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1.
BMJ Case Rep ; 13(1)2020 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-31907214

RESUMO

We report a case of iatrogenic rectourethral fistula (RUF) in an elderly man with benign prostatic enlargement and acute urinary retention, following a transurethral resection of prostate (TURP). This patient presented a unique challenge of tackling the RUF in the presence of a large residual prostate gland and urinary tract infection. RUF was repaired only after getting the access to the fistula following transvesical prostatectomy. Follow-up imaging showed well-healed repair of RUF. Transvesical prostatectomy is a useful adjunctive procedure in repair of RUF when associated with a large prostate. This case also highlights the importance of technique selection while planning for surgery on large prostate glands. TURP is not the preferred first modality of choice for larger glands as noted in this case.


Assuntos
Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/cirurgia , Fístula Retal/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Fístula Urinária/cirurgia , Idoso , Humanos , Doença Iatrogênica , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Fístula Retal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Fístula Urinária/diagnóstico por imagem
2.
Niger J Clin Pract ; 22(11): 1600-1605, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719283

RESUMO

Background: Findings from studies on obesity and benign prostatic enlargement (BPE) have been inconsistent. With a previous study done in our facility showing no correlation between anthropometric indices of obesity and BPE, this study aimed at reevaluating the association between obesity and BPE using sonographic indices of abdominal/central obesity. Materials and Methods: Ninety consenting subjects with clinically confirmed BPE had their height and weight [(to calculate body mass index (BMI)] as well as waist and hip circumference [to calculate waist-hip ratio (WHR)] done. The subcutaneous, preperitoneal, and visceral fat thicknesses (SFT, PFT, and VFT, respectively) of these subjects and their prostate volumes were measured on transabdominal Ultrasonography (USS). Transrectal USS was also done to measure the total prostate and transitional zone volumes. Data were analyzed using SPSS version 22. Results: WHR and waist circumference correlated positively with SFT (r = 0.325, P = 0.002 and r = 0.370, P = 0.000, respectively) and PFT (r = 0.209, P = 0.048 and r = 0.313, P = 0.003, respectively). While BMI correlated positively (r = 0.23, P = 0.029) with transrectal transitional zone volume, all three sonographic indices of adiposity correlated negatively (SFT: r = -0.223, P = 0.035; PFT: r = -0.321, P = 0.002; VFT: r = -0.242, P = 0.021) with transrectal total prostate volume. In addition, PFT correlated negatively with transabdominal prostate volume (r = -0.222, P = 0.037) and transrectal transitional zone volume (r = -0.211, P = 0.046). Conclusion: The relationship of BMI with transrectal transitional zone volume was a direct one, while that of SFT, PFT, and VFT with transrectal total prostate volume as well as PFT with transabdominal prostate volume and transrectal transitional zone volume was an inverse one.


Assuntos
Gordura Intra-Abdominal , Obesidade/complicações , Hiperplasia Prostática/diagnóstico por imagem , Gordura Subcutânea Abdominal , Ultrassonografia/métodos , Adiposidade , Adulto , Antropometria , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Obesidade/epidemiologia , Obesidade Abdominal , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/etiologia , Fatores de Risco , Centros de Atenção Terciária , Circunferência da Cintura , Relação Cintura-Quadril
3.
J Vasc Interv Radiol ; 30(11): 1807-1816, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587946

RESUMO

PURPOSE: To evaluate the presence of intravesical prostatic protrusion (IPP) and its thickness-to-height (T/H) ratio as a predictor for the clinical outcome and morbidity of prostatic artery embolization (PAE) for benign prostatic hyperplasia. MATERIALS AND METHODS: This was a prospective, single-center, institutional review board-approved study from June 2015 to December 2018 of 82 consecutive patients (age, 53-79 years; median, 66 years) with International Prostate Symptom Score (IPSS) ≥15 and quality-of-life (QOL) score ≥3. The presence of IPP and its T/H ratio were assessed on baseline magnetic resonance imaging for their correlation with the clinical outcomes of suboptimal IPSS (IPSS ≥10) and suboptimal QOL (QOL ≥3) up to 12 months after PAE and the occurrence of post-procedure complications (≤30 days), which caused a certain degree of urinary outflow obstruction. The chi-squared test was used for analysis. RESULTS: IPP was present in 57 of 82 patients (69.5%). The presence of IPP correlated with the occurrence of post-procedure complications (P = .009) but not with suboptimal IPSS at 12 months (P = .758). IPP with a T/H ratio ≤1.3 correlated with suboptimal IPSS at 12 months (P = .025) and suboptimal QOL at 6 months (P = .025) and 12 months (P = .008), as well as with the occurrence of post-procedure complications (P = .009). CONCLUSIONS: IPP with a T/H ratio ≤1.3 predicted the occurrence of post-procedure complications with urinary obstruction. A T/H ratio ≤1.3 but not the presence of IPP alone predicted the clinical outcome up to 12 months after PAE.


Assuntos
Resinas Acrílicas/administração & dosagem , Artérias , Cateteres , Embolização Terapêutica/instrumentação , Gelatina/administração & dosagem , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Resinas Acrílicas/efeitos adversos , Idoso , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Gelatina/efeitos adversos , Hong Kong , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miniaturização , Estudos Prospectivos , Próstata/diagnóstico por imagem , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Urodinâmica
4.
J Vasc Interv Radiol ; 30(11): 1798-1806, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587950

RESUMO

PURPOSE: To compare balloon occlusion prostatic artery embolization (bPAE) with conventional microcatheter PAE (cPAE). MATERIALS AND METHODS: In this single-center trial, between November 2017 and November 2018, 89 patients with symptomatic benign prostatic hyperplasia were randomly assigned to cPAE (n = 43) or bPAE (n = 46). All patients received embolization with 300-500 µm Embosphere microspheres and were evaluated before and 1 and 6 months after PAE. Primary outcome measure was change from baseline in International Prostate Symptom Score (IPSS). Student t test was used for between-group comparisons of change from baseline, and paired t test was used for within-group comparisons. RESULTS: At baseline, groups were identical (P > .05). Unilateral PAE was performed in 4 patients receiving cPAE and 3 patients receiving bPAE (9.30% and 6.52%, P = .708). Procedural and fluoroscopy times, dose area product, air kerma, embolic volume, and mean prostate-specific antigen (PSA) 24 hours after PAE did not differ between groups (P > .05). Coils were used in 6 patients receiving cPAE and 4 patients receiving bPAE (14.0% and 8.70%, P = .51). Assessments at 6 months after PAE showed mean IPSS reduction was 7.58 ± 6.88 after cPAE and 8.30 ± 8.12 after bPAE (P = .65); mean prostate volume reduction was 21.9 cm3 ± 51.6 (18.2%) after cPAE and 6.15 cm3 ± 14.6 (7.3%) after bPAE (P = .05); mean PSA reduction was 0.9 ng/mL ± 2.22 after cPAE and 0.22 ng/mL ± 1.65 after bPAE (P = .10). Penile skin lesions (n = 3) and rectal bleeding (n = 2) were documented only in patients receiving cPAE (11.9%, P = .01). No major adverse events occurred. CONCLUSIONS: bPAE is as effective as cPAE in treating benign prostatic hyperplasia with a potential to reduce nontarget embolization.


Assuntos
Resinas Acrílicas/administração & dosagem , Artérias , Oclusão com Balão , Cateteres , Embolização Terapêutica/instrumentação , Gelatina/administração & dosagem , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Resinas Acrílicas/efeitos adversos , Idoso , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Oclusão com Balão/efeitos adversos , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Gelatina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Miniaturização , Portugal , Estudos Prospectivos , Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista , Fluxo Sanguíneo Regional , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
5.
J Vasc Interv Radiol ; 30(9): 1452-1458, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31371137

RESUMO

PURPOSE: To evaluate the radiation dose in patients undergoing prostatic artery embolization (PAE) using cone-beam CT and 3-dimensional (3D) guidance software. MATERIALS AND METHODS: In this single-center retrospective study, 100 patients with benign prostatic hyperplasia (mean prostate volume, 83.6 mL ± 44.2; 69.4 ± 9.6 years of age; body mass index, 26.5 ± 4.2) were treated using PAE between October 2016 and April 2018. Informed consent was obtained from all participants included in the study. All patients received at least 1 intraprocedural cone-beam CT per side for evaluation of the vessel anatomy and software rendering of 3D guidance for catheter guidance. Digital subtraction angiography (DSA) was performed in the distal branches only. The total dose area product (DAP), along with the DAP attributed to fluoroscopy, DSA, and cone-beam CT, were assessed. RESULTS: Bilateral embolization was achieved in 83 patients (83%). The average total DAP was 134.4 Gy ⋅ cm2 ± 69.5 (range, 44.7-410.9 Gy ⋅ cm2). Fluoroscopy, DSA, and cone-beam CT accounted for 35.5 Gy ⋅ cm2 ± 21.3 (range, 8.6-148.6 Gy ⋅ cm2) or 26.4% (percentage of total DAP), 58.2 Gy ⋅ cm2 ± 48.3 (range, 10.3-309.3 Gy ⋅ cm2) or 43.3%, and 40.7 Gy ⋅ cm2 ± 14.5 (range, 15.9-86.3 Gy ⋅ cm2) or 30.3%, respectively. Average procedure time was 89.4 ± 27.0 minutes, and the average fluoroscopy time was 30.9 ± 12.2 minutes. CONCLUSIONS: Intraprocedural cone-beam CT in combination with 3D guidance software allows for identification and catheterization of the prostatic artery in PAE. Furthermore, the results of this trial indicate that this study protocol may lead to a low overall radiation dose.


Assuntos
Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Tomografia Computadorizada de Feixe Cônico , Embolização Terapêutica , Imageamento Tridimensional , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Doses de Radiação , Radiografia Intervencionista/métodos , Software , Idoso , Angiografia por Tomografia Computadorizada/efeitos adversos , Tomografia Computadorizada de Feixe Cônico/efeitos adversos , Embolização Terapêutica/efeitos adversos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Hiperplasia Prostática/diagnóstico por imagem , Exposição à Radiação , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo
6.
Int J Comput Assist Radiol Surg ; 14(11): 1859-1869, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377964

RESUMO

PURPOSE: With X-ray radiation protection and dose management constantly gaining interest in interventional radiology, novel procedures often undergo prospective dose studies using anthropomorphic phantoms to determine expected reference organ-equivalent dose values. Due to inherent uncertainties, such as impact of exact patient positioning, generalized geometry of the phantoms, limited dosimeter positioning options, and composition of tissue-equivalent materials, these dose values might not allow for patient-specific risk assessment. Therefore, first the aim of this study is to quantify the influence of these parameters on local X-ray dose to evaluate their relevance in the assessment of patient-specific organ doses. Second, this knowledge further enables validating a simulation approach, which allows employing physiological material models and patient-specific geometries. METHODS: Phantom dosimetry experiments using MOSFET dosimeters were conducted reproducing imaging scenarios in prostatic arterial embolization (PAE). Associated organ-equivalent dose of prostate, bladder, colon, and skin was determined. Dose deviation induced by possible small displacements of the patient was reproduced by moving the X-ray source. Dose deviation induced by geometric and material differences was investigated by analyzing two different commonly used phantoms. We reconstructed the experiments using Monte Carlo (MC) simulations, a reference male geometry, and different material properties to validate simulations and experiments against each other. RESULTS: Overall, MC-simulated organ dose values are in accordance with the measured ones for the majority of cases. Marginal displacements of X-ray source relative to the phantoms lead to deviations of 6-135% in organ dose values, while skin dose remains relatively constant. Regarding the impact of phantom material composition, underestimation of internal organ dose values by 12-20% is prevalent in all simulated phantoms. Skin dose, however, can be estimated with low deviation of 1-8% at least for two materials. CONCLUSIONS: Prospective reference dose studies might not extend to precise patient-specific dose assessment. Therefore, online organ dose assessment tools, based on advanced patient modeling and MC methods, are desirable.


Assuntos
Embolização Terapêutica/métodos , Imagens de Fantasmas , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico por imagem , Radiografia Intervencionista/métodos , Adulto , Relação Dose-Resposta à Radiação , Humanos , Masculino , Método de Monte Carlo , Estudos Prospectivos , Próstata/diagnóstico por imagem , Hiperplasia Prostática/terapia , Doses de Radiação , Radiometria
8.
J Vasc Interv Radiol ; 30(9): 1459-1470, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31375451

RESUMO

PURPOSE: To compare procedural metrics and clinical improvement for prostatic artery embolization (PAE) performed with a balloon-occlusion (BO) versus end-hole (EH) microcatheter in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Retrospective review was performed of 129 patients undergoing PAE with 100-300 µm Embosphere microspheres from April 2013 through August 2018. Microcatheter selection was nonrandom, based on prostatic artery anatomy. Five technical failures and 5 microcatheter crossover cases were excluded. BO group (n = 46, age 72.8 y ± 9.0, gland volume 184 mL ± 83, 42% in retention) and EH group (n = 73, age 76.0 y ± 9.0, gland volume 190 mL ± 116, 44% in retention) were compared using procedural metrics (excluding 30 EH learning-curve cases); symptomatic improvement at 3, 6, and 12 months after PAE; voiding trial success; and adverse events (reported used Clavien-Dindo classification). RESULTS: Procedural and fluoroscopy times were lower in the BO group (n = 46) vs EH group (n = 43) (152.0 min ± 34.0 vs 172.8 min ± 47.9, P < .02; 37.8 min ± 12.9 vs 50.3 min ± 18.9, P < .001). Collaterals coiled, contrast material used, and injected particle volume were similar for both groups (P = NS). International Prostate Symptom Score improvement was similar for BO group (n = 25) (before PAE 23.5 ± 6.5, 12 months after PAE 7.6 ± 6.8) and EH group (n = 30) (before PAE 20.9 ± 5.9, 12 months after PAE 6.6 ± 5.2) (P = NS). Quality-of-life improvements were also similar (BO: before PAE 4.5 ± 1.2, 12 months after PAE 1.4 ± 0.9; EH: before PAE 4.1 ± 1.0, 12 months after PAE 0.9 ± 0.7), as were 12-month postvoid residual improvements, voiding trial failure rates (EH 12%, BO 8%), and adverse event rates (grade II, III: EH 15%, BO 11%) (P = NS for all). CONCLUSIONS: BO microcatheter use in PAE did not affect injected particle volume, contrast material use, or protective coiling and did not impact symptomatic improvement, postvoid residual improvement, voiding trial success, or adverse events after PAE. Lower procedure and fluoroscopy times with BO microcatheter were likely due to selection bias.


Assuntos
Artérias , Cateteres , Embolização Terapêutica/instrumentação , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Oclusão com Balão/efeitos adversos , Desenho de Equipamento , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Urodinâmica
9.
Radiographics ; 39(5): 1526-1548, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348735

RESUMO

Symptomatic benign prostatic hyperplasia is a common condition in the aging population that results in bothersome lower urinary tract symptoms and decreased quality of life. Patients often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are critical to optimize results. To perform PAE safely and avoid nontarget embolization, interventional radiologists must have a detailed understanding of the pelvic arterial anatomy. Although the prostatic arteries often arise from the internal pudendal arteries, several anatomic variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses have shown improved symptoms after treatment, with serious adverse effects occurring rarely. This article reviews the basic principles of PAE that must be understood to develop a thriving PAE practice. These principles include patient evaluation, review of surgical therapies, details of pelvic arterial anatomy, basic principles of embolization, and an overview of published results. Online supplemental material is available for this article. ©RSNA, 2019.


Assuntos
Artérias , Embolização Terapêutica/métodos , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Masculino
11.
Minerva Urol Nefrol ; 71(5): 524-530, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31166103

RESUMO

BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated the role of multiparametric magnetic resonance imaging of the prostate (mpMRI) as a tool to exclude incidental prostate cancer (iPCa) and to compare mpMRI alone with a contextual transrectal ultrasound guided biopsy (TRUS-GB). METHODS: Retrospective multicentric evaluation of 244 patients underwent to HoLEP with a suspicion of prostate cancer (PCa) due to raised PSA and/or abnormal digital rectal examination (DRE) and a negative mpMRI (PI-RADS score <3), was performed. Of these, 118 patients had only a negative mpMRI (MRI group) while 126 had a negative mpMRI and a contextual preoperative negative TRUS-GB (MRI + TRUS-GB group). Comparison between the two groups, univariate and multivariate analysis were conducted in order to identify any predictive factors of iPCa. RESULTS: Median age, PSA, prostate volume and PSA density were 64.0 years (IQR: 58.0-69.0), 6.10 ng/mL (IQR: 4.76-9.65), 86.0 cc (IQR: 65.0-115.0), 50.0 cc (IQR: 37.5-80.0) and 0.08 ng/mL/cc (IQR: 0.06-0.10), respectively. In surgical specimen, iPCa was detected in 21 cases (8.8%). No statistically differences between MRI and MRI + TRUS-GB group were found in terms of iPCa (7.6% and 8.5%, respectively), pathological T stage and ISUP Grade Group. A contextual TRUS-GB added to mpMRI did not correlate to iPCa either at uni- and multivariate analysis while a significant correlation of a PSA density >0.15 ng/mL/cc was found only at univariate analysis. CONCLUSIONS: Including a mpMRI in clinical evaluation of patients eligible to HoLEP with a preoperative PCa suspicion leads to low the rates of iPCa and might avoid unnecessary TRUS-GB.


Assuntos
Terapia a Laser/métodos , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/cirurgia , Idoso , Estudos de Coortes , Humanos , Biópsia Guiada por Imagem , Lasers de Estado Sólido , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/patologia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
12.
Invest Radiol ; 54(10): 661-668, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31211710

RESUMO

OBJECTIVES: The aim of this study was to evaluate the feasibility of a computed tomography (CT) protocol enabling the visualization of the prostatic artery (PA) before prostatic artery embolization (PAE) in benign prostatic hyperplasia, which provides quantitative perfusion information of the prostate gland. MATERIALS AND METHODS: In this institutional review board-approved study, 22 consecutive patients (mean age, 67 ± 7 years) who were planned to undergo PAE underwent a dynamic CT scan of the pelvis (scan range, 22.4 cm; cycle time, 1.5 seconds; scan time, 44 seconds; 25 scan cycles; 70 kVp; 100 mAs) after the administration of 70 mL of iodinated contrast media (flow rate, 6 mL/s; 10 seconds' delay). Image postprocessing consisted of a spatiotemporal, frequency-depending multiband filtering technique with noise reduction, motion correction, resulting in (1) time-resolved, temporal maximum intensity projection (MIP) images from fusion of multiple arterial time points; (2) 4-dimensional (4D) CT angiography images after bone and calcium plaque removal; and (3) parametric perfusion maps of the prostate. Intraprocedural cone-beam CT was performed with a microcatheter in the PA. In both modalities, the contrast-to-noise ratio of the right internal iliac artery or the PA was calculated, respectively. Visibility of the PA was scored using a Likert scale (score 1 = not seen, to score 4 = intraprostatic PA branches seen). Quantitative perfusion analysis of the dynamic pelvic CT included calculation of the blood flow, blood volume, mean transit time, and flow extraction product. RESULTS: The average volume CT dose index and dose length product of CT was 35.7 ± 6.8 mGy and 737.4 ± 146.3 mGy·cm, respectively. Contrast-to-noise ratio of the pelvic vessels on temporal MIP images and cone-beam CT were 45 ± 19 and 69 ± 27, respectively (P < 0.01). The mean visibility score of the PA was 3.6 ± 0.6 for 4D-CT angiography and 3.97 ± 0.2 for cone-beam CT (P < 0.001). The PA was visualized in 100% of 4D-CT angiography examinations, with one PA being visible only proximally. Prostate CT perfusion analysis showed blood flow, blood volume, mean transit time, and flow extraction product values of 27.9 ± 12.5 mL/100 mL/min, 2.0 ± 0.8 mL/100 mL, 4.5 ± 0.5 second, and 12.6 ± 5.4 mL/100 mL/min, respectively, for the whole prostate gland. About half the patients showed a pronounced difference between the lobes. CONCLUSIONS: We introduced a CT protocol for PAE planning providing excellent visualization of the PA on temporal MIP images and 4D-CT angiography at a reasonable dose and low contrast volume. In addition, quantitative perfusion information is available, which might be useful for outcome prediction after embolization.


Assuntos
Embolização Terapêutica/métodos , Tomografia Computadorizada Quadridimensional/métodos , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Idoso , Estudos de Viabilidade , Humanos , Masculino , Imagem de Perfusão , Próstata/irrigação sanguínea , Próstata/diagnóstico por imagem
13.
Med Phys ; 46(7): 3034-3043, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049993

RESUMO

PURPOSE: Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra. METHODS: A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 ± 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 ± 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract. RESULTS: Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 ± 0.08 mm) was significantly smaller than that for the normal phantom (2.49 ± 0.20 mm). Also, the maximum flow velocity of the BPH-featured phantom (59.3 ± 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 ± 9.0 cm/s). CONCLUSION: The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.


Assuntos
Imagens de Fantasmas , Próstata/fisiologia , Urodinâmica , Fenômenos Biomecânicos , Humanos , Masculino , Próstata/diagnóstico por imagem , Próstata/fisiopatologia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/patologia , Uretra/fisiopatologia , Sistema Urinário/anatomia & histologia , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/patologia
14.
Vasc Health Risk Manag ; 15: 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114214

RESUMO

A 74-year-old patient presented with isolated fecal incontinence 6 weeks following endovascular aneurysm repair. The delayed presentation of spinal cord ischemia was precipitated by commencement of alpha-blockers for benign prostatic hyperplasia. This case stresses that vulnerability to spinal cord perfusion is not limited to the perioperative period. In addition, systemic arterial pressure should be closely monitored in cases of marginal vascular insufficiency of the spinal cord.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Pressão Arterial/efeitos dos fármacos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Hiperplasia Prostática/diagnóstico por imagem , Quinazolinas/efeitos adversos , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/terapia , Idoso , Angiografia Digital , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Hiperplasia Prostática/diagnóstico , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
15.
Cancer Imaging ; 19(1): 26, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122297

RESUMO

BACKGROUND: To establish a new accumulating model to enhance the accuracy of prostate cancer (PCa) diagnosis by incorporating prostate-specific antigen (PSA) and its derivative data into the Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2). METHODS: A total of 357 patients who underwent prostate biopsy between January 2014 and December 2017 were included in this study. All patients had 3.0 T multiparametric magnetic resonance imaging (MRI) and complete laboratory examinations. PI-RADS v2 was used to assess the imaging. PSA, PSA density (PSAD), the free/total PSA ratio (f/t PSA) and the Gleason score (GS) were classified into four-tiered levels, and optimal weights were pursued on these managed levels to build a PCa accumulating model. A receiver operating characteristic curve was generated. RESULTS: In all, 174 patients (48.7%) had benign prostatic hyperplasia, and 183 (51.3%) had PCa, among whom 149 (81.4%, 149/183) had clinically significant PCa. The established model 6 (PI-RADS v2 + level of PSAD + level of f/t PSA+ level of PSA) had a sensitivity and specificity of 81.4 and 84.5%, respectively, at the cut-off point of 11 in PCa diagnosis. Correspondingly, at the 12 cut-off point, the sensitivity and specificity were 87.7 and 83.0%, respectively, in diagnosing clinically significant PCa. The score of the new accumulating system was significantly different among the defined GS groups (p < 0.001). The mean values and 95% confidence intervals for GS 1-4 groups were 10.20 (9.63-10.40), 12.03 (11.19-12.87), 14.12 (13.60-14.64) and 15.44 (15.09-15.79). CONCLUSIONS: A new PCa accumulating model may be useful in improving the accuracy of the primary diagnosis of PCa and helpful in the clinical decision to perform a biopsy when MRI results are negative.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Imagem por Ressonância Magnética , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Hiperplasia Prostática/sangue , Hiperplasia Prostática/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Sensibilidade e Especificidade
16.
Urol Int ; 103(2): 180-186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039569

RESUMO

BACKGROUND: Although prostate cancer releases more prostate-specific antigen (PSA) per unit of prostate volume (PV), data are limited regarding the association between intravesical prostatic protrusion (IPP) and the PSA level. OBJECTIVES: The study aim was to evaluate the IPP effect in patients with benign prostatic hyperplasia. METHOD: This study included patients with (n = 119) and without (n = 121) IPP. The age, International Prostate Symptom Score (IPSS), PSA level, maximum and average flow rates, PV, hematuria, urinary retention, and post-void residual (PVR) volume were compared between the 2 groups. RESULTS: The mean ages were similar between the 2 groups (66.56 ± 8.67 and 66.92 ± 8.7 years, respectively, p = 0.747), and there were no statistically significant differences in the IPSS, maximum and average flow rates, hematuria, PVR volume, and urinary retention means (p > 0.05). However, the IPP patients had lower total PSA (tPSA) and free PSA (fPSA) levels than those without IPP (3.55 [4.18] vs. 5.26 [5.24] ng/mL, p = 0.013 and 0.7 [1.09] vs. 1.05 [1.23] ng/mL, p = 0.029, respectively). Moreover, there were strong positive correlations between the IPP grade and the tPSA and fPSA levels (r = 0.262, p = 0.001 and r = 0.254, p = 0.002 respectively). CONCLUSIONS: This study demonstrated that IPP results in a decreased PSA level, even with a higher PV.


Assuntos
Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia
17.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936357

RESUMO

A 61-year-old man presented with urinary retention with obstructive uropathy (urea/creatinine: 126/9.2 mg/dL) secondary to a large prostatic haematoma while being medically managed for benign enlargement of the prostate. The patient did not have any fever or local symptoms and the prostate was enlarged and non-tender on examination. Ultrasound and MRI of the pelvis showed a 9.4×10.4×11.1 cm sized prostatic haematoma seen displacing and compressing the urinary bladder anteriorly with bilateral hydroureteronephrosis. The patient was managed with per-urethral catheterisation, haemodialysis and injectable antibiotics. Percutaneous pigtail placement into the prostatic haematoma led to gradual drainage of the haematoma with improvement in the renal parameters. Definitive surgery in the form of transurethral resection of the prostate was done at a later date. Intraoperatively multiple encapsulated cavities containing organised clots were deroofed. On follow-up, the patient did well and had good urinary flow and normal renal parameters.


Assuntos
Antibacterianos/uso terapêutico , Hematoma/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico por imagem , Ressecção Transuretral da Próstata/métodos , Retenção Urinária/etiologia , Hematoma/complicações , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/cirurgia , Hiperplasia Prostática/patologia , Hiperplasia Prostática/cirurgia , Resultado do Tratamento , Ultrassonografia , Cateterismo Urinário , Retenção Urinária/diagnóstico por imagem
18.
Niger J Clin Pract ; 22(4): 454-459, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30975947

RESUMO

Background: Intravesical prostatic protrusion (IPP) is a noninvasive test that can predict bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). Objective: The objective of this study was to determinethe correlation between IPP and International Prostate Symptom Score (IPSS) in patients with BPH. Patients and Methods: A cross-sectional prospective study of new patients with symptomatic BPH who presented to the urology clinics of NAUTH, Nnewi. Ethical approval and informed consent were obtained. Participants had abdominal ultrasonography measurements of IPP from midline sagittal image of the prostate (at bladder volume ≥100 mL) using Prosound SSD3500 with abdominal probe frequency of 3.5 MHz. IPP was divided into three grades (grade I: 0-4.9mm, grade II: 5.0-9.9 mm, and grade III: ≥10.0 mm). Data were analyzed using SPSS version 20. The data were subjected to analysis of variance, and Pearson's correlation was used to assess correlation where necessary. P value < 0.05 was considered significant. Results: In all, 101 men with a mean age of 67.09 ± 10.93 years were included in the study. The average IPSS, storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and IPP were 17.05 ± 7.62, 7.81 ± 5.17, 9.24 ± 3.16, 4.75 ± 1.59, and 13.50 ± 7.47 mm, respectively. There were significant differences between the mean IPSS (P = 0.000), mean IPSS-S (P = 0.000), and mean IPSS-V (P = 0.002) among the three grades of IPP. There were significant positive correlations between IPP and IPSS (P = 0.000), IPSS-S (P = 0.000), IPSS-V (P = 0.000), and IPSS QoL index (P = 0.000). Conclusion: There were significant positive correlations between IPP and IPSS, IPSS-S, IPSS-V, and IPSS QoL index.


Assuntos
Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico por imagem , Inquéritos e Questionários/normas , Avaliação de Sintomas/métodos , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Idoso , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hiperplasia Prostática/complicações , Qualidade de Vida , Avaliação de Sintomas/normas , Ultrassonografia , Obstrução do Colo da Bexiga Urinária/etiologia
19.
Clin Radiol ; 74(7): 569.e1-569.e8, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30955835

RESUMO

AIM: To describe the authors' experience with prostate artery embolisation (PAE) to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) or refractory haematuria of prostatic origin (RHOPA). MATERIALS AND METHODS: PAE was attempted in 159 patients. Procedural details, pre/post-PAE symptom scores, and pre/post-PAE magnetic resonance imaging (MRI) data were recorded. Statistical analysis was performed to determine clinical outcomes and factors predicting clinical success. RESULTS: Technical success was achieved in 156 patients. In patients with LUTS, the International Prostate Symptom Score (IPSS) improved from a mean of 22 at baseline to 9.5 at 6-months post-PAE, then to 10.7, 10, 11.3, and 11 at 1, 2, 3, and 4 years. The quality of life (QoL) score improved from 4.6 at baseline to 2, 2.2, 2.4, 3.1, and 2.5 at the same time points. The International Index of Erectile Function (IIEF-5) scores remained stable. There was no significant difference in IPSS between bilateral or unilateral embolisation to 2 years, or between BPH alone or BPH with biopsy-proven prostate cancer to 3 years post-PAE. Percentage improvement in IPSS at 1 year correlated with percentage reduction in prostate volume on first post-PAE MRI. Percentage improvement in IPSS at 3 years correlated with initial IPSS. PAE facilitated urinary catheter removal in 13/24 patients in retention. PAE controlled bleeding in 12/12 patients with RHOPA. CONCLUSION: PAE is safe and effective in the management of symptomatic BPH. Patients with the highest baseline IPSS and reduction in prostate volume on first post-PAE MRI are likely to derive most benefit from embolisation.


Assuntos
Embolização Terapêutica/métodos , Hematúria/etiologia , Sintomas do Trato Urinário Inferior/etiologia , Próstata/irrigação sanguínea , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Retenção Urinária/etiologia , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Seguimentos , Hematúria/terapia , Humanos , Sintomas do Trato Urinário Inferior/terapia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico por imagem , Resultado do Tratamento , Retenção Urinária/terapia
20.
Cardiovasc Intervent Radiol ; 42(7): 1001-1007, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993369

RESUMO

PURPOSE: To determine the effects of prostatic artery embolization (PAE) on prostatic elasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation. MATERIALS AND METHODS: This is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up. RESULTS: After PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, - 29.8%, p = 0.002) and in m/s (3.75 vs. 4.63, - 19.0%, p < 0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p < 0.05). All eight patients presented with significant LUTS improvement after PAE (p < 0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA). CONCLUSIONS: Findings described in this study suggest that PAE significantly reduces prostatic EM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Embolização Terapêutica/métodos , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Idoso , Estudos de Viabilidade , Seguimentos , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Próstata/diagnóstico por imagem , Hiperplasia Prostática/complicações , Resultado do Tratamento
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