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1.
Cardiovasc Intervent Radiol ; 47(1): 115-120, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38012342

RESUMEN

PURPOSE: Prostate artery embolisation (PAE) is a key treatment for the management of symptomatic benign prostatic hyperplasia (BPH). Common cardiovascular risk factors might be associated with suboptimal outcomes and thus influence patient treatment selection. The aim of the study was to evaluate whether cardiovascular comorbidities affect PAE outcomes. METHODS: Retrospective subset analysis of the UK Registry of Prostate Artery Embolisation (UK-ROPE) database was performed with patients who had a full documented past medical histories including hypertension, diabetes, coronary artery disease (CAD), diabetes and smoking status as well as international prostate symptom score (IPSS) at baseline and at 12 months. Multiple regression was performed to assess for any significant predictors. RESULTS: Comorbidity data were available for 100/216 patients (mean age 65.8 ± 6.4 years), baseline IPSS 20.9 ± 7.0). Regression analysis revealed that the presence of hypertension (53.7% IPSS reduction vs. absence 51.4%, p = 0.94), diabetes (52.6% vs. absence 52.1%, p = 0.6), CAD (59.2% vs. absence 51.4%, p = 0.95), no comorbidities (49.8% vs. any comorbidity present 55.3%, p = 0.66), smoking status (non-smoker, 52.6%, current smoker, 61.5%, ex-smoker, 49.8%, p > 0.05), age (p = 0.52) and baseline Qmax (p = 0.41) did not significantly impact IPSS reduction at 12 months post-PAE. Baseline prostate volume significantly influenced IPSS reduction (≥ 80 cc prostates, 58.9% vs. < 80 cc prostates 43.2%, p < 0.05). CONCLUSION: The presence of cardiovascular comorbidities/smoking history does not appear to significantly impact PAE symptom score outcomes at 12 months post procedure. Our findings suggest that if the prostatic artery can be accessed, then clinical success is comparable to those without cardiovascular comorbidities.


Asunto(s)
Diabetes Mellitus , Embolización Terapéutica , Hipertensión , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Masculino , Humanos , Persona de Mediana Edad , Anciano , Recién Nacido , Próstata/irrigación sanguínea , Estudios Retrospectivos , Resultado del Tratamiento , Hiperplasia Prostática/epidemiología , Hiperplasia Prostática/terapia , Hiperplasia Prostática/complicaciones , Embolización Terapéutica/métodos , Arterias , Comorbilidad , Hipertensión/etiología , Sistema de Registros , Reino Unido/epidemiología , Síntomas del Sistema Urinario Inferior/terapia , Calidad de Vida
4.
J Vasc Interv Radiol ; 34(2): 218-224.e1, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36283591

RESUMEN

PURPOSE: To explore whether coil embolization of penile collateral arteries to prevent nontarget embolization during prostatic artery embolization (PAE) negatively affects erectile function. MATERIALS AND METHODS: Retrospective analysis was performed on a prospectively maintained multicenter PAE database on all patients with benign prostatic hyperplasia (January 2014 to July 2016). International Index of Erectile Function (IIEF-5) scores were collected at baseline and within 12 months after the procedure. A logistic regression and nearest neighbor propensity-matched analysis (matched for age, baseline IIEF-5 scores, and use of 5α-reductase inhibitors) and paired t test were used to evaluate for differential impact on IIEF-5 scores between the group of patients who underwent (unilateral) penile collateral coil embolization and a matched control group of patients who did not. RESULTS: Of a total of 216 patients, 26 underwent coil protection of an accessory pudendal vessel/penile collateral. After exclusions, 22 propensity-matched pairs were identified. The mean IIEF-5 score at baseline for the coil-embolized group was 14.8 ± 8.3 (out of a possible score of 30) and that for the matched control group was 14.0 ± 7.8. At the 12-month follow-up after the procedure, the mean follow-up IIEF-5 score was 15.5 ± 8.0 for the coil-embolized group and 14.2 ± 8.2 for the matched control group. The change in IIEF-5 scores after PAE was not significantly different between the 2 groups (0.66 ± 3.8 vs 0.20 ± 2.0; P = .64; 95% CI, -1.53 to 2.44). CONCLUSIONS: When penile collateral arteries were identified, protective coil embolization of penile collateral/accessory pudendal vessels during PAE was unlikely to affect erectile function negatively.


Asunto(s)
Embolización Terapéutica , Disfunción Eréctil , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Masculino , Humanos , Próstata/irrigación sanguínea , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/terapia , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Arterias/diagnóstico por imagen , Síntomas del Sistema Urinario Inferior/terapia
5.
Turk J Urol ; 48(3): 166-173, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35634934

RESUMEN

Prostate artery embolization is emerging as one of the most effective therapies amidst a new era of mini- mally invasive benign prostate hyperplasia treatment and technology. However, several current controver- sies remain unanswered which could impact the widespread adoption of this novel and unique transarterial(rather than transurethral) intervention. This is reflected in the differences between the UK (NICE), European (EAU), and American (AUA) guidelines, the latter of which only recommends the use of prostate arteryembolization in a clinical trial setting. The main issues include questions over the duration of symptom response, cost-effectiveness, mechanism of action, patient selection, and other procedural technical consid- erations. These factors are the most pressing faced by proponents of prostate artery embolization, and we seek to highlight why their resolution is important to ensure men with benign prostate hyperplasia seeking a minimally invasive solution are optimally informed and most effectively managed.

6.
J Pediatr Urol ; 18(2): 113.e1-113.e6, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35074274

RESUMEN

INTRODUCTION: Paediatric varicocele embolization has many benefits over surgical ligation, but lacks published long-term data. We investigated technical and clinical outcomes in this under reported patient group. OBJECTIVE: To evaluate technical success, complications and recurrence rates following varicocele embolization in paediatric patients. MATERIALS AND METHODS: A single-centre retrospective review of procedural data and electronic notes of consecutive patients referred for varicocele embolization over a 10-year period was performed (February 2010-March 2020). The primary outcomes were technical success and clinical efficacy (lack of symptom recurrence). Secondary outcomes included complications, testicular vein size reduction and procedural parameters including radiation exposure. Chi-square analysis was used to identify predictors of clinical success. Follow-up involved outpatient clinical assessment and telephone interview. RESULTS: 40 patients (median age 15) were referred for left-sided symptomatic varicocele. Technical embolization success was achieved in 36/40 patients (90%), with 4 procedures abandoned (inaccessible vein). Embolization technique was platinum-based coils ± sclerosant. There were no immediate or long-term procedural complications. 32/36 patients completed short term follow-up at a median interval of 2.8 months. 30/32 (93.78%) experienced early clinical success. We found a significant reduction in peritesticular vein size following embolization (pre-3.70 vs post-2.56 mm, p = 0.00017) and a significant relationship between varicocele grade and early clinical success (χ2 = 4.2, p = 0.04), but not pre-treatment peritesticular vein size (χ2 = 0.02, p = 0.88). 33/36 patients completed long-term follow-up (median 4.2 years, range 0.36-9.9 years) producing a late clinical success rate of 93.9% (31/33). No post procedural complications including hydroceles were identified. DISCUSSION: This study demonstrates technical success, matching rates described in adult patients which is reassuring and in support of embolization in the younger patient cohort. More importantly, the overall clinical success rate is comparable with previous embolization studies. Reassuringly, all symptom recurrences occurred early in follow-up, and there is a cogent argument for a single follow-up appointment at this juncture. Our long-term average follow-up duration, primarily gained via telephone interview, exceeds other studies. Although our study has the longest follow-up for varicocele embolization in children, it is limited by a few patients being lost to early and long-term follow-up. This is a recognised issue faced by studies attempting to follow-up benign conditions with a high clinical success rate. CONCLUSION: Paediatric varicocele embolization is a successful alternative to surgical ligation, with no complications and good clinical outcomes over a long-term follow-up.


Asunto(s)
Embolización Terapéutica , Varicocele , Adolescente , Adulto , Niño , Embolización Terapéutica/métodos , Estudios de Seguimiento , Humanos , Ligadura , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Varicocele/cirugía , Varicocele/terapia , Procedimientos Quirúrgicos Vasculares
7.
Hum Fertil (Camb) ; 25(5): 881-887, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33926340

RESUMEN

The effect of Uterine Fibroid Embolization on fertility and ovarian reserve remains uncertain. We assessed the impact of a new resorbable, spherical particle (Gelbead) on concentration of Anti-Mullerian (AMH) hormone, fibroid volume and uterine artery patency. This prospective cohort study recruited consecutive patients from July 2017 to June 2018. Serum AMH, fibroid and uterine volume, UFS-QOL (uterine fibroid score-quality of life) scores were measured prior to and at 1 month and/or 3 months post embolization. Twenty-four participants were enrolled (median age 44 years, uterine volume 484 cm3, initial dominant fibroid volume 167 cm3). One patient was lost to follow-up. AMH (median ± SD) immediately prior to embolization was 3.2 ± 13.7 pmol/L. At 1-month postembolization, AMH was 4.1 ± 8.6 pmol/L and at 3 months 4.4 ± 8.6 pmol/L. We found no significant difference in AMH levels between baseline and at 1 month (p = 0.58) or baseline and 3 months (p = 0.17). The median dominant uterine fibroid volume decreased (167 to 64 cm3, p < 0.001). At 3 months post-embolization, 17/23 patients had patent uterine arteries bilaterally (73.9%). UFE with Gel-bead did not significantly affect AMH at 3 months post embolization, whilst maintaining a high rate of uterine artery patency.


Asunto(s)
Leiomioma , Embolización de la Arteria Uterina , Neoplasias Uterinas , Femenino , Humanos , Adulto , Arteria Uterina , Neoplasias Uterinas/terapia , Hormona Antimülleriana , Calidad de Vida , Estudios Prospectivos , Leiomioma/terapia , Resultado del Tratamiento
8.
Front Oncol ; 11: 730854, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34950575

RESUMEN

Colorectal liver metastases (CRLM) have heterogenous histopathological and immunohistochemical phenotypes, which are associated with variable responses to treatment and outcomes. However, this information is usually only available after resection, and therefore of limited value in treatment planning. Improved techniques for in vivo disease assessment, which can characterise the variable tumour biology, would support further personalization of management strategies. Advanced imaging of CRLM including multiparametric MRI and functional imaging techniques have the potential to provide clinically-actionable phenotypic characterisation. This includes assessment of the tumour-liver interface, internal tumour components and treatment response. Advanced analysis techniques, including radiomics and machine learning now have a growing role in assessment of imaging, providing high-dimensional imaging feature extraction which can be linked to clinical relevant tumour phenotypes, such as a the Consensus Molecular Subtypes (CMS). In this review, we outline how imaging techniques could reproducibly characterize the histopathological features of CRLM, with several matched imaging and histology examples to illustrate these features, and discuss the oncological relevance of these features. Finally, we discuss the future challenges and opportunities of CRLM imaging, with a focus on the potential value of advanced analytics including radiomics and artificial intelligence, to help inform future research in this rapidly moving field.

9.
Cardiovasc Intervent Radiol ; 44(7): 1095-1102, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33825062

RESUMEN

PURPOSE: To compare the relative IPSS (International Prostate Symptom Score) improvement in storage and voiding symptoms between prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). METHOD: Retrospective analysis of the UK-ROPE (UK Register of Prostate Embolization) multicentre database was conducted with inclusion of all patients with full IPSS questionnaire score data. The voiding and storage subscore improvement was compared between interventions. Student's t-test (paired and unpaired) and ANOVA (Analysis of variance) were used to identify significant differences between the groups. RESULTS: 146 patients (121 PAE, 25 TURP) were included in the analysis. Storage symptoms were more frequently the most severe symptom ('storage' in 75 patients vs 'voiding' in 17 patients). Between groups, no significant difference was seen in raw storage subscore improvement (TURP 4.9 vs PAE 4.2; p = 0.34) or voiding subscore improvement (TURP 8.4 vs PAE 6.7; p = 0.1). ANOVA demonstrated a greater proportionate reduction (relative to total IPSS) towards voiding symptoms in the TURP group (27.3% TURP vs 9.9% PAE, p = 0.001). CONCLUSION: Although both TURP and PAE improve voiding symptoms more than storage, a significantly larger proportion of total symptom reduction is due to voiding in the TURP cohort, with PAE providing a more balanced improvement between voiding and storage.


Asunto(s)
Embolización Terapéutica/métodos , Síntomas del Sistema Urinario Inferior/terapia , Hiperplasia Prostática/terapia , Resección Transuretral de la Próstata/métodos , Anciano , Arterias , Estudios de Cohortes , Humanos , Síntomas del Sistema Urinario Inferior/diagnóstico , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico , Estudios Retrospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Reino Unido
10.
BMJ Surg Interv Health Technol ; 3(1): e000071, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35047801

RESUMEN

OBJECTIVE: To determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up. DESIGN SETTING AND MAIN OUTCOME MEASURES: A retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions. RESULTS: The mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up. CONCLUSION: Our findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years. TRIAL REGISTRATION NUMBER: NCT02434575.

11.
Cardiovasc Intervent Radiol ; 43(6): 897-903, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32236673

RESUMEN

INTRODUCTION: Optisphere (Teleflex, Wayne, PA, USA, currently distributed by Medtronic, Minneapolis, MN, USA) is a new, resorbable, calibrated spherical embolic agent. We aimed to evaluate its clinical safety and effectiveness for fibroid embolization through a prospective case series. METHOD: This prospective case series studied patients treated with fibroid embolization using Optisphere between July 2017 and June 2018. The primary outcomes were device-related adverse event assessments and MRI-determined percentage infarct of the dominant fibroid (DF %) and infarct of all fibroids (AF %) at 3 months post-embolization. Secondary outcomes included symptom improvement with the validated Uterine Fibroid Symptom Score and Quality of Life questionnaire (UFS-SS and UFS-QOL) at 3 months and 12 months post-embolization. Statistical analysis was through the Wilcoxon signed-rank test for nonparametric paired data. RESULTS: Twenty-three consecutive patients were treated with Optisphere (median age 44.0, uterine volume 484.0 ml, dominant fibroid volume 167.0 ml). The complete dominant fibroid infarction (DF %) rate was 91.3% (21/23 patients), and the complete all fibroid infarction rate (AF %) was 82.6% (19/23). No adverse device-related safety events were encountered. Significant improvement was demonstrated in 3-month UFS-SS (56 vs 19, p < 0.0001), UFS-QOL (40 vs 88, p = 0.0008), uterine volume (484 ml vs 246 ml, p < 0.0001) and dominant fibroid volume (167 vs 64 ml, p < 0.0001). Symptomatic improvement continued to 12 months (UFS-SS 56 vs 11, p = 0.0008, UFS-QOL 40 vs 98.7, p = 0.0008). CONCLUSION: Optisphere is an effective embolic agent for fibroid embolization with good symptomatic response and percentage fibroid infarct.


Asunto(s)
Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Leiomioma/terapia , Neoplasias Uterinas/terapia , Adulto , Femenino , Humanos , Estudios Prospectivos , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento
12.
Cardiovasc Intervent Radiol ; 43(1): 23-28, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31440784

RESUMEN

INTRODUCTION: Many studies have looked at global changes in the International Prostate Symptom Score (IPSS) following PAE; however, no studies have examined the breakdown between storage and voiding symptoms. We aimed to explore the extent to which PAE improves storage symptoms in relation to voiding symptoms. METHOD: This single-center, prospective cohort study recruited consecutive patients undergoing PAE from June 2012 to June 2016. The IPSS breakdown was recorded pre-PAE, at 3 months and 12 months post-PAE. Planned statistical analysis included the paired t test. RESULTS: A total of 43 patients were recruited (mean age 64.72 ± 6.27, prostate volume 88.65 ± 37.23 cm3, IPSS 23.02 ± 5.84, QoL 4.98 ± 1.01, PSA 4.2 ± 2.8). Storage symptoms were more frequently the most severe symptom (58.1%). Voiding score (13.35-5.39, p < 0.001) and storage score (9.67-5.08, p < 0.001) both improved; however, voiding improved to a greater extent (1.9 vs. 1.5 mean per question, p = 0.023). PAE was most consistent when improving storage symptoms ('Urgency' improved in 86% patients, 'Frequency' and 'Nocturia' 77%). CONCLUSION: Storage symptoms are a significant problem for patients with benign prostatic obstruction. PAE is an effective treatment for both storage and voiding symptoms. More research is needed to evaluate how this compares with surgical techniques.


Asunto(s)
Embolización Terapéutica/métodos , Próstata/irrigación sanguínea , Enfermedades de la Próstata/complicaciones , Enfermedades de la Próstata/terapia , Trastornos Urinarios/complicaciones , Trastornos Urinarios/terapia , Arterias , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades de la Próstata/fisiopatología , Resultado del Tratamiento , Trastornos Urinarios/fisiopatología
13.
Cardiovasc Intervent Radiol ; 43(3): 459-465, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31797101

RESUMEN

INTRODUCTION: Few studies on prostate artery embolization (PAE) follow patients up after 12 months. We aimed to evaluate the symptomatic efficacy of PAE in our patient cohort at 3 years. METHOD: A total of 48 consecutive patients undergoing PAE from June 2012 to August 2014 were included in this retrospective study. All patients underwent formal urodynamics to confirm bladder outflow obstruction prior to PAE. International Prostate Symptom Score (IPSS) was performed at baseline, 3 months, 12 months and 3 years post-PAE. RESULTS: Mean patient age was 65.6 ± 7.4, prostate volume 99.1 ± 56.6 cm3, IPSS 23.5 ± 6.0, quality-of-life score 4.6 ± 0.9, Qmax 8.4 ± 2.8 ml/s, post-void residual volume 185.8 ± 55.6 ml. Technical success (bilateral embolization) was achieved in 43 out of 48 cases (89.6%). 11/39 bilateral PAE patients completing follow-up (2 died, 2 lost to follow-up) underwent surgery, indicating a 71.8% clinical success rate at 3 years. No significant change was demonstrated in IPSS or QOL between 1 and 3 years for patients free from surgical intervention (IPSS 8.3 vs 10.0, p = 0.09 and QOL 1.3 vs 1.5, p = 0.23). 3/11 patients undergoing surgery had a prominent 'ball-valve' median lobe, and 1/11 patients had a high bladder neck elevation contributing to symptoms. CONCLUSION: Clinical success post-PAE remains high with few patients opting for surgery or experiencing a worsening of symptoms after 12 months.


Asunto(s)
Embolización Terapéutica/métodos , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/terapia , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico por imagen , Obstrucción del Cuello de la Vejiga Urinaria/terapia , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Angiografía por Tomografía Computarizada/métodos , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Próstata/irrigación sanguínea , Próstata/diagnóstico por imagen , Hiperplasia Prostática/complicaciones , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento , Obstrucción del Cuello de la Vejiga Urinaria/etiología
14.
Cardiovasc Intervent Radiol ; 42(5): 666-676, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30603967

RESUMEN

INTRODUCTION: The UK Registry of Prostate Artery Embolization (UK-ROPE) was a prospective, multicentre study comparing PAE against surgical therapies for symptomatic benign prostatic hyperplasia (BPH). A wealth of data was collected supplementary to the main study outcomes which provide a snapshot of UK PAE practice. We aimed to interpret these data in the hope of providing insight into factors which affect clinical outcome and radiation dose. METHODS: 216 patients (mean age 66, mean IPSS 21.3) undergoing PAE at 20 British centres from July 2014 to January 2016 were prospectively followed up to 12 months with retrospective analysis of the data. Technical outcome was evaluated based on procedural and fluoroscopy times, skin dose and dose area product (DAP). Clinical outcome was evaluated through collection of Qmax, IPSS reduction and prostate volume reduction. Multiple analysis of variance (MANOVA) was used to assess the significance of various patients and procedural factors on clinical outcome and patient dose. RESULTS: Significant predictors of technical outcome which affected patient skin dose included severity of CTA-detected atheroma (p < 0.001), the practitioner (p < 0.001) and use of protective coil embolization (p = 0.019). Predictors of clinical outcome included initial prostate size (dichotomized into groups > 80 ml and = <80 ml, d = 1, p = 0.0138), embolic agent (spherical particles < 300 nm performed best, p = 0.01) and number of arteries embolized (IPSS reduction of 32.9% in unilateral PAE versus 54.4% for bilateral PAE, p = 0.026). CONCLUSION: We have identified several important factors which are associated with improved clinical outcome and increased patient dose which we hope will facilitate optimal patient selection and encourage improved embolization technique.


Asunto(s)
Embolización Terapéutica/métodos , Próstata/irrigación sanguínea , Hiperplasia Prostática/terapia , Anciano , Arterias , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Resultado del Tratamiento , Reino Unido
15.
Cardiovasc Intervent Radiol ; 41(4): 628-632, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29167966

RESUMEN

PURPOSE: A highly variable prostatic artery origin coupled with frequent anastomoses to adjacent organs makes prostate artery embolisation a challenging procedure. Despite CT angiography facilitating procedural planning, it is not performed in all centres. Therefore, we explored the utility of prostatic CT angiography by assessing its capacity to identify the prostatic arteries and highlight troublesome anastomoses. MATERIALS AND METHODS: A retrospective review of patients undergoing prostate artery embolisation for symptoms of benign prostatic obstruction between June 2012 and October 2016 was conducted, with analysis of the pre-procedural CT angiography. CT findings were compared with subsequent intraprocedural angiography to assess the accuracy with which CT angiography predicts the origin of prostatic arteries and identifies anastomoses. RESULTS: In total, 110 patients underwent prostate artery embolisation, with pre-procedural CT angiography acquired in all patients, enabling assessment of 220 pelvic sides of hemiprostatic arterial supply. Mean dose length product was 808.4 mGycm. CT angiography successfully identified prostatic arterial supply in 214/220 pelvic sides, an accuracy of 97.3%. Anastomoses of prostatic vessels were suggested by CT angiography in 52 pelvic sides. These were confirmed by angiogram in 49/52 sides (94.2%). CT angiography demonstrated a sensitivity of 59.0% and specificity of 94.2% for anastomoses detection. CONCLUSION: CT angiography prior to embolisation reliably predicts the arterial anatomy and facilitates procedural planning. Therefore, it should be a considered as a pre-procedural investigation for patients undergoing prostate artery embolisation. Sensitivity is low for predicting anastomoses, so careful periprocedural evaluation of the target vessels is still required.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Embolización Terapéutica/métodos , Próstata/irrigación sanguínea , Próstata/diagnóstico por imagen , Anciano , Arterias/anomalías , Arterias/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad
16.
Ther Adv Urol ; 9(8): 209-216, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29662545

RESUMEN

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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