 10/01/2024] Open
Abstract
Objective This prospective comparative study aimed to highlight and compare two types of transurethral resection of the prostate (TURP), namely M-TURP (monopolar) and B-TURP (bipolar), in the endoscopic management of benign prostatic hyperplasia (BPH). Methods and materials This research was conducted between 2022 and 2023 at a tertiary care health center. Included in the investigation were 100 consenting study participants undergoing M-TURP and B-TURP at our center. All referred patients presenting with clinical, ultrasound, or uroflowmetry features of BPH and those with failed attempts at medical management were included in the study. Patients with carcinoma of the prostate were excluded from the study. Post-operatively, the endpoints for comparison included maximal urinary flow rate (Qmax), prostate volume, duration of hospital stay, duration of catheterization, drop in serum sodium concentration, and drop in hemoglobin levels. Descriptive statistics were computed to delineate the study sample. After the completion of data collection, data analysis was performed using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago, IL, USA), and the correlations sought were achieved using the Chi-square test of significance. Results The peak incidence of BPH was seen in the sixth decade of life: the M-TURP group was 65.16 ± 7.07 years (mean ± standard deviation), while that in the B-TURP group was 62.32 ± 8.16 years (mean ± standard deviation). Nine percent of the study participants did not show any comorbidities. The most frequent symptom of BPH at presentation was a poor urinary stream (78%, n = 100), followed by nocturia (67%, n = 100). In our study, patients undergoing M-TURP had a mean serum prostate-specific antigen (PSA) level of 4.31 ± 1.03 ng/mL, while patients undergoing B-TURP had a mean serum PSA of 4.24 ± 0.99 ng/mL (p = 0.820; p > 0.05). The study found that patients undergoing M-TURP had a mean prostate size of 35.04 ± 3.57 cc, while those undergoing B-TURP had a mean prostate size of 35.72 ± 3.22 cc (p = 0.765). For the B-TURP group, the mean decrease in postoperative serum sodium concentration was 4.3 mEq/L, while for the M-TURP group, it was 6.4 mEq/L (p = 0.903). In the M-TURP group, there were three cases of transurethral resection (TUR) syndrome, while the B-TURP group had only one case. Conclusion BPH is a common problem affecting the quality of life of several male patients. Both M-TURP and B-TURP are comparable in their efficacy in treating BPH, with the exception of a higher incidence of hyponatremia and TUR syndrome in the M-TURP group.
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Affiliation(s)
- Mahendra Wante
- Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Mathew John Mathai
- Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Varun Shetty
- Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Cai H, Zhu C, Fang J. Ultrasound-guided perineal laser ablation versus prostatic arterial embolization for benign prostatic hyperplasia: two similar short-term efficacies. Acta Radiol 2023; 64:2033-2039. [PMID: 36437581 DOI: 10.1177/02841851221140214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are many ways to treat prostatic hyperplasia; these are currently more inclined to minimally invasive treatment. We mainly compared the differences between two treatment methods, ultrasound-guided transperineal laser ablation (US-TPLA) and prostatic artery embolization (PAE). PURPOSE To evaluate the efficacy and safety of US-TPLA and PAE in the treatment of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS The clinical information for 40 patients with BPH admitted to our hospital between June 2018 and January 2021 were retrospectively analyzed. The changes in International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume (PV), and the incidence of complications were compared between groups. RESULTS The IPSS (P < 0.001; P < 0.001), QoL (P < 0.001; P < 0.001), Qmax (P < 0.001; P < 0.001), PVR (P < 0.001; P < 0.001), and PV (P < 0.001; P < 0.001) at three and six months after US-TPLA and PAE improved with respect to those before surgery. There was no significant difference in IPSS (P = 0.235; P = 0.151), QoL (P = 0.527; P = 0.294), Qmax (P = 0.776; P = 0.420), PVR (P = 0.745; P = 0.607), and PV (P = 0.527; P = 0.573) between the groups at three and six months after surgery. No serious complications occurred in either group. CONCLUSION US-TPLA and PAE seem to have a similar short-term efficacy. The efficacy of the two procedures is comparable, and neither is associated with serious complications. US-TPLA and PAE are both effective complementary measures for the treatment of BPH.
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Affiliation(s)
- Huaijie Cai
- Department of Ultrasound, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, PR China
| | - Conghui Zhu
- Department of Interventional Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, PR China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
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Chang YC, Chen SJ, Huang WH, Huang CP, Chen YH, Chen WC. Prostate Cancer after Percutaneous Arterial Embolization of the Prostate: A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12102378. [PMID: 36292067 PMCID: PMC9600189 DOI: 10.3390/diagnostics12102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
We report a patient with prostate cancer found 2 years after percutaneous arterial embolization (PAE) of the prostate with a rapid increase in prostate specific antigen (PSA) 3 months later, even though the initial result was low. He did not consult a urologist during or after PAE until acute urinary retention developed. The clinical stage was cT2cN1M1b with Gleason grade 5 + 5 = 10. An increase in PSA a short interval after PAE may suggest the presence of prostate cancer. We suggest that patients undergoing PAE should consult a urologist, and that PSA levels should be checked every 3 months in the first year after PSA.
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Affiliation(s)
- Ying-Chieh Chang
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Wei-Hsuan Huang
- Department of Urology, Everan Hospital, Taichung 41159, Taiwan
| | - Chi-Ping Huang
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yung-Hsiang Chen
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Wen-Chi Chen
- Department of Urology, Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Correspondence:
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Retrospective observation of the efficacy and safety of prostatic artery embolization combined with transurethral resection of the prostate and simple transurethral resection of the prostate in the treatment of large (> 100 mL) benign prostatic hyperplasia. Abdom Radiol (NY) 2021; 46:5746-5757. [PMID: 34448024 DOI: 10.1007/s00261-021-03258-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively compare the efficacy and safety of prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) and simple TURP in treating large (> 100 mL) benign prostatic hyperplasia (BPH). METHODS We retrospectively analyzed the clinical data of 13 and 17 patients with large BPH who underwent TURP and PAE + TURP, respectively, from January 2016 to January 2020. The changes in various indices before and after surgery were compared between the two groups. RESULTS In the PAE + TURP group, the operation time (OT), intraoperative blood loss (BL), postoperative bladder flushing time (PBFT), and postoperative catheter retention time (PCRT) were lower, and the speed of the excised lesion (SEL) was higher than that in the TURP group (P < 0.05). Following-up for 12 months, the prostatic volume (PV), maximum urinary flow rate (Qmax), postvoid residual volume (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL) score, total prostate-specific antigen (T-PSA), and free prostate-specific antigen (F-PSA) in each group improved as compared to before the surgery (P < 0.05), and the above improved indicators, IPSS ratio, and obstructive symptoms in the PAE + TURP group were higher than those in the TURP group (P < 0.05). The incidence of postoperative complications in the PAE + TURP group was lower than that in the TURP group. We obtained the pathological picture of a prostate biopsy after PAE for the first time. CONCLUSION Compared to TURP alone, PAE + TURP should be promoted, because of its greater efficacy and safety in treating large BPH and fewer post-surgical complications.
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Culp WTN, Johnson EG, Giuffrida MA, Palm CA, Skorupski KA, Burton JH, Rebhun RB, Willcox JL, Kent MS, Rodriguez CO, Glaiberman CB. Procedural description and prospective evaluation of short-term outcome for the use of prostatic artery embolization in dogs with carcinoma of the prostate. J Am Vet Med Assoc 2021; 259:1154-1162. [PMID: 34727073 DOI: 10.2460/javma.20.06.0324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the procedure of prostatic artery embolization (PAE) in dogs with prostatic carcinoma and to evaluate the short-term outcome for treated dogs. ANIMALS 20 client-owned dogs with prostatic carcinomas between May 2014 and July 2017. PROCEDURES In this prospective cohort study, dogs with carcinoma of the prostate underwent PAE with fluoroscopic guidance. Before and after PAE, dogs underwent CT and ultrasonographic examinations of the prostate, and each owner completed a questionnaire about the dog's clinical signs. Results for before versus after PAE were compared. RESULTS Prostatic artery embolization was successfully performed in all 20 dogs. Tenesmus, stranguria, and lethargy were significantly less common 30 days after PAE (n = 2, 1, and 0 dogs, respectively), compared with before PAE (9, 10, and 6 dogs, respectively). Median prostatic volume was significantly less 30 days after PAE (14.8 cm3; range, 0.4 to 48.1 cm3; interquartile [25th to 75th percentile] range, 6.7 to 19.5 cm3), compared with before PAE (21.7 cm3; range, 2.9 to 77.7 cm3; interquartile range, 11.0 to 35.1 cm3). All dogs had a reduction in prostatic volume after PAE, with a median prostatic volume loss of 39.4% (95% CI, 20.3% to 59.3%). CONCLUSIONS AND CLINICAL RELEVANCE Prostatic artery embolization was associated with decreased prostate volume and improved clinical signs in this cohort. The short-term response to PAE appears promising, and evaluation of the long-term impact on survival time is needed.
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Maqboul F, Umranikar S. Retention by sloughed prostatic tissue: A rare complication after prostate artery embolization. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211018133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fouad Maqboul
- Urology Department, Ashford and St Peter’s Hospital, UK
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Sare A, Kothari P, Cieslak JA, Gantz O, Aly S, Kumar A, Patel N, Shukla PA. Perioperative Blood Loss after Preoperative Prostatic Artery Embolization in Patients Undergoing Simple Prostatectomy: A Propensity Score‒Matched Study. J Vasc Interv Radiol 2021; 32:1113-1118. [PMID: 34062272 DOI: 10.1016/j.jvir.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess perioperative blood loss following prostatic artery embolization (PAE) before surgery in patients undergoing simple prostatectomy. METHODS A retrospective chart review was used to identify 63 patients (mean age, 65.3 ± 8.0 years) with prostatic hypertrophy and severe lower urinary tract symptoms who underwent prostatectomy from September 2014 to December 2019, 18 (28.5%) of whom underwent PAE before surgery. Demographic data, pertinent laboratory results, procedural or operative information, hospital course details, and pathology reports were obtained. A 2:1 propensity score‒matching analysis was performed to compare intraoperative blood loss in patients who underwent prostatectomy alone with intraoperative blood loss in those who first underwent bilateral PAE before surgery. RESULTS Sixteen (89%) of the 18 patients underwent bilateral PAE before surgery. Thirty-two patients who underwent prostatectomy without embolization before surgery were selected for the 2:1 propensity score‒matched analysis based on age, race, surgery type, prostate gland size, and comorbidities. The mean estimated blood loss (EBL) for prostatectomy alone was 545 ± 380 mL (mean ± standard deviation). There was a statistically significant reduction in the EBL for patients who underwent bilateral PAE (303 ± 227 mL, P < .01). The operative time was also significantly decreased for patients who underwent PAE before surgery (P < .05). For patients who underwent PAE, there were no complications related to the procedure. CONCLUSIONS Bilateral PAE before surgery appears to be safe and may be effective in reducing perioperative bleeding and operative time.
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Affiliation(s)
- Antony Sare
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Pankti Kothari
- Division of Urology, Department of Surgery, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - John A Cieslak
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Owen Gantz
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Samuel Aly
- Division of Urology, Department of Surgery, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Abhishek Kumar
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Nitin Patel
- Division of Urology, Department of Surgery, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Pratik A Shukla
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey.
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8
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Tang Y, Zhang JH, Zhu YB, Wu SJ, Cai SL, Zhou YF, Qian X, Luo JW, Fang ZT. Effect of superselective prostatic artery embolization on benign prostatic hyperplasia. Abdom Radiol (NY) 2021; 46:1726-1736. [PMID: 33025152 DOI: 10.1007/s00261-020-02782-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/16/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the safety and effectiveness of superselective prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). METHODS Sixty-five patients diagnosed with BPH in Fujian Provincial Hospital between December 2014 and July 2019 were included. Patients with ineffective drug treatment after 6 months, who refused surgery, or who were unsuitable for surgery were included. We observed postoperative complications, followed up at 1, 3, and 6 months, compared clinical symptoms, and monitored changes in prostate-specific antigen (PSA) and prostatic volume (PV) before and after treatment. RESULTS Of the 65 patients, 58 (89.23%) successfully received PAE; 44 and 14 bilateral and unilateral embolization, respectively. Clinical efficacy was 94.83% (55/58) after the 6-month follow-up. Postoperative PV, International Prostate Symptom Score, quality of life, maximum flow rate, and post-void residual significantly improved after 6 months (P < 0.05). One month after PAE, the serum total PSA increased by 1.47 (10.84/7.37) times and dropped 3 months later to a level lower than that before surgery (P < 0.05). Six months after PAE, the degree of relief from obstructive symptoms was more apparent than that of irritative symptoms. No serious complications were observed after PAE. CONCLUSION PAE was safe and effective for the treatment of BPH. The efficacy of bilateral PAE was better than that of unilateral PAE.
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Affiliation(s)
- Yi Tang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Jian-Hui Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Yao-Bin Zhu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Shao-Jie Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Sen-Lin Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yan-Feng Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Xin Qian
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Jie-Wei Luo
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, 350001, China.
| | - Zhu-Ting Fang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China.
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Palumbo P, Manetta R, Izzo A, Bruno F, Arrigoni F, De Filippo M, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement. Gland Surg 2020; 9:2235-2247. [PMID: 33447576 DOI: 10.21037/gs-20-547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity. Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Izzo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Ziglioli F, Maestroni U, Manna C, Negrini G, Granelli G, Greco V, Pagnini F, De Filippo M. Multiparametric MRI in the management of prostate cancer: an update-a narrative review. Gland Surg 2020; 9:2321-2330. [PMID: 33447583 DOI: 10.21037/gs-20-561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The growing interest in multiparametric MRI is leading to important changes in the diagnostic process of prostate cancer. MRI-targeted biopsy is likely to become a standard for the diagnosis of prostate cancer in the next years. Despite it is well known that MRI has no role as a staging technique, it is clear that multiparametric MRI may be of help in active surveillance protocols. Noteworthy, MRI in active surveillance is not recommended, but a proper understanding of its potential may be of help in achieving the goals of a delayed treatment strategy. Moreover, the development of minimally invasive techniques, like laparoscopic and robotic surgery, has led to greater expectations as regard to the functional outcomes of radical prostatectomy. Multiparametric MRI may play a role in planning surgical strategies, with the aim to provide the highest oncologic outcome with a minimal impact on the quality of life. We maintain that a proper anatomic knowledge of prostate lesions may allow the surgeon to achieve a better result in planning as well as in performing surgery and help the surgeon and the patient engage in a shared decision in planning a more effective strategy for prostate cancer control and treatment. This review highlights the advantages and the limitations of multiparametric MRI in prostate cancer diagnosis, in active surveillance and in planning surgery.
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Affiliation(s)
| | | | - Carmelinda Manna
- Department of Radiology, University-Hospital of Parma, Parma, Italy
| | - Giulio Negrini
- Department of Radiology, University-Hospital of Parma, Parma, Italy
| | - Giorgia Granelli
- Department of Urology, University-Hospital of Parma, Parma, Italy
| | - Valentina Greco
- Department of Radiology, University-Hospital of Parma, Parma, Italy
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11
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Young S, Gasparetto A, Jalaeian H, Golzarian J. Biomarkers in the setting of benign prostatic hyperplasia-induced lower urinary tract symptoms: what an interventional radiologist needs to know. Br J Radiol 2020; 93:20200484. [PMID: 32706988 PMCID: PMC7548351 DOI: 10.1259/bjr.20200484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 11/05/2022] Open
Abstract
With increasing evidence to support prostate artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS), Interventional Radiologists have begun to play an important role in the management of these patients. One area of knowledge needed when developing a PAE practice is knowledge of prostate-specific antigen (PSA) and other biomarkers utilized to detect prostate cancer in this population and what role they should play in the work up and follow-up of patients presenting with presumed BPH-induced LUTS. Furthermore, understanding how to evaluate presumed BPH-induced LUTS and stratify the risk of prostate cancer is an important skill to develop. The goal of this review is to provide Interventional Radiologists who have begun or aim to begin a PAE practice with the information they need to know regarding PSA levels and prostate cancer risk stratification for this patient population.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
| | - Alessandro Gasparetto
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami 1115 NW 14 St, Miami, FL, 33136, United States
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota. 420 Delaware ST SE MMC 292, Minneapolis, MN 55455, United States
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Arrichiello A, Angileri SA, Buccimazza G, Di Bartolomeo F, Di Meglio L, Liguori A, Gurgitano M, Ierardi AM, Papa M, Paolucci A, Carrafiello G. Interventional radiology management of high flow priapism: review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020010. [PMID: 33245065 PMCID: PMC8023077 DOI: 10.23750/abm.v91i10-s.10233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023]
Abstract
Introduction: High-flow priapism is a persistent partial penile tumescence, related to high flow arterial blood into the corpora. It is much less common than the low-flow priapism, and history of trauma is the more common aetiology. In the treatment of high flow priapism, super-selective embolization is considered treatment of choice when conservative treatment fails as reported in the “European Association of Urology Guidelines on Priapism”, but there are only few series reporting the outcome, the efficacy of different embolic materials and these studies are uncontrolled and relatively small. Objectives: The aim of this study is to review the literature to outline the state of the art of this interventional treatment and to analyse the outcome of the different embolic agents. Methods: Through Medline database (via PubMed) we searched all the English-language published articles related to priapism. Keywords were chosen according to MeSH terms. We selected case-series from 1990 to 2020 including at least five cases of high-flow priapism. The variables extracted from the selected articles were: number of patients, mean age, diagnostic imaging modality, mono or bilateral involvement of the arteries, embolization material, technical success, clinical success, complications, recurrence rate and type of reintervention, mean follow up, onset of erectile dysfunction. Results: We analyzed 11 papers. A total of 117 patients, mean age of 30 years, were studied during a period of 8 to 72 months. Technical success average was 99%, varying from 93 to 100%. Clinical success average was 88%, varying from 56 to 100%. After two or more treatments, resolution of priapism was obtained in all patients. No major adverse events registered. Recurrence rate of 21% (25/117) was observed, and only 4 patients underwent surgery. A total of 17 patients (15%) developed erectile dysfunction (ED). We also created a subgroup analysis focusing on specific outcome with different types of materials. Technical success was very high, 100% for all materials except for PVA particles Clinical Success was at least 70% with all kind of material. Best result was obtained with gel-foam (89%) and the worse with PVA (70%). Conclusion: Our data suggested comparable outcomes using different types of materials. In line with the last evidences we suggest that the choice of the embolic material should be selected basing on the expertise of the operator, the characteristic of the fistula and characteristic of the patients. (www.actabiomedica.it)
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Affiliation(s)
- Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Univeristà Degli Studi di Milano, Milan, Italy.
| | - Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Giorgio Buccimazza
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy Via Festa del Perdono 7, 20122, Milan, Italy.
| | | | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, Univeristà Degli Studi di Milano, Milan, Italy.
| | - Alessandro Liguori
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Martina Gurgitano
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy.
| | - Anna Maria Ierardi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Maurizio Papa
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Department of Diagnostic, Complex Unit of Radiology, Lodi, Italy.
| | - Aldo Paolucci
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Gianpaolo Carrafiello
- 1-Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. 2-Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
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13
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Pandolfi M, Liguori A, Gurgitano M, Arrichiello A, Di Meglio L, Rodà GM, Guadagni A, Angileri SA, Ierardi AM, Buccimazza G, Donat D, Paolucci A, Carrafiello G. Prostatic artery embolization in patients with benign prostatic hyperplasia: perfusion cone-beam CT to evaluate planning and treatment response. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020013. [PMID: 33245070 PMCID: PMC8023075 DOI: 10.23750/abm.v91i10-s.10260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
This proof of concept is to evaluate the utility of perfusion cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia (BPH) with moderate or severe-grade lower urinary tract symptoms (LUTS). PAE is a novel minimally invasive therapy and is both safe and effective procedure with low risks and high technical successes, making this procedure as the best alternative to surgery. A lot of technical changes would compromise clinical outcomes after procedure, including a variable prostate vascular anatomy, thin PA, and extensive atherosclerotic disease. The purpose of our study is to exploit the advantages of Perfusion Cone Beam Computed Tomography (CBCT) that could impact treatment and help interventional radiologists for treatment planning, diagnosis and for assessing the technical feasibility during PAE, mitigating the risk of nontarget embolization and suggesting clinical outcomes. Qualitative and quantitative clinical pre- and post-treatment values will be compared, to reach the best possible results.
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Affiliation(s)
- Marco Pandolfi
- Radiology Unit, Istituto Clinico Città Studi Milano, via Niccolò Jommelli, 17, 20131 Milano, Italy.
| | - Alessandro Liguori
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Martina Gurgitano
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
| | - Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Giovanni Maria Rodà
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Alice Guadagni
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Anna Maria Ierardi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Giorgio Buccimazza
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Daniela Donat
- Clinical Center od Vojvodina, Center for Radiology, Serbia, Novi Sad, Hajduk Veljkova 1.
| | - Aldo Paolucci
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy; Department of Health Sciences, Università degli Studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.
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14
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Moschouris H, Stamatiou K, Malagari K, Marmaridou K, Kladis-Kalentzis K, Kiltenis M, Papadogeorgopoulos N, Tsavari A, Manoloudaki K. The value of contrast-enhanced ultrasonography in detection of prostatic infarction after prostatic artery embolization for the treatment of symptomatic benign prostatic hyperplasia. ACTA ACUST UNITED AC 2019; 25:134-143. [PMID: 30860077 DOI: 10.5152/dir.2019.18410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We aimed to assess the clinical and predictive role of contrast-enhanced ultrasonography (CEUS) as the primary method for imaging evaluation of prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH). METHODS Thirty-one patients with symptomatic BPH, treated with PAE from October 2016 until February 2018, were enrolled in this prospective, single-center study. Microspheres (100-700 µm) were utilized for PAE. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow (Qmax), prostatic volume (PV) and post void residual volume (PVR) were measured at baseline and at 1, 3, and 6 months post PAE. Unenhanced transabdominal US was utilized for PV and PVR measurements; prostatic enhancement was studied with transabdominal CEUS at baseline, during the procedure, 1 day and 1, 3, and 6 months post PAE. Technical success was defined as embolization of the PA of at least one pelvic side. Clinical success was based on the improvement of IPSS and QoL, with no need for any additional treatment. Follow-up time ranged from 6 to 18 months (mean, 9.7±4.3 months). Clinical success rates were calculated and changes in prostatic enhancement were correlated with the outcome parameters. RESULTS Technical success rate was 90.3%. Clinical success rates at 3, 6, and 12 months post PAE were 85.7%, 85.7%, and 79.1% respectively. Improvement of outcome parameters (baseline vs. 6-month values) was statistically significant, with 12.4 points mean reduction of IPSS (50.4%, P = 0.003), 2.0 points mean reduction of QoL (45.4%, P < 0.001), 30.3 mL mean reduction of PV (30.2%, P < 0.001), 72.6 mL mean reduction of PVR (51.8%, P = 0.005) and 8.6 mL/s mean increase in Qmax (103%, P = 0.002). The most significant complications were bladder ischemia (n=1), and ischemic rectal ulcer (n=1), both attributable to nontarget embolization, with complete recovery. CEUS 1 day post PAE demonstrated prostatic infarcts in 26/28 (92.8%) patients. The percentage of prostatic infarction (pPI, defined as prostatic infarcted volume 1 day post PAE divided by baseline PV) was 1%-71%. There was a very strong positive correlation between pPI and prostate shrinkage (r=0.81, P < 0.001), but a weak correlation between pPI and the improvement of the other outcome parameters (r= 0.01-0.36; P = 0.093-0.965). However, in the subgroup of patients with indwelling bladder catheter (9/28 patients), successful removal of the catheter was achieved only in patients with pPI>10%. CONCLUSION CEUS appears to be a practical method for the study of the local ischemic effect of PAE, with potential predictive value.
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Affiliation(s)
| | | | - Katerina Malagari
- Department of Radiology, Athens University, Attikon Hospital, Chaidari, Athens, Greece
| | | | | | - Michail Kiltenis
- Departments of Radiology, Tzaneion General Hospital, Piraeus, Greece
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