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2.
Urology ; 136: 212-217, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734349

RESUMO

OBJECTIVE: To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in nonindex benign prostatic hyperplasia patients. MATERIALS AND METHODS: Seventy-five patients undergoing PAE from December 2013 to August 2018 (age = 77.5 ± 8.6, age-adjusted Charlson comorbidity index = 4.6 ± 2.0, prostate volume = 224 mL ± 135 mL) for retention (n = 46) and/or gross prostatic hematuria (n = 55) were retrospectively reviewed. Twenty-six patients had both problems. Urinary retention patients (UR, n = 46, catheterization = 162.4 ± 148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and postvoid residual (PVR) recorded at 3, 6, 12, 24, and 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n = 39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n = 16). Ninety-day adverse event tabulation used Clavien-Dindo classification. RESULTS: Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS = 8.9 ± 5.3, QoL = 1.6 ± 1.7, PVR = 158 mL ± 207 mL). Results were similar at 6 months (catheter-free = 26/28(93%), IPSS = 6.5 ± 4.4, QoL = 1.1 ± 0.9, PVR = 149 mL ± 139 mL), 12 months (catheter-free = 19/20(95%), IPSS = 4.7 ± 4.8, QoL = 0.6 ± 0.9, PVR = 125 mL ± 176 mL), 24 months (catheter-free = 11/12(92%), IPSS = 4.4 ± 3.0, QoL = 0.9 ± 0.8, PVR = 66 mL ± 68 mL), and 36 months (catheter-free = 5/6(83%), IPSS = 5.8 ± 3.8, QoL = 0.8 ± 1.0, PVR =99 mL ± 71 mL). Out of 37, 34(92%) GH patients remained hematuria-free at 483 ± 137 days, with 22 hematuria-related visits pre-PAE vs none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. Subsequently, 13/16(81%) remained hematuria-free at 500 ± 501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections. CONCLUSION: PAE provided safe, effective, and durable treatment for retention and gross hematuria in nonindex benign prostatic hyperplasia patients.


Assuntos
Embolização Terapêutica , Hematúria/etiologia , Hematúria/terapia , Próstata/irrigação sanguínea , Doenças Prostáticas/etiologia , Doenças Prostáticas/terapia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Retenção Urinária/etiologia , Retenção Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Artérias , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Urologiia ; (5): 86-93, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808638

RESUMO

AIM: to study the course of chronic abacterial prostatitis with the inflammatory component (CAPIC) depending on the somatotype in men of the first period of mature age taking complex treatment with a use of local and systemic ozone therapy. MATERIALS AND METHODS: A total of 306 men of asthenic, normostenic and pyknic somatotypes with CAPIC were followed-up. Along with standard therapy, all patients received systemic and local ozone therapy. Clinical, laboratory and imaging characteristics were recorded before and after treatment. In addition, hemodynamic parameters in the prostate, prostatic part of the urethra and skin projection of the prostate were evaluated. RESULTS: In patients with pyknic somatotype (from 34.12+/-0.51 cm3 to 29.08+/-0.64 cm3) the most significant reduction in prostate size during the treatment with CAPIC was observed, while the improvement of microcirculation parameters were seen in patients with asthenic somatotype. Changes in the microcirculation in the mucous membrane of the prostatic part of the urethra and skin projection of the prostate during the treatment of CAPIC are somatotype-dependent. The highest values of tissue perfusion were found in patients of the normostenic somatotype, while pyknic patients had the smallest values. Along with somatotyping, this allows to use in clinical practice the abovementioned methods for early diagnosis and subsequent monitoring of the effectiveness of CAPIC therapy.


Assuntos
Ozônio/administração & dosagem , Próstata/irrigação sanguínea , Prostatite/terapia , Doença Crônica , Humanos , Masculino , Próstata/patologia , Somatotipos
4.
Nihon Yakurigaku Zasshi ; 154(5): 250-254, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31735753

RESUMO

Benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE) is a common proliferative disease, and giving rise to associate with lower urinary tract symptoms (LUTS). However, the pathogenesis is not well clarified, and thought to be multifactorial. There are some lines of evidence that impairment in the blood supply of the lower urinary tract causes development of BPH/BPE. Clinical data showed an association between the development of BPH/BPE and atherosclerotic disease such as hypertension, diabetes and hyperlipidemia. The spontaneously hypertensive rat (SHR) has been used as model of genetic hypertension. SHR also shows decreased blood flow and hyperplastic morphological abnormalities in the ventral prostate. Our previous studies demonstrated that chronic treatment with vasodilative drugs nicorandil (ATP sensitive potassium channel opener) and silodosin (alpha1 adrenoceptor antagonist) increased blood flow and suppressed the growth factor and morphological abnormalities in the SHR ventral prostate. These data suggested that prostatic blood flow could be therapeutic targets for BPH/LUTS.


Assuntos
Próstata/irrigação sanguínea , Hiperplasia Prostática/tratamento farmacológico , Vasodilatadores/uso terapêutico , Animais , Hipertensão/complicações , Indóis/uso terapêutico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Nicorandil/uso terapêutico , Próstata/fisiopatologia , Hiperplasia Prostática/complicações , Ratos , Ratos Endogâmicos SHR
5.
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
6.
Andrologia ; 51(9): e13361, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31264247

RESUMO

We aimed to evaluate whether pelvic magnetic resonance imaging (MRI) could play a role in better assessing chronic pelvic pain syndrome. We evaluated 44 male patients (median 41 aged) with a clinical history of painful pelvic symptoms, lasting for at least three of the previous 6 months, associated with urinary, anorectal and sexual disorders in the absence of bacterial prostate infection. All these patients underwent ultrasound (US) and MRI evaluation of the pelvis. Prostate imaging findings, such as gland morphology evaluated by US and prostatic signal intensity on MRI, appeared normal in the majority of patients (38/44; 82%). Extraparenchymal alterations were found in 28 patients (63.6%); the most frequent was the dilatation of periprostatic vein plexus (20/28; 71.4%), significantly correlated to chronic pelvic pain syndrome (p = 0.0013), regardless of different clinical presentations. This finding was tested in a control group of 90 patients, demonstrating an excellent specificity (97%), good positive predictive value (87%) and diagnostic accuracy (80%). MRI confirmed its high capability in evaluating prostatic and extraprostatic structures. Periprostatic vein dilatation, which identified approximately two-thirds of the patients with chronic pelvic pain syndrome using pelvic MRI, significantly correlated to chronic pelvic pain syndrome, independently of patient age, symptoms and prostatic volume.


Assuntos
Dor Crônica/diagnóstico , Imagem por Ressonância Magnética , Dor Pélvica/diagnóstico , Próstata/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Dor Crônica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/patologia , Valor Preditivo dos Testes , Próstata/irrigação sanguínea , Próstata/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia
7.
Presse Med ; 48(4): 447-453, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31047745

RESUMO

Benign Prostatic Hyperplasia (BPH) concerns 50% of men older that 60 Years old and can induce symptoms also earlier. Medical treatment are mostly alpha blockers (AB), 5-alpha réductase inhibitors (5ARI) and phospho-diestérase inhibitors. In case of failure or poor tolerance of drug treatment, surgery can be indicated, after evaluation of the Bladder Outlet Obstruction (BOO), based on urodynamic studies. Endoscopic or open surgery is selected according to the size of the prostate, the expertise of the urologist and patient preference. Surgical treatment is very efficient but carries frequent complications, especially retrograde ejaculation which is very frequent and can compromise fertility and sexual pleasure. Prostatic Artery Embolisation, an outpatient intervention performed by Interventional Radiologists and available in France since 2012 is a new alternative to surgery in case of failure or poor tolerance of medical treatment. It consists in super-selective injection of calibrated micro-particles into both prostatic arteries after femoral artery puncture at the groin. It is safe and efficient and provides appropriate symptomatic improvement BOO related to BPH.


Assuntos
Embolização Terapêutica , Hiperplasia Prostática/terapia , Artérias , Humanos , Masculino , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico
8.
Scand J Urol ; 53(2-3): 151-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096824

RESUMO

Background: Transurethral resection of the prostate (TURP) is 'Gold Standard' treatment for moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) with bladder-outlet obstruction (BOO). However, TURP is associated with a risk of complications, so minimally invasive methods have been developed. Prostate artery embolization (PAE) is a new minimally invasive procedure. This study reports the outcomes of PAE when introduced in a 'real life' clinical setting in a Swedish County hospital. Methods: A prospective, single-center, single-arm study in a consecutive vascular-anatomy 'all comers' population, eligible for TURP or adenomaenukleation, but unsuitable for this, treated with PAE from January 2015 to June 2018. Defined improvement of IPSS/QoL scores, or freedom from urinary catheter if previous urinary catheter-dependent, or clean intermittent catheterization (CIC) were considered as clinically successful treatments. PAE was performed until arterial stasis using the Perfected technique. Most patients were treated during a day-care procedure. Results: Of 37 treated men, bilateral PAEs were achieved in 32 patients, unilateral PAEs in four patients, and bilateral failure in one patient due to difficult vascular anatomy. Clinically successful treatment was achieved in 84%, without serious adverse events. Conclusions: PAE was introduced in Sweden, showing PAE as a novel and good minimally invasive alternative in treatment of symptomatic BPH, possible to perform as a day-care procedure.


Assuntos
Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hiperplasia Prostática/complicações , Suécia , Ressecção Transuretral da Próstata , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/complicações
9.
Prog Urol ; 29(5): 263-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30948187

RESUMO

INTRODUCTION: Prostatic arterial embolization (PAE) is an experimental therapy for benign prostatic hyperplasia. Its feasibility is based on the knowledge of the pelvic arterial anatomy, and more specifically the prostate. The aim of this study was to describe the prostatic arterial supply: origins, distribution and variability. MATERIAL AND METHODS: We reviewed retrospectively, with two radiologists, 40 arteriographies of patients who underwent PAE in our center. With these observations of 80 hemipelvics, we described the number of prostatic arteries, their origins, their distributions and eventually their anastomoses with other pelvic arteries. RESULTS: There was one prostatic artery in 70% of the cases. It came from a common trunk for the prostate and the bladder in 55% of the cases, from the obturator artery in 17.5% of the cases, from the pudendal artery in 25% of the cases, from the intern iliac artery in 1% of the cases, and from the superior gluteal artery in 1% of the cases. The prostatic artery splitted in two branches (medial and lateral), with no anastomoses in 37% of the cases. Anastomoses with penile and rectal arteries were observed in 29% of the cases. CONCLUSIONS: For our 40 patients, we observed many variations of arterial prostatic anatomy. We proposed a classification in order to increase security and efficacy of PAE, and it should be validated with more patients. LEVEL OF EVIDENCE: 2.


Assuntos
Artérias/anatomia & histologia , Artérias/patologia , Embolização Terapêutica/métodos , Próstata/anatomia & histologia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Artérias/diagnóstico por imagem , Artérias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/patologia , Estudos Retrospectivos
10.
J Vasc Interv Radiol ; 30(5): 645-651, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30948326

RESUMO

PURPOSE: To describe mechanisms of prostate revascularization based on imaging findings during repeat prostatic artery embolization (PAE; rPAE). MATERIALS AND METHODS: This is a retrospective analysis of 10 rPAEs performed between October 2012 and September 2018 in patients with recurrent lower urinary tract symptoms (LUTS) after PAE (mean age, 68.2 y ± 4.5). Two interventional radiologists reviewed PAE and rPAE images and defined 6 patterns of revascularization. Correlation between embolization of the posterolateral (PL) prostatic branch during previous PAE and prostate revascularization on rPAE was assessed by Fisher exact test. One hemiprostate was excluded because no detectable revascularization was observed. RESULTS: All patients showed LUTS improvement after previous PAEs (P < .01 for 5 outcome measures) and had recurrence during follow-up. rPAEs were performed a mean of 40.9 months after previous PAEs (18-96 mo). Of 19 hemiprostates analyzed, 11 presented revascularization by 2 or more branches (57.9%). The PL branch (29.0%) and the recanalized main prostatic artery (25.8%) were the most frequent revascularizing branches observed, followed by distal branches of obturator (12.9%), internal pudendal (12.9%), superior vesical (12.9%), and contralateral arteries (6.5%). Embolization of the PL branch during previous PAE significantly reduced the incidence of revascularization by this branch (P = .002). CONCLUSIONS: Mechanisms of revascularization in rPAE are diverse and complex. Revascularization by the PL branch and recanalization of the previously embolized prostatic artery were the most frequent patterns observed. Embolization of the PL branch may reduce the incidence of prostate revascularization and LUTS recurrence after PAE.


Assuntos
Angiografia/métodos , Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Embolização Terapêutica/efeitos adversos , Humanos , Injeções Intra-Arteriais , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Recidiva , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
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
12.
J Vasc Interv Radiol ; 30(7): 1021-1026, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31003843

RESUMO

This article demonstrates the use of a representative commercially available automated vessel-tracking software originally intended for liver-only application (Vessel Assist Flight Plan for Liver; GE) in 4 patients. Treatment settings included embolization of small bowel hemorrhage source, treatment of renal cell carcinoma, management of symptomatic benign prostate hypertrophy, and detection with subsequent closure of a mesenteric pseudoaneurysm. All patients were treated successfully.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Carcinoma de Células Renais/irrigação sanguínea , Angiografia por Tomografia Computadorizada/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Imageamento Tridimensional/métodos , Neoplasias Renais/irrigação sanguínea , Artéria Mesentérica Superior/diagnóstico por imagem , Hemorragia Pós-Operatória/diagnóstico por imagem , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Artéria Renal/diagnóstico por imagem , Software , Idoso , Falso Aneurisma/terapia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Embolização Terapêutica , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Masculino , Pancreaticoduodenectomia/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Valor Preditivo dos Testes , Dados Preliminares , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Estudos Retrospectivos , Resultado do Tratamento
13.
J Vasc Interv Radiol ; 30(5): 638-644, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31029381

RESUMO

PURPOSE: This study compared the safety and efficacy of prostatic arterial embolization (PAE) with that of trisacryl gelatin microspheres of different sizes for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This study consisted of a single-center, randomized controlled clinical trial in 138 patients who underwent PAE for BPH between July 2015 and December 2016. Patients were randomized to PAE using microspheres of different sizes: group A patients were treated with microspheres 100-300 µm, group B with 300-500 µm, and group C with 100-300 µm followed by 300-500 µm. All patients were evaluated before and at 1, 3, 6, 12, and 18 months after PAE. Baseline data were comparable across the 3 groups, using the following mean International Prostate Symptom Score/quality of life (IPSS/QoL); prostate volume (PV) scores, respectively: 23.0/4.14; 87.9 cm3 (group A); 23.0/4.09; 89.0 cm3 (group B); and 24.2/4.29; 81.0 cm3 (group C) (P > 0.05). RESULTS: Mean IPSS/QoL scores; PV after PAE were: 9.98/2.49; 65.1 cm3 (group A); 8.24/2.26; 63.1 cm3 (group B); and 10.1/2.69; 53.1 cm3 (group C) (P = 0.23; P = 0.39; P = 0.24). There were 26 clinical failures. The cumulative probabilities of clinical success at 18 months were 76.7% in group A, 82.6% in group B, and 83.3% in group C (P = 0.68). Nontarget embolization was prevented in 6 patients by coil embolization. All adverse events were mild and self-limited with rates of 86.0% in group A (37 of 43); 41.3% in group B (19 of 46); and 58.3% in group C (28 of 48) (P < 0.001). Dysuria was the most frequent adverse event (28 of 137 [20.4%]). CONCLUSIONS: PAE outcomes were not significantly different among microspheres of different sizes. The use of 100- to 300-µm microspheres was associated with an increased risk of minor adverse events.


Assuntos
Resinas Acrílicas/administração & dosagem , Artérias , Embolização Terapêutica , Gelatina/administração & dosagem , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Resinas Acrílicas/efeitos adversos , Idoso , Embolização Terapêutica/efeitos adversos , Gelatina/efeitos adversos , Humanos , Injeções Intra-Arteriais , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Estudos Prospectivos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Resultado do Tratamento
15.
J Vasc Interv Radiol ; 30(5): 655-660, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31029384

RESUMO

PURPOSE: To investigate the safety and effectiveness of preoperative prostatic artery embolization (PAE) in relation to decrease in hemoglobin level, requirement for blood transfusion, length of hospitalization, and procedure-related complications. MATERIALS AND METHODS: Ten consecutive patients who underwent surgery after preoperative PAE were identified from May 2017 to October 2018 (embolization group: holmium-laser enucleation of the prostate [HoLEP] in 6 patients and robotic simple prostatectomy in 4 patients, mean age 72.9 ± 8.7 years, mean prostatic volume 106.5 ± 22.0 mL). For comparison, consecutive patients with a large prostatic volume (≥70 mL) who underwent surgery without preoperative PAE during the same period were enrolled (nonembolization group: HoLEP in 9 patients and robotic simple prostatectomy in 1 patients, mean age 71.2 ± 5.7 years, mean prostatic volume 87.8 ± 26.7 mL). RESULTS: PAE was technically successful in 90% of patients (9/10). The median interval between PAE and surgery was 2 days. The mean hemoglobin reduction was lower (1.40 ± 0.92 g/dL vs 3.07 ± 1.50 g/dL; P = .008) and the median length of hospitalization was shorter (8.5 days vs 11 days; P = .039) in the embolization group than the nonembolization group. The operating time (mean for HoLEP 146 ± 38 min vs 179 ± 59 min [P = .248], mean for robotic simple prostatectomy 223 ± 32 min vs 354 min) and number of blood transfusion (1 patient vs 2 patients; P = .392) were not significantly different between the 2 groups. None of the patients developed any complications except bleeding requiring transfusion. CONCLUSIONS: Preoperative PAE is safe and may reduce blood loss during prostate surgery.


Assuntos
Artérias , Embolização Terapêutica , Esponja de Gelatina Absorvível/administração & dosagem , Terapia a Laser , Cuidados Pré-Operatórios/métodos , Próstata/irrigação sanguínea , Próstata/cirurgia , Prostatectomia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Embolização Terapêutica/efeitos adversos , Esponja de Gelatina Absorvível/efeitos adversos , Humanos , Terapia a Laser/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/efeitos adversos , Prostatectomia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
J Vasc Interv Radiol ; 30(5): 661-667, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31029385

RESUMO

PURPOSE: To evaluate the efficacy and safety of prostatic artery embolization (PAE) performed to treat gross hematuria secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between February 2014 and December 2017, 20 patients with gross hematuria secondary to BPH refractory to medical treatment underwent PAE in our institution. Technical success was defined as bilateral PAE. International Prostate Symptom Score (IPSS), quality of life (QoL), and clinical review were assessed before PAE and at 3 and 12 months after procedure. Short- and medium-term clinical successes were defined as resolution of gross hematuria with no recurrence at 3 and 12 months, respectively. RESULTS: Technical success rate was 100%. No major adverse events were recorded. Minor complications included gluteal pain, nausea, and fever in 7 patients. At 3 months, there were improvements in IPSS (21.1 ± 6.6 to 9.8 ± 4.7, P < .001) and QoL (5.1 ± 1.7 to 2.4 ± 1.3, P < .001). At 12 months, there were improvements in IPSS (8.1 ± 2.5, P < .001) and QoL (2.1 ± 1.0, P < .001). At 3 months, recurrent hematuria was reported in 3 of 20 patients (85% short-term clinical success rate). One of the remaining 17 patients had developed recurrent hematuria by 12 months (80% medium-term clinical success rate). CONCLUSIONS: PAE is a safe and effective means of treating gross hematuria caused by BPH refractory to medical treatment. PAE offers a reasonable option for such patients who are not suitable for surgical therapy.


Assuntos
Artérias , Embolização Terapêutica , Hematúria/terapia , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Hematúria/diagnóstico por imagem , Hematúria/etiologia , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Diagn Interv Radiol ; 25(2): 134-143, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30860077

RESUMO

PURPOSE: We aimed to assess the clinical and predictive role of contrast-enhanced ultrasonography (CEUS) as the primary method for imaging evaluation of prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH). METHODS: Thirty-one patients with symptomatic BPH, treated with PAE from October 2016 until February 2018, were enrolled in this prospective, single-center study. Microspheres (100-700 µm) were utilized for PAE. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow (Qmax), prostatic volume (PV) and post void residual volume (PVR) were measured at baseline and at 1, 3, and 6 months post PAE. Unenhanced transabdominal US was utilized for PV and PVR measurements; prostatic enhancement was studied with transabdominal CEUS at baseline, during the procedure, 1 day and 1, 3, and 6 months post PAE. Technical success was defined as embolization of the PA of at least one pelvic side. Clinical success was based on the improvement of IPSS and QoL, with no need for any additional treatment. Follow-up time ranged from 6 to 18 months (mean, 9.7±4.3 months). Clinical success rates were calculated and changes in prostatic enhancement were correlated with the outcome parameters. RESULTS: Technical success rate was 90.3%. Clinical success rates at 3, 6, and 12 months post PAE were 85.7%, 85.7%, and 79.1% respectively. Improvement of outcome parameters (baseline vs. 6-month values) was statistically significant, with 12.4 points mean reduction of IPSS (50.4%, P = 0.003), 2.0 points mean reduction of QoL (45.4%, P < 0.001), 30.3 mL mean reduction of PV (30.2%, P < 0.001), 72.6 mL mean reduction of PVR (51.8%, P = 0.005) and 8.6 mL/s mean increase in Qmax (103%, P = 0.002). The most significant complications were bladder ischemia (n=1), and ischemic rectal ulcer (n=1), both attributable to nontarget embolization, with complete recovery. CEUS 1 day post PAE demonstrated prostatic infarcts in 26/28 (92.8%) patients. The percentage of prostatic infarction (pPI, defined as prostatic infarcted volume 1 day post PAE divided by baseline PV) was 1%-71%. There was a very strong positive correlation between pPI and prostate shrinkage (r=0.81, P < 0.001), but a weak correlation between pPI and the improvement of the other outcome parameters (r= 0.01-0.36; P = 0.093-0.965). However, in the subgroup of patients with indwelling bladder catheter (9/28 patients), successful removal of the catheter was achieved only in patients with pPI>10%. CONCLUSION: CEUS appears to be a practical method for the study of the local ischemic effect of PAE, with potential predictive value.


Assuntos
Embolização Terapêutica/métodos , Próstata/diagnóstico por imagem , Hiperplasia Prostática/terapia , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Embolização Terapêutica/efeitos adversos , Fluoroscopia/métodos , Humanos , Infarto/diagnóstico por imagem , Infarto/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/irrigação sanguínea , Próstata/patologia , Qualidade de Vida
19.
J Vasc Interv Radiol ; 30(5): 627-637.e1, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926185
20.
J Vasc Interv Radiol ; 30(2): 228-232, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30717954

RESUMO

PURPOSE: To compare the 12-month post-prostatic artery embolization (PAE) clinical outcomes of patients who were and were not taking 5-alpha-reductase inhibitors (5ARIs) at the time of PAE. MATERIALS AND METHODS: A retrospective review was conducted of patients who underwent PAE from 2010 to 2017 due to lower urinary tract symptoms, secondary to benign prostatic hyperplasia (BPH). One hundred fifty-five patients were included and divided in 2 groups; these groups did not present statistically significant differences in their baseline characteristics-those taking 5ARIs (Y-5ARIs, n = 40) and those not taking 5ARIs (N-5ARIs, n = 115). International Prostate Symptom Score (IPSS), the sub-item Quality of Life (QoL), and the incidence of clinical failure were used as primary endpoints. Secondary endpoints included mean prostate volume reduction and mean peak flow rate (Qmax) improvement. Clinical failure or recurrence was defined as absence of symptomatic improvement (IPSS ≥ 8 or QoL ≥ 3) or the need for invasive BPH treatment (PAE or transurethral resection of the prostate) during the 12-month follow-up period. RESULTS: After 12-month follow-up, IPSS, QoL, and prostatic volume were significantly lower compared to baseline in both groups, and Qmax showed a significant increase. No statistically significant differences were observed in outcomes between N-5ARIs and Y-5ARIs, and the clinical failure rate for both groups was approximately 20%. CONCLUSIONS: The use of 5ARIs did not show a detrimental effect on clinical outcomes of PAE, in either subjective (IPSS, QoL, and clinical failure) or objective (prostatic volume and Qmax) parameters.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Artérias , Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Inibidores de 5-alfa Redutase/efeitos adversos , Idoso , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Recidiva , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Ressecção Transuretral da Próstata , Resultado do Tratamento , Urodinâmica
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