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Prostate artery embolization

Andre Uflacker, Ziv J Haskal, Tiago Bilhim, James Patrie, Timothy Huber, João Martins Pisco
PURPOSE: To perform meta-analysis of available data on prostatic artery embolization (PAE). MATERIALS AND METHODS: Meta-analysis was conducted on articles published between November 2009 and December 2015. Peer-reviewed studies with > 5 patients and standard deviations and/or individual-level data on one or more of the following outcomes were included: prostate volume (PV), peak flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality of life (QOL) score, International Index of Erectile Function (IIEF) score, and prostate-specific antigen (PSA) level...
October 11, 2016: Journal of Vascular and Interventional Radiology: JVIR
Xavier Chaufour, Julien Gaudric, Yann Goueffic, Réda Hassen Khodja, Patrick Feugier, Sergei Malikov, Guillaume Beraud, Jean-Baptiste Ricco
OBJECTIVE: Endovascular aneurysm repair (EVAR) is widely used with excellent results, but its infectious complications can be devastating. In this paper, we report a multicenter experience with infected EVAR, symptoms, and options for explantation and their outcome. METHODS: We have reviewed all consecutive endograft explants for infection at 11 French university centers following EVAR, defined as index EVAR, from 1998 to 2015. Diagnosis of infected aortic endograft was made on the basis of clinical findings, cultures, imaging studies, and intraoperative findings...
October 5, 2016: Journal of Vascular Surgery
Simone Albisinni, Fouad Aoun, Thierry Roumeguère, Francesco Porpiglia, Andrea Tubaro, Cosimo De Nunzio
Life expectancy is constantly increasing and as a consequence older men, frequently with multiple comorbidities, are seeking treatment for benign prostatic hyperplasia. Given their frail health, these men need extreme attention in their management, as efficacious and safe treatment strategies in the general population may not be adequate for them. Across medications, α1-antagonists should be used with caution given the risk of orthostatic hypotension and consequent falls, cause of significant morbidity in the elderly...
September 28, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Daisuke Katayama, Keiko Kuriyama, Tatsuya Kinoshita, Keisuke Nagai, Hidenari Hongyo, Kentaro Kishimoto, Atsuo Inoue, Manabu Takamura, Soomi Choi
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal malignancy-related condition that involves rapidly progressing hypoxia and pulmonary hypertension. We report a case of PTTM caused by prostate carcinoma, which was diagnosed before autopsy in an 81-year-old man. Computed tomography showed diffuse ground-glass opacities, consolidation, and small nodules in the peripheral regions of the lung. Autopsy showed adenocarcinoma cells embolizing small pulmonary arteries with fibrocellular intimal proliferation, which was consistent with PTTM caused by prostate carcinoma...
August 2016: Acta Radiologica Open
Sung Ryul Shim, Karan Kanhai, Young Myoung Ko, Jae Heon Kim
PURPOSE: This study attempted to overcome the limitations of previous systematic reviews and to demonstrate the overall treatment efficacy and safety of prostatic arterial embolization (PAE) compared with standard therapy. MATERIALS AND METHODS: Meta-analyses were done for both RCTs and single-group trials. Meta-regression analysis for the moderator effect was performed with single-group analysis. Outcomes measured were mean changes in IPSS, quality of life, maximal urinary flow rate, prostate volume, post-voided residual volume, and prostate specific antigen levels...
August 31, 2016: Journal of Urology
Sandeep Bagla, Ari J Isaacson
Prostatic artery embolization (PAE) is a promising, new, safe, minimally invasive procedure for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, it can be a one of the most technically difficult interventional radiology procedures because of the challenging anatomy involved. To help achieve technical success and limit complications, the authors present here a series of tips and tricks that have been proven useful from prior PAE experience.
September 2016: Seminars in Interventional Radiology
Hyeon Yu, Ari J Isaacson, Charles T Burke
Prostatic artery embolization (PAE) is an emerging, novel interventional technique in the management of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is a common clinical condition in middle-aged and elderly men resulting in LUTS, including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Traditionally, LUTSs have been managed by medical or surgical therapies. Since the initial incidental discovery that selective PAE performed for uncontrolled bleeding secondary to BPH resulted in improved LUTS, the technique has continually evolved with a growing body of evidence supporting its safety and efficacy...
September 2016: Seminars in Interventional Radiology
Ari J Isaacson, Lauren M B Burke
Pelvic computed tomography angiography (CTA) prior to prostatic artery embolization is a beneficial tool for preprocedural planning to increase the likelihood of success during what can be a challenging procedure. Additionally, the same CTA images can be used for calculating the baseline prostate volume as well as for intraprocedural anatomic guidance, adding to the value of the scan. This article discusses the technique used for pelvic CTA and its role in preprocedural assessment of the pelvic vasculature prior to prostatic artery embolization...
September 2016: Seminars in Interventional Radiology
Octavio Meneghelli Gonçalves, Francisco Cesar Carnevale, Airton Mota Moreira, Alberto Azoubel Antunes, Vanessa Cristina Rodrigues, Miguel Srougi
PURPOSE: The purpose of the study was to compare safety and efficacy outcomes following prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 100-300 versus 300-500 μm tris-acryl gelatin microspheres. MATERIALS AND METHODS: Patients were prospectively treated between August 2011 and June 2013 to receive PAE with 100-300 μm (group A) or 300-500 μm (group B) tris-acryl gelatin microspheres...
October 2016: Cardiovascular and Interventional Radiology
Mao Qiang Wang, Feng Duan, Kai Yuan, Guo Dong Zhang, Jieyu Yan, Yan Wang
Purpose To describe findings in prostatic arteries (PAs) at digital subtraction angiography (DSA) and cone-beam computed tomography (CT) that allow identification of benign prostatic hyperplasia and to determine the value added with the use of cone-beam CT. Materials and Methods This retrospective single-institution study was approved by the institutional review board, and the requirement for written informed consent was waived. From February 2009 to December 2014, a total of 148 patients (mean age ± standard deviation, 70...
July 28, 2016: Radiology
Celia Moya, Julián Cuesta, Alfonsina Friera, Jose María Gil-Vernet Sedó, Francisco J Valderrama-Canales
INTRODUCTION: Development of prostatic arterial embolization (PAE) to treat benign prostatic hyperplasia (BPH) has raised interest in the variations of the PA. The aim of this study is to identify these vascular variations, to compare them with previous data, and to propose a simple classification. MATERIALS AND METHODS: Ten adult male pelvis sides from embalmed cadavers were dissected, ages 69 to 92 years, and 10 PA were examined. In a retrospective analysis of 34 DSA pelvic angiographies on 28 patients aged 50 to 90 years, 48 PA were identified...
July 14, 2016: Clinical Anatomy
Gregory Amouyal, Pierre Chague, Olivier Pellerin, Helena Pereira, Costantino Del Giudice, Carole Dean, Nicolas Thiounn, Marc Sapoval
INTRODUCTION: During PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE. MATERIALS AND METHODS: We treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015...
September 2016: Cardiovascular and Interventional Radiology
Ziga Cizman, Ari Isaacson, Charles Burke
PURPOSE: To review the available safety and efficacy data for prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: PubMed was searched for publications that included PAE for the treatment of BPH through May 2015. Two independent reviewers determined the appropriateness for inclusion of each article and compiled data by using pooled weighted means and standard deviations. RESULTS: The literature search identified 161 articles, of which 7 studies, with a total of 562 patients, met all inclusion/exclusion criteria...
October 2016: Journal of Vascular and Interventional Radiology: JVIR
Ahmed H Gabr, Mohamed F Gabr, Basheer N Elmohamady, Abul-Fotouh Ahmed
INTRODUCTION: Prostatic artery embolization (PAE) has recently started to be viewed as a promising technology that could be an alternative to different treatment options of benign prostatic hyperplasia (BPH), especially in high-risk patients. The aim of our study was to evaluate the efficacy and safety of PAE in BPH patients who are at high risk for surgery and/or anesthesia. MATERIALS AND METHODS: Between June 2013 and February 2015, BPH patients >50 years with lower urinary tract symptoms (LUTS) refractory to BPH-related medical therapy or had an indwelling urethral catheter due to refractory urine retention were prospectively enrolled in the study...
June 21, 2016: Urologia Internationalis
João M Pisco, Tiago Bilhim, Luis C Pinheiro, Lucia Fernandes, Jose Pereira, Nuno V Costa, Marisa Duarte, António G Oliveira
PURPOSE: To confirm that prostatic artery embolization (PAE) has a positive medium- and long-term effect in symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between March 2009 and October 2014, 630 consecutive patients with BPH and moderate-to-severe lower urinary tract symptoms refractory to medical therapy for at least 6 months or who refused any medical therapy underwent PAE. Outcome parameters were evaluated at baseline; 1, 3, and 6 months; every 6 months between 1 and 3 years; and yearly thereafter up to 6...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Joji Inamasu, Keisuke Ito, Natsuki Hattori, Yuichi Hirose
Intracerebral hemorrhage is a well-known complication resulting from warfarin use. By contrast, warfarin-associated intraspinal hematoma is very rare. The intraspinal hematoma may exhibit delayed progression and patients may present with atypical symptoms, occasionally resulting in diagnostic delay. A 65-year-old man with non-valvular atrial fibrillation, arterial hypertension and benign prostatic hyperplasia who used warfarin for prevention of systemic embolism, visited our emergency department (ED) with a complaint of acute urinary retention...
May 26, 2016: Keio Journal of Medicine
Tiago Bilhim, João Pisco, José A Pereira, Nuno Vasco Costa, Lúcia Fernandes, Luís Campos Pinheiro, Marisa Duarte, António G Oliveira
Purpose To assess predictors of outcome after prostate artery embolization (PAE) for benign prostatic hyperplasia with spherical particle polyvinyl alcohol (sPVA) and compare outcomes with the use of nonspherical particle polyvinyl alcohol (nsPVA). Materials and Methods This was a single-center retrospective institutional review board-approved study conducted from 2009 to 2015 in patients undergoing PAE with sPVA (n = 186; mean age ± standard deviation, 65.5 years ± 7.7) and nsPVA (n = 300; mean age, 65.3 years ± 7...
October 2016: Radiology
M C Arya, Lalit Kumar, Ruchi Mittal, Rajeev Kumar, Mayank Baid
Herein, we present a case report of post-TURP (transurethral resection of prostate) recurrent severe hematuria due to right internal iliac artery pseudoaneurysm protruding into bladder lumen. A 60-year-old male presented with recurrent massive hematuria following TURP done elsewhere 15 days before. His hemoglobin was 4 gm/dL after 13 units of blood transfusion and repeated clot evacuations. His blood urea, serum creatinine, and coagulation profile studies were normal. Ultrasonography of abdomen showed multiple clots in the bladder...
2016: Case Reports in Urology
Keith Pereira, Joshua A Halpern, Timothy D McClure, Nicholas A Lewis, Isaam Kably, Shivank Bhatia, Jim C Hu
Prostatic haematuria is among the most common genitourinary complaints of emergency room visits, distressing and troublesome to men and a challenging clinical problem to the treating physician. The most common aetiologies of prostatic haematuria include benign prostatic hyperplasia and prostate cancer. Prostatic haematuria usually resolves with conservative and medical methods; failure of these interventions results in refractory haematuria of prostatic origin (RHPO), a potentially life-threatening scenario...
September 2016: BJU International
Amir Noor, Aaron M Fischman
The gold standard treatment for benign prostate hyperplasia (BPH) is transurethral resection of the prostate (TURP) or open prostatectomy (OP). Recently, there has been increased interest and research in less invasive alternative treatments with less morbidity including prostate artery embolization (PAE). Several studies have shown PAE to be an effective alternative to TURP to treat lower urinary tract symptoms (LUTS) associated with BPH with decreased morbidity. Specifically, PAE has been advantageous in selected patient populations such as those with prostates too large for TURP or unsuitable surgical candidates, showing a promising potential for the future care of patients with BPH...
July 2016: Current Urology Reports
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