Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.284
Filtrar
1.
Arch Esp Urol ; 74(2): 254-260, 2021 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33650541

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery. MATERIALS AND METHODS: 17 elderly patients with moderate to severe LUTS/BPH were included in the study and treated with prostatic artery embolization. The patients were evaluated by transrectal ultrasonography (to assess prostate size), IPSS, and PVR urine volume preoperatively and 6 months after the procedure. RESULTS: The mean age of patients was 76.67 ± 7.69. The mean prostate volume was 139.8 ± 81.83 g. The mean preoperative IPSS and PVR were 23 ± 5.4, and 94.43 ± 88.94 ml, respectively. The mean operative time was 90 minutes. Only three patients suffered from postoperative complications (two patients suffered from urinary tract infection and one patient had partial penile necrosis). At 6 months follow up, there was a significant reduction in the prostate volume (101 ± 73.65 cc), IPSS (12.5 ± 3.65), and PVR urine volume (48.64 ± 43.55). CONCLUSION: prostatic artery embolization is a safe and effective nonsurgical alternative treatment of BPH/LUTS particularly in elderly patients with multiple comorbidities.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Idoso , Artérias , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Resultado do Tratamento
2.
Curr Urol Rep ; 22(4): 21, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554319

RESUMO

PURPOSE OF REVIEW: Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is a disease complex with enormous societal burden and yet the pathogenesis of LUTS/BPH is poorly understood. We set out to review the literature on the relationship between depression, marijuana usage, and erectile dysfunction (ED) to LUTS/BPH. RECENT FINDINGS: LUTS/BPH has independent associations with depression as well as with ED. In each case, the causality and mechanistic relationship is unknown. The impact of marijuana, as it increasingly pervades the general population, on the disease complex of LUTS/BPH is not well studied but recent results support short-term benefit and long-term caution. Depression, a form of central nervous dysfunction, and ED, which is likely mediated via endothelial dysfunction, are independently associated with LUTS/BPH. The presence of cannabinoid receptors in urologic organs, coupled with recent population studies, supports a modulatory effect of marijuana on voiding although an enormous knowledge gap remains.


Assuntos
Depressão , Disfunção Erétil , Sintomas do Trato Urinário Inferior , Fumar Maconha , Hiperplasia Prostática , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/fisiopatologia , Depressão/fisiopatologia , Depressão/psicologia , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Disfunção Erétil/terapia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/psicologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/fisiopatologia , Fumar Maconha/psicologia , Fumar Maconha/terapia , Hiperplasia Prostática/etiologia , Hiperplasia Prostática/psicologia , Hiperplasia Prostática/terapia , Fatores de Tempo
3.
Cardiovasc Intervent Radiol ; 44(1): 95-101, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33037455

RESUMO

PURPOSE: To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. MATERIALS AND METHODS: We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical follow-up occurred at a minimum of 3 months. RESULTS: 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p < 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). CONCLUSION: We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery.


Assuntos
Embolização Terapêutica/métodos , Hiperplasia Prostática/terapia , Idoso , Angiografia , Artérias , Tomografia Computadorizada de Feixe Cônico , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
4.
Tech Vasc Interv Radiol ; 23(3): 100693, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308525

RESUMO

Many interventions to treat men with benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS) are associated with sexual side effects or complications, such as hematospermia, erectile dysfunction, or ejaculatory dysfunction. As loss of sexual function can significantly impact quality of life, an optimal treatment for BPH associated LUTS would be one without any sexual dysfunction side effects. Prostatic artery embolization is a minimally invasive treatment for men with BPH associated LUTS. The aim of this paper is to review the effects of prostatic artery embolization on sexual function and compare the sexual side effect profile to the other available BPH procedures.


Assuntos
Embolização Terapêutica/efeitos adversos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Medição de Risco , Fatores de Risco , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/psicologia , Resultado do Tratamento
5.
Tech Vasc Interv Radiol ; 23(3): 100696, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308526

RESUMO

There are active debates surrounding patient evaluation and procedural techniques of prostate artery embolization. This review evaluates the available evidence on the value of urodynamics, the effect of prostate gland size, the benefits of pre- and intraprocedural cross-sectional imaging, the utility of a balloon-occlusion microcatheter, the differences among embolic particle sizes and types, and the merits of radial versus femoral arterial access.


Assuntos
Embolização Terapêutica/normas , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Seleção de Pacientes , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Radiografia Intervencionista/efeitos adversos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Urodinâmica
6.
Tech Vasc Interv Radiol ; 23(3): 100694, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308527

RESUMO

Hematuria of prostatic origin has multiple etiologies including benign prostatic hyperplasia (BPH), iatrogenic urological trauma, prostate cancer, and radiation therapy. Hematuria secondary to benign prostatic hyperplasia can occur because of the increased vascularity of the primary gland, itself, or because of the vascular re-growth following a transurethral resection of the prostate. Prostatic hematuria usually resolves with conservative measures; however, refractory hematuria of prostatic origin may require hospitalization with treatment with blood transfusions, repeated indwelling urinary catheterization, and continuous bladder irrigation. Prostate artery embolization is an emerging minimally invasive procedural therapy for men with BPH that was originally utilized for the treatment of refractory hematuria of prostatic origin . This article aims to summarize the currently available evidence around prostate artery embolization for the treatment of refractory hematuria of prostatic origin.


Assuntos
Embolização Terapêutica , Hematúria/terapia , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Embolização Terapêutica/efeitos adversos , Hematúria/diagnóstico por imagem , Hematúria/etiologia , Hematúria/fisiopatologia , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
7.
Tech Vasc Interv Radiol ; 23(3): 100687, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308528

RESUMO

As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Radiografia Intervencionista , Procedimentos Cirúrgicos Urológicos Masculinos , Agentes Urológicos/uso terapêutico , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Agentes Urológicos/efeitos adversos
8.
Tech Vasc Interv Radiol ; 23(3): 100689, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308529

RESUMO

Identification of the prostatic arteries (PAs) is one of the most challenging aspects of prostate artery embolization for treatment of benign prostatic hyperplasia-associated lower urinary tract symptoms. Operators require a detailed understanding of the prostate arterial anatomy to ensure technical and clinical success with minimal complications. Due to substantial variability in internal iliac artery branch patterns and specifically the origin of the PA, we focus on 3 clinically relevant classification systems used to categorize the pelvic vasculature. These include classification systems to understand the internal iliac artery branching pattern, PA origin variation, and intraprostatic branching.


Assuntos
Embolização Terapêutica , Artéria Ilíaca , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Artéria Ilíaca/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia
9.
Tech Vasc Interv Radiol ; 23(3): 100688, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308530

RESUMO

Prostate artery embolization (PAE) has been shown to be safe and effective at treating lower urinary tract symptoms (LUTS), urinary retention, and hematuria caused by benign prostatic hyperplasia (BPH). To distinguish from other causes of these symptoms, a multidisciplinary evaluation by a urologist and interventional radiologist should include a complete history to screen for any nonprostate causes of LUTS. The International Prostate Symptom Score is a useful objective measure to quantify the patient's urinary complaints. A physical exam should be performed to evaluate a patient's candidacy for angiography, and baseline laboratory evaluation should ensure that the patient's coagulation and kidney function are adequate. In certain situations, patients may benefit from cystoscopy and urodynamic evaluation to ensure their symptoms are related to BPH. A review of the patient's imagining can be the most important component of the evaluation of a patient prior to PAE, because a patient's gland size is often a primary driver of what procedural options available are to him. Men with small glands (≤30 mL) can be treated with several of the available minimally invasive transurethral procedures, but larger glands (≥80-120 mL) may be limited to holmium laser enucleation of prostate, thulium laser enucleation of prostate, surgical prostatectomy, or PAE, depending on institutional practice patterns. Secondary considerations include medical comorbidities, the risks for sexual side effects, the risk for bleeding, and the possible adverse events associated with the procedure, which are all low for PAE. Most patients suffering from symptomatic BPH resulting in LUTS, retention, or hematuria will benefit from PAE.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Urodinâmica
10.
Tech Vasc Interv Radiol ; 23(3): 100695, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308532

RESUMO

Medically refractory benign prostatic hyperplasia induced lower urinary tract symptoms is an extremely prevalent issue in older men. The current gold standard therapy transurethral resection of the prostate does produce urologic improvements but is also associated with higher than desired morbidity. This has led to the need to develop new minimally invasive means to treat this disease; prostate artery embolization (PAE) has emerged as one minimally invasive treatment option for these patients. The body of evidence which supports the use of PAE has grown quickly and substantially over the last decade. The goal of this review is to introduce and summarize the published urologic outcomes for PAE when utilized to treat benign prostatic hyperplasia induced lower urinary tract symptoms as well as document the established complication profile. Finally, the paper reviews current societal recommendations as they relate to PAE.


Assuntos
Embolização Terapêutica/normas , Medicina Baseada em Evidências/normas , Sintomas do Trato Urinário Inferior/terapia , Guias de Prática Clínica como Assunto/normas , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Radiografia Intervencionista/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Urodinâmica
11.
Tech Vasc Interv Radiol ; 23(3): 100692, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308533

RESUMO

As prostate artery embolization (PAE) for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia becomes more commonly performed, operator knowledge of the adverse events is essential to inform patient selection, patient preparation, and postprocedural management. The aim of this article is to discuss the incidence, presentation, and management of adverse effects after PAE.


Assuntos
Embolização Terapêutica/efeitos adversos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Fatores de Risco , Resultado do Tratamento
12.
Tech Vasc Interv Radiol ; 23(3): 100691, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308534

RESUMO

In the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.


Assuntos
Cateteres , Embolização Terapêutica/instrumentação , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/instrumentação , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
13.
Tech Vasc Interv Radiol ; 23(3): 100690, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308535

RESUMO

Prostate artery embolization (PAE) is a minimally invasive treatment for benign prostatic hyperplasia associated lower urinary tract symptoms. The prostatic arterial anatomy, origins and collaterals, are highly variable and can lead to technical pitfalls and suboptimal results during PAE. In this paper we aim to discuss the variant prostate artery origins and collateral circulation to provide a primer on relevant anatomy for interventional radiologists performing PAE.


Assuntos
Circulação Colateral , Embolização Terapêutica , Artéria Ilíaca/anormalidades , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Fluxo Sanguíneo Regional
16.
Medicine (Baltimore) ; 99(36): e22006, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899049

RESUMO

BACKGROUND: Benign prostatic hyperplasia (BPH) is a disease of the urinary system. It is common in middle-aged and elderly men. Moxibustion is widely used to manage BPH and the associated lower urinary tract symptoms, but there is still lack of systematic review of moxibusiton for BPH. So the aim of this review is to comprehensively evaluate the effectiveness and safety of moxibustion in the treatment of BPH. METHODS: The following 8 electronic databases including PubMed (1966-2020), EMbase (1980-2020), the Cochrane Library, Web of Science (1900-2020), China National Knowledge Infrastructure Database (1979-2020), WanFang Database (1998-2020), Chinese Scientific Journal Database (1989-2020), and Chinese Biomedical Literature Database (1979-2020) will be searched. No language restrictions will be used. Researchers will retrieve databases, identify trials, extract data, and evaluate the quality of eligible randomized controlled trials, independently. The outcomes will include: total effective rate, the American Urologic Association Symptom Score, International Prostate Symptom Score, urinary flow rate (measured in mL/s), changes in prostate size (measured in cc), quality of life, side effects and adverse events. The quality of methodology and evidence will be rated by using the Cochrane risk-of-bias assessment tool and grading of recommendations, assessment, development, and evaluation tool, respectively. Data synthesis will be presented by the manager of the Cochrane Collaboration's RevMan 5.3.0. RESULTS: We will show the results of this study in a peer-reviewed journal. CONCLUSIONS: The findings will provide credible clinical evidence of moxibustion treatment for BPH. PROSPERO REGISTRATION NUMBER: CRD42020190630.


Assuntos
Moxibustão , Hiperplasia Prostática/terapia , Humanos , Masculino , Metanálise como Assunto , Revisões Sistemáticas como Assunto
18.
Urologe A ; 59(10): 1195-1203, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32880664

RESUMO

Multimorbid older men are increasingly more common in daily practice and present a challenge because they are often affected by lower urinary tract symptoms (LUTS) and age-associated benign prostatic hyperplasia (BPH). In order to identify possible risks in diagnostics, therapy and counselling at an early stage, screening for functional deficits or risk factors with standardized procedures is helpful. An initial screening with subsequent assessment of everyday skills using the Barthel Index, Timed up & Go Test, and a cognitive test are recommended. If frailty syndrome is detected, it should be taken into account during the pre-, peri-, and postoperative management, as it may indicate increased morbidity and mortality. Noninvasive methods for reducing the prostate volume without anesthesia can be a therapy option in older multimorbid patients, and with individual planning and consideration of risk factors, up to 70% of individuals become symptom-free. However, there is currently no gold standard for this vulnerable patient group. Number of medications and concomitant diseases and higher need for help are per se risk factors for unsatisfactory results after transurethral resection of the prostate (TURP) or laser vaporization. With drug therapy, concomitant medications and their interactions, especially in the cytochrome system, an existing multimorbidity and adherence to therapy must be taken into account. Combination therapies may complement each other and may bridge the time until surgery. Minimally invasive methods that can be performed without general anesthesia are suitable for geriatric patients, especially those with recurrent retention. Studies with the Rezüm® system (NxThera Inc., Maple Grove, MN, USA) and UroLift® (NeoTract Inc., Pleasanton, CA, USA) show that about 70% of patients can be relieved from the permanent catheter.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Idoso , Idoso Fragilizado , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/terapia , Resultado do Tratamento
19.
Arch. esp. urol. (Ed. impr.) ; 73(7): 573-581, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195955

RESUMO

OBJETIVO: Los médicos de Atención Primaria (MAP) son fundamentales en la regulación del flujo de pacientes desde Atención Primaria (AP), por tanto, es esencial buscar métodos de adecuada gestión de la demanda asistencial y así optimizar recursos. En la hipertrofia benigna de próstata (HBP) se estima que 2/3 de los pacientes pueden ser manejados íntegramente desde AP a lo largo de todo el proceso de la HBP. MATERIAL Y MÉTODOS: Hemos realizado un estudio pre experimental en dos períodos, antes (pre-test) y después (post-test) de la creación de un protocolo de manejo y derivación de pacientes con HBP. Analizamos la adecuación a los criterios de derivación y el uso de los estudios complementarios para llevar a cabo el diagnóstico, realizando un análisis estadístico (descriptivo, bivariante, multivariante y cálculo de tasas) utilizando SPSS (versión 21). RESULTADOS: La tasa de derivación disminuyó tras la aplicación del protocolo, pero no logró mejorar la adecuación. Los pacientes derivados por los MAP que asistieron al programa educativo fueron más jóvenes. Se remitieron menos pacientes con PSA elevado y más pacientes con progresión clínica. Se utilizaron menos estudios complementarios. Los MAP que no acudieron a la formación eran más jóvenes, principalmente mujeres, sin formación especifica en HBP y con contrato temporal. CONCLUSIONES: A pesar de reducir la tasa de derivación no se consiguió mejorar la adecuación de la derivación de los pacientes. Consideramos necesario analizar la problemática de los MAP y valorar otras intervenciones que podrían mejorar la calidad en la transferencia de responsabilidades


OBJECTIVE: In the Spanish health system, General Practitioners (GPs) play a key role in regulating the flow of patients to hospital care. Most of patients with BPH can be managed throughout the evolution of the disease exclusively by the GPs. METHODS: A pre-experimental study was carried out in two periods, before (pre-test) and after (post-test) of the dissemination of a management protocol for patients with BPH. The protocol was trialled in the health area of Villarrobledo and included all referrals to the urology clinic for BPH from Primary Care. We analyzed the appropriate referrals according with the criteria set forth in the protocol and compared the complementary tests through statistical study (descriptive, a bivariate, multivariate analysis and rate calculation) using version 21 of the SPSS. RESULTS: Referral rate decreased after the application of the protocol but did not increase the rate of appropriated referrals. Patients referred after setting forth protocol by GPs that assisted to the education program were younger. There were referred less patients with elevated PSA and more patients with clinical progression. These GPs used less test to achieve diagnosis. The GPs who did not attend were significantly younger, mainly women, with no previous specific training in BPH and without a full time GP position. CONCLUSIONS: The implementation of a protocol has reduced the referral rate, but it has not improved the appropriate referrals. More research is required to understand the determinants of inequalities in referral from primary care


Assuntos
Humanos , Masculino , Idoso , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde , Hiperplasia Prostática/terapia , Sintomas do Trato Urinário Inferior/terapia , Encaminhamento e Consulta/normas , Fatores de Tempo , Algoritmos , Encaminhamento e Consulta/estatística & dados numéricos , Reprodutibilidade dos Testes , Clínicos Gerais , Análise Multivariada , Espanha
20.
J Vasc Interv Radiol ; 31(8): 1272-1280, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32741552

RESUMO

PURPOSE: To evaluate the safety and efficacy of repeat prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A single-center retrospective study was conducted from 2009 to 2018 in 108 patients with symptomatic BPH treated with repeat PAE: group A (n = 39; 36.1%) were patients who never showed a response to PAE, and group B (n = 69; 63.9%) were patients who had clinical improvement in the first 6 months following PAE but relapsing symptoms afterward. The main patterns of revascularization were 75% from the previously embolized PA and 25% from collateral vessels (superior vesical, posterior-lateral PA, penile branches). Technical outcomes and adverse events were registered. International Prostate Symptom Score (IPSS), quality of life (QOL), and clinical success were compared between groups. RESULTS: Median follow-up was 18 months (range, 1-36 mo); median interval between PAE and repeat PAE was 420 days (range, 77-2,240 d). Mean procedural time was significantly longer for repeat PAE vs initial PAE (81.1 min vs 67.4 min; P = .0007). There were no major complications and no urinary incontinence. Mean IPSS/QOL improvements were greater in group B vs group A: 9.51 vs 6.13 and 1.30 vs 0.56, respectively (P < .001). The cumulative probability of clinical success after repeat PAE was higher in group B than in group A (P = .0001): 84.1% vs 46.2% at 1 month, 56.7% vs 28.2% at 12 months, and 51.9% vs 16.9% at 24-36 months. CONCLUSIONS: Repeat PAE is safe and effective for recurrence of lower urinary tract symptoms caused by BPH but has limited impact in patients who did not show a response to initial PAE.


Assuntos
Artérias , Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Angiografia Digital , Artérias/diagnóstico por imagem , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , 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 , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...