RESUMO
AIM: To identify predictive factors of clinical success after prostatic artery embolisation (PAE) for patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Twenty-four patients with long-term indwelling urinary catheters (duration: 8±3 months) underwent PAE. Factors such as patient age, duration of urinary retention, prostate volume decrease, volume of ischaemic prostate tissue (assessed using magnetic resonance imaging [MRI]), and embolisation technique were studied as potential predictors of clinical success of PAE, defined as the ability to remove the urinary catheter (allowing spontaneous voiding) within 60 days of PAE. RESULTS: Bilateral embolisation was performed in 21 patients, and unilateral embolisation was performed in three, due to technical challenges. Length of follow-up was 17 months (range: 3-29). No major complications were encountered. Clinical success was achieved in 15 patients (63%) with prostate volume decreasing 24% versus 16% (p=0.03) in the unsuccessful cases. Thirteen of the 15 successful cases (87%) showed ischaemic areas in the prostate on MRI obtained 30 days after embolisation, but only one unsuccessful case (11%) showed a very small area of ischaemia. CONCLUSION: Prostatic ischaemia observed on early post-embolisation MRI appears to be the best predictor of clinical success after PAE in patients with AUR secondary to BPH.
Assuntos
Embolização Terapêutica/métodos , Isquemia/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Boston , Brasil , Embolização Terapêutica/efeitos adversos , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Próstata/diagnóstico por imagem , Hiperplasia Prostática/complicações , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
BACKGROUND/PURPOSE: Children presenting with persistent symptoms attributed to gastroesophaeal reflux disease (GERD) that are unresponsive to both medical and surgical therapies are commonly submitted to esophageal biopsies, the results of which show an abnormal presence of eosinophils. In this setting, eosinophilic esophagitis may be the correct diagnosis. The purpose of this report is to clarify the importance of esophageal eosinophilic infiltration, regardless of whether associated with acid reflux, ie, as an independent symptomatic entity, when treating a patient with refractory GERD. METHODS: Two boys, aged 8 and 7 years, had the classic symptoms of GERD. They were treated with antacid without improvement of the esophagic lesions. Subsequent esophageal biopsy results showed marked eosinophilic infiltration. From this moment on, eosinophilic esophagitis started to be considered the main diagnosis. RESULTS: Although eosinophilic infiltration caused by GERD is very frequently found in esophageal biopsy, in case of refractory drug treatment and microscopic findings of a great number of eosinophils and mast cells, eosinophilic esophagitis must be considered. This disease is better treated with corticoids instead of antacid drugs. It explains the reason some patients do not respond to antacid and surgical treatment and remain symptomatic with esophagic lesions. CONCLUSIONS: In refractory cases of GERD, eosinophilic esophagitis must be considered before any surgical measure.