Prostatic Artery Research Articles

V10-01 A COMPREHENSIVE REVIEW OF NEUROANATOMY, PROSTATE ANATOMY AND PERI-PROSTATIC STRUCTURES

You have accessJournal of UrologyCME1 Apr 2023V10-01 A COMPREHENSIVE REVIEW OF NEUROANATOMY, PROSTATE ANATOMY AND PERI-PROSTATIC STRUCTURES Sneha Parekh and Ashutosh Tewari Sneha ParekhSneha Parekh More articles by this author and Ashutosh TewariAshutosh Tewari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to present the most revised anatomy of prostate, surrounding structures and its neuroanatomy in the form a 3D animated video. METHODS: We searched the PubMed database to identify original and review articles that addressed the anatomy of the prostate and relevant surrounding structures, with an emphasis on work published from July 2002 to January 2022. Understanding the findings in literature, we applied this knowledge and created a 3D animation video. RESULTS: Laterally the prostate is surrounded by the Endopelvic fascia, which has Parietal and medially has prostatic fascia. Ventrally prostatic capsule attached to Anterior Fibromuscular Stroma (AFMS), reaches postero-lateral prostate embracing Neurovascular bundle (NVB) medially and becomes pararectal fascia covering the rectum. The detrusor apron is an extension of anterior wall of bladder towards posterior area of pubic bone and contributes to AFMS. The urethral sphincter complex consists of external rhabdosphincter, inner lissosphincter and membranous urethra. Seminal Vesicles(SV) and Vas Deferens (VD) are extra peritoneal tubular structures, located at base of prostate, surrounded by major nerves posterolaterally, associations with Proximal neurovascular plate (PNP). Prostate with surrounding structures is supplied by autonomic and somatic branches originating from lower (T11-L2) and (S2-S4). Nerve fibers from centers coalesce to form pelvic plexus, aka PNP.The autonomic fibers from PNP are distributed into NVB and ANP (Accessory Neural Pathway) in a spray like pattern, with 60% of fibers on postero-lateral and 40% on antero-lateral prostate.DVC is composed of nerve fibers, dorsal veins and prostatic arteries. The puboprostatic ligamentous complex comprises of puboprostatic ligaments, arcus tendineus, and puboperinealis muscle. The puboprostatic ligaments are dense pyramid-shaped medial portions of distal endopelvic fascia. The puboperinealis is a paired muscle that originates from pubis, flanks prostatic-urethral junction, terminates at perineal body. CONCLUSIONS: Prostate is a dense fibromuscular gland, situated in the true pelvis surrounded by a compact multi-layered fascia with intermingling nerves and vessels.The nerves from the lumbar and sacral roots along with somatic supply form the pelvic plexus, further giving the prostatic neural hammock. This forms the basis of nerve sparing and its grades. Puboprostatic ligamentous complex along with peri-prostatic fascia and detrusor apron support the prostate and has a role in erectile and continence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e926 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sneha Parekh More articles by this author Ashutosh Tewari More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-03 COMPLICATIONS ASSOCIATED WITH MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH): A MANUFACTURER AND USER FACILITY DEVICE EXPERIENCE (MAUDE) DATABASE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP13-03 COMPLICATIONS ASSOCIATED WITH MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH): A MANUFACTURER AND USER FACILITY DEVICE EXPERIENCE (MAUDE) DATABASE ANALYSIS João Porto, Ruben Blachman Braun, Dimple Chanamolu, and Hemendra Shah João PortoJoão Porto More articles by this author , Ruben Blachman BraunRuben Blachman Braun More articles by this author , Dimple ChanamoluDimple Chanamolu More articles by this author , and Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MAUDE database houses medical device reports of suspected device related complications received by Food and Drug Administration (FDA). In the present study we aim to evaluate the MAUDE database for reported complications of MIST procedures. METHODS: The FDA, MAUDE database website was queried using keywords: rezum, urolift, prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), prostate stent and Temporarily Implanted Nitinol Device (ITIND) on 10/1/22. Details related to the device problem, complications, aborted/canceled procedures, use of anticoagulant drugs, blood transfusion, operative intervention, hospitalization were extracted from the cases. We used the Gupta classification system to stratify complications. Statistical analysis was performed with SPSS v.28. Chi-square was used to compare frequency of complications among surgical procedures. RESULTS: We found a total of 780 cases of MIST procedures and after removing irrelevant/no information (n=58) and duplicate cases (n=30), we included 692 cases. (Rezum-358, urolift-226, PAE-53, TUNA-31, TUMT-19, prostatic stent-4 and ITIND-1). Level I complications were commonest (62%) and most of these (95%) were related to devices. The screen display error was responsible for 93% and 83% aborted cases in rezum and TUNA, respectively. The PAE showed 40% of device component detachment/fracture. Most of the level II-III complications were not related to device or user (Table 1). Urolift had 49% of II-III complications, especially due to pelvic/retroperitoneal hematoma, which was associated with hospitalization and blood transfusion. There were 10 deaths reported after urolift, 2 after rezum and 1 after TUMT mostly due to cardiovascular events, which, according to the physicians involved, were not associated with the proposed treatment. CONCLUSIONS: Although MIST for BPH is a procedure with low complication rates, it is important to point out that adversities can happen. Our data should assist urologists and patients in selecting appropriate MIST procedure with shared decision-making process. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e174 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information João Porto More articles by this author Ruben Blachman Braun More articles by this author Dimple Chanamolu More articles by this author Hemendra Shah More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-08 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES AFTER MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR BPH

You have accessJournal of UrologyCME1 Apr 2023MP13-08 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES AFTER MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR BPH Mark Assmus, Nick Dean, Matthew Lee, Jenny Guo, and Amy Krambeck Mark AssmusMark Assmus More articles by this author , Nick DeanNick Dean More articles by this author , Matthew LeeMatthew Lee More articles by this author , Jenny GuoJenny Guo More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2021 American Urologic Association benign prostate hyperplasia (BPH) guideline recommends several minimally invasive surgical therapies (MIST). We look to describe outcomes of individuals undergoing holmium laser enucleation of the prostate (HoLEP) after failing prior minimally invasive BPH procedures, specifically prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), robotic waterjet treatment (RWT) or prostatic artery embolization (PAE). METHODS: We retrospectively examined patients within our IRB approved clinical database that underwent HoLEP over a 19-month period (March 2021 – Oct 2022). Patient demographics, surgical BPH treatments, operative variables, and perioperative courses were examined. Patients with a prior neurological diagnosis or prior bladder cancer were excluded from the analysis. Descriptive statistics, two-tailed T-Tests, and ANOVA were performed with SPSS (p<0.05). Although PAE is not an office-based procedure, due to its minimally invasive nature we included it in the MIST category. RESULTS: We identified 600 HoLEP patients who met inclusion criteria, with 24.2% (n=145) of patients having undergone a prior BPH procedure. Of these procedures, 31.7% (n=46) were MISTs including PUL (n=22), WVTT (n=11), RWT (n=3), and PAE (n=10) and the remaining 68.3% (n=99) of procedures were TURP (n=63) and photo-selective vaporization of the prostate (PVP) (n=36). Time from original treatment to HoLEP did not differ between MIST procedures (p>0.05), but was significantly shortened comparing MISTs to TURP and PVP (2.9 versus 6.8 years, p<0.01). Patients with a prior BPH procedure were older (72.4 versus 69.7 years, p<0.01) than those without a history of BPH procedures; however, there were no other differences in pre-operative patient variables or post-operative functional outcomes including catheter free status, anti-cholinergic requirements, and continence rates, or 90-day complications (all p>0.05). Patients with a prior PUL had a significantly worse morcellation efficiency (7.3 vs 9.0 grams/min, p=0.03) and required more sets of morcellator blades per case (1.3 vs 1.0, p=0.03) compared to other prior BPH treatments. CONCLUSIONS: Patients undergoing HoLEP after prior failed BPH surgery experienced equivalent outcomes to patients without prior BPH surgery. Patient functional outcomes after HoLEP were maintained regardless of prior treatment modality. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Assmus More articles by this author Nick Dean More articles by this author Matthew Lee More articles by this author Jenny Guo More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-03 COMBINATION PROSTATIC ARTERY EMBOLIZATION PRIOR TO AQUABLATION® FOR BENIGN PROSTATIC HYPERTROPHY: A PROPENSITY SCORE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP51-03 COMBINATION PROSTATIC ARTERY EMBOLIZATION PRIOR TO AQUABLATION® FOR BENIGN PROSTATIC HYPERTROPHY: A PROPENSITY SCORE ANALYSIS Sandeep Bagla, Anthony Sare, Abin Sajan, Pratik Desai, and Inderjit Singh Sandeep BaglaSandeep Bagla More articles by this author , Anthony SareAnthony Sare More articles by this author , Abin SajanAbin Sajan More articles by this author , Pratik DesaiPratik Desai More articles by this author , and Inderjit SinghInderjit Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation has been previously reported with a 10% bleeding risk and a 6% requiring transfusion rate. The purpose of this study was to demonstrate the feasibility and safety of Prostatic Artery Embolization (PAE) before Aquablation® in patients with Benign Prostatic Hypertrophy (BPH). METHODS: A retrospective chart review identified 148 patients treated with Aquablation® for BPH from May 2018 to June 2021. Patients were divided into two groups: Aquablation® alone (n=56) vs. combination PAE and Aquablation® (n=89). Patient demographics, pertinent laboratory values, operative reports, and the hospital courses between the two groups were reviewed. After propensity score matching for age and prostate gland size, outcomes were compared between Aquablation alone vs combination therapy. RESULTS: PAE was technically successful in 89/89(100%) combination patients and all 89 patients underwent successful Aquablation® within a median time of 2 days. Compared to Aquablation® alone, PAE prior resulted in significant reduction in hospital length of stay (34.4±23.5 vs 13.8±26.1 hours, p<0.001). Additionally, PAE before Aquablation® resulted in 16 times (p=0.001) less likely use of perioperative hemostatic measures (balloon traction, cautery). Patients without prior PAE were 7.8 times more likely (p<0.001) to require >2 hours of post-operative continuous bladder irrigation. Patients with Aquablation® alone were also more likely to return to the operating room within 30 days of the procedure (p<0.001). Lastly, the incidence of persistent hematuria at 2 or 4 week followup was 3.2 times higher in the Aquablation® alone group (p<0.001) compared to the combination group. There were no major PAE related adverse events reported in the combination arm. CONCLUSIONS: Combination PAE and Aquablation® resulted in a reduction in length of hospital stay, intraprocedural hemostastatic maneuvers, and less post-operative bleeding complications than patients undergoing Aquablation® monotherapy for treatment of BPH. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandeep Bagla More articles by this author Anthony Sare More articles by this author Abin Sajan More articles by this author Pratik Desai More articles by this author Inderjit Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

Initial Experience Using Digital Variance Angiography in Context of Prostatic Artery Embolization in Comparison with Digital Subtraction Angiography.

In previous clinical studies digital variance angiography (DVA) provided higher contrast-to-noise ratio (CNR) and better image quality in lower extremity angiography than digital subtraction angiography (DSA). Our aim was to investigate whether DVA has similar quality reserve in prostatic artery embolization (PAE). The secondary aim was to explore the potential advantages of the color-coded DVA (ccDVA) technology in PAE. This retrospective study evaluated 108 angiographic acquisitions from 30 patients (mean ± SD age 68.0 ± 8.9, range 41-87) undergoing PAE between May and October 2020. DSA and DVA images were generated from the same unsubtracted acquisition, and their CNR was calculated. Visual evaluation of DVA and DSA image quality was performed by four experienced interventional radiologists in a randomized, blinded manner. The diagnostic value of DSA and ccDVA images was also evaluated using clinically relevant criteria (visibility of small [< 2.5 mm] and large arteries [> 2.5 mm], feeding arteries and tissue blush) in a paired comparison. Data were analysed by the Wilcoxon signed rank test or the binomial test, the interrater agreement was determined by the Kendall W or Fleiss Kappa analysis. DVA provided 4.11 times higher median CNR than DSA (IQR: 1.72). The visual score of DVA images (4.40 ± 0.05) was significantly higher than that of DSA (3.39 ± 0.07, p < 0.001). The Kendall W analysis showed moderate but significant agreement (WDVA = 0.38, WDSA = 0.53). The preference of ccDVA images was significantly higher in all criteria (63-89%) with an interrater agreement of 58-79%. The Fleiss Kappa range was 0.02-0.18, significant in all criteria except large vessels. Our data show that DVA provides higher CNR and better image quality in PAE. This quality reserve might be used for dose management (reduction of radiation dose and contrast agent volume), and ccDVA technology has also a high potential to assist PAE interventions in the future.

PD41-09 RANDOMIZED CONTROLLED TRIAL COMPARING PROSTATE ARTERY EMBOLIZATION VS OPEN PROSTATECTOMY: CLINICAL AND URODYNAMIC ASSESSMENT IN A ONE YEAR FOLLOW UP

You have accessJournal of UrologyCME1 Apr 2023PD41-09 RANDOMIZED CONTROLLED TRIAL COMPARING PROSTATE ARTERY EMBOLIZATION VS OPEN PROSTATECTOMY: CLINICAL AND URODYNAMIC ASSESSMENT IN A ONE YEAR FOLLOW UP Bruno Lebani, André Silva, Eduardo Silveira, Milton Skaff, and Fernando Almeida Bruno LebaniBruno Lebani More articles by this author , André SilvaAndré Silva More articles by this author , Eduardo SilveiraEduardo Silveira More articles by this author , Milton SkaffMilton Skaff More articles by this author , and Fernando AlmeidaFernando Almeida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Open Prostatectomy (OP) remains one of the gold standard treatments for Benign prostate enlargement larger than 80 ml. The Prostate Artery embolization (PAE) is a minimally invasive procedure that interrupts the blood flow, shrinking the prostatic adenoma. There is no randomized controlled trials assessing PAE for prostates larger than 80 ml in patients with bladder outlet obstruction (BOO) and good detrusor function. The aim of this study is to evaluate PAE in prostates larger than 80 ml, comparing the results to patients underwent to open prostatectomy. METHODS: A non-inferiority, randomized, open label-controlled trial was developed in a single center, between January 2020 and May 2022. OP was indicated according to prostate weight (larger than 80 ml measured by MRI) and symptoms, urodynamics parameters meeting Bladder Outlet Obstruction (defined by BOOI >40) and good detrusor function (defined by Bladder contractility index - BCI >100). The patients were randomized to OP and PAE. The primary endpoint was urodynamic comparisons, embracing changes on Maximum urinary flow rate in pressure-flow studies (Qmax-QxP), Detrusor pressure at maximum flow rate (PdetQmax) and Bladder outlet obstruction index (BOOI) from baseline to 6 months. Secondary endpoints include clinical assessment, laboratory and ultrasonography . Analyses between groups of all schedule visits at 1, 3, 6 and 12 months were performed. RESULTS: 23 patients were evaluated in PAE arm and 25 were evaluated in OP arm. Groups are similar, without differences in clinical, radiological or urodynamic parameters. In baselinte, PAE group presented Qmax of 3,78±3,32, IPSS of 27,4±5,65, BOOI of 93,7±30,9 and BCI of 128±25,3. OP presented Qmax of 3,78±3,32, IPSS of 30±4,95, BOOI of 116±53,8 and BCI of 147±50,4. After 6 months, both groups presented significant improvement in Qmax compared to their respective baseline (8,3±4,17 for PAE group vs 15,1±8,04 for OP group), nonetheless the effectiveness was greater in OP arm, with a statistical difference reaching 7.8 ml/second. The decrease from baseline to month 6 in PDetQmax was lower in PAE than in OP group, despite Qmax improvement (-5,17 vs -79,92 cm H2O). Similar findings were observed in BOOI (PAE – 9,03 vs OP -95 cm H2O, p<0,001). It was observed a large reduction in IPSS (more than 15 points) in both groups, with no difference between them. CONCLUSIONS: Both procedures resulted in significant clinical improvements in the treatment of BPH. However, PAE is inferior compared to OP, assessing urodynamic parameters. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1062 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Lebani More articles by this author André Silva More articles by this author Eduardo Silveira More articles by this author Milton Skaff More articles by this author Fernando Almeida More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostatic Artery Embolization (PAE) - Endo-vascular Treatment of Lower Urinary Tract Symptoms Presumed Secondary to Benign Prostatic Obstruction

Prostatic Artery Embolization (PAE) - Endo-vascular Treatment of Lower Urinary Tract Symptoms Presumed Secondary to Benign Prostatic Obstruction Abstract: Based on the available evidence on efficacy and safety in the short to midterm, Prostatic Artery Embolization (PAE) is now endorsed by international evidence-based guidelines as a treatment of lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) for selected patients. As PAE has a unique treatment approach (i.e., endovascular instead of transurethral), its profile and ideal application differ clearly from other treatments of LUTS/BPO, which must be considered for patient selection. Performance in local anesthesia with ongoing anticoagulation and no upper prostate size limitation represent advantages of the technique. Limited availability, an inferior relief of obstruction associated with higher retreatment rates and inferior outcomes in small prostates represent disadvantages. This should be considered for patient selection and counselling.

Prostatic Artery Embolization for The Treatment of Benign Prostatic Obstruction - A Retrospective Review of The Novel Experience Of 2 Tertiary Urology Centers

Background: Benign Prostatic Hyperplasia (BPH) is common in aging men with worldwide prevalence at 20-62%, while Malaysian prevalence was 39.3% (2001) and increased at 8% per decade. In surgical treatment of BPH, Trans-Urethral Resection of Prostate (TURP) remains the gold standard. Other surgical options would mostly also require general anesthesia (GA). Therefore, more Local-Anaesthesia (LA) based options should be made available for patients who are not fit or unwilling to be under GA. Those currently available LA-based procedure has shown promising results including prostatic stents and trans-urethral lifts, but have drawbacks due to being expensive, not widely available, less suitable in median lobe enlargement or may cause complications including migration, overgrowth of prostatic tissue or foreign-body related complications which may require GA for their treatment. Prostatic Artery Embolization (PAE), initially an LA-based emergency treatment option for persistent life-threatening hematuria from a bleeding BPH, now has been proven to be a safe elective treatment. In Malaysia this novel technique was first reported in 2017 for treatment of post TURP intractable hematuria. Methods and Material: We retrospectively evaluated all 13 catheter-dependent BPH patients in two tertiary urology centres treated with PAE from April 2019 until December 2021 to assess post-treatment efficacy. Results: One patient failed removal of catheter within 3 months post-procedure but 12 out of 13 patients safely got their catheter removed within 1-3 months and resulted in significant IPSS improvement. Conclusion: PAE is a safe and effective treatment option for BPH patients of the Malaysian population but needs prospective evaluation.

Case report of avascular necrosis of the glans penis after PAE embolization

BackgroundProstate artery embolization (PAE) is a relatively safe and effective alternative method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. The adverse events caused by PAE are primarily mild, including urinary tract infection, acute urinary retention, dysuria, fever, etc. Severe complications, such as nontarget organ embolism syndrome or penile glans ischemic necrosis, are rare. Here, we report a case of severe ischemic necrosis of the glans penis after PAE and review the literature.Case presentationAn 86-year-old male patient was admitted to the hospital due to progressive dysuria with gross hematuria. The patient underwent placement of a three-way urinary catheter to facilitate continuous bladder flushing, hemostasis, and rehydration. After admission, his hemoglobin decreased to 89 g/L. After an examination, the diagnosis was benign prostatic hyperplasia with bleeding. During communication with the patient regarding treatment, he requested prostate artery embolization due to his advanced age and concomitant disease status. He underwent bilateral prostate artery embolization under local anesthesia. His urine gradually turned clear. However, on the 6th day after embolization, the glans gradually showed ischemic changes. On the 10th day, there was partial necrosis and blackening of the glans. The glans completely healed, and the patient was able to urinate smoothly on the 60th day after local cleaning and debridement, the administration of pain relief, anti-inflammatory and anti-infection agents, and external application of burn ointment.ConclusionPenile glans ischemic necrosis after PAE is rare. The symptoms include pain, congestion, swelling, and cyanosis in the glans.

Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization

BackgroundTo investigate the influence of benign prostatic hyperplasia (BPH) patterns detected with MRI on clinical outcomes after prostatic artery embolization (PAE).Materials & methodsThis retrospective study included 71 consecutive patients with lower urinary tract symptoms (LUTS), who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). LUTS were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome.ResultsFor clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41—75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion, and prostatic urethral angle in our collective (p < 0.01). Median volume reduction was 25% (IQR 15%—34%). Bilateral embolization was a significant predictor for volume reduction at follow-up. Multiple linear regression analysis showed significant effect of high initial volume on reduction in IPSS after treatment (p < 0.01). Presence of AdBPH was significantly associated with both, volume loss and clinical improvement in terms of IPSS reduction (p < 0.01). Neither BPH pattern based on the Wassermann type nor modified BPH classification were significantly related with postinterventional IPSS and volume loss.ConclusionsMen benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume and presence of AdBPH on MRI should be considered for outcome prognosis after PAE.

Imaging patterns of the arterial supply of the prostate gland in adult Ghanaian men.

Prostatic arterial embolization (PAE) is a novel procedure in West Africa and Ghana. A thorough understanding of the prostate artery's (PA) anatomy and pattern is required for successful prostatic arterial embolization and to guarantee targeted intervention. This study focuses onprostate arterial supply in adult males, including prevalence, variability, and imaging pattern. A prospective cross-sectional study was conducted, at Euracare Advanced Diagnostics and Heart Centre. Patients who presented for Computed Tomography Angiography of the pelvis were included in the study. A total of 52 males were included and 104 pelvic CT angiography (one for each side) were analyzed, including: prostatic artery diameter, prostatic gland volume and prostate artery branching pattern. The PA branching pattern was classified using de Assis et al. classification. Thirty-seven (71.15%) men had enlarged prostate volume (>30ml). On each side there was only one prostatic artery and no accessory one was found. Only three types of arterial branching were identified: type I, II,III. The type I artery was the most common origin 58.7% (61/104). PA originating from the anterior division of the internal iliac artery (type II) and the type III is from the internal pudendal artery, accounted for 16.3% (17/104) and 25% (26/104) respectively. The most frequent type of PA origin was type I followed by type III then II. Knowing the different and most frequent types of anatomy of PA may help standardization and effectiveness of the PAE in developing countries.

The effect of systemic hypertension on prostatic artery resistive indices in patients with benign prostate enlargement.

To investigate the effect of systemic hypertension on the prostatic artery resistive indices by a comparative ultrasonographic evaluation of the prostate gland in normotensive and hypertensive patients with benign prostatic enlargement (BPE). The participants had BPE and presented at the outpatient urologic clinic of a tertiary hospital. They were divided into normotensive and hypertensive groups. Each group had fifty patients. Calculation of international prostate symptom score, measurement of blood pressure, and transrectal ultrasonographic evaluation were done. The mean age for the normotensive and hypertensive groups were 66.9±9.8 and 66.0±10.7years, respectively (P =0.662). Patients with hypertensive BPE had a significantly higher mean transitional zone volume, transitional zone index, presumed circle area ratio, quality of life score, and prostatic arterial resistive indices than the age-matched normotensive BPE patients. Patients with BPE and with hypertension had significantly higher prostate arteries resistive indices than normotensives with BPE. Even in patients with BPE and controlled hypertension, the prostatic artery resistance indices were still elevated than that of normotensive men with BPE.

Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review.

Prostate artery embolization is a minimally invasive treatment for benign prostatic hyperplasia, and imaging is indispensable for the technical success of this procedure; however, imaging is a major source of radiation exposure for patients and healthcare providers. Radiation emission during prostate artery embolization procedures at a single institution was evaluated to determine radiation exposure with the goal to work toward minimizing exposure. All patients at a single institution that underwent outpatient unilateral/bilateral prostate artery embolization between 4 January 2019 and 16 November 2021 were retrospectively evaluated; data collected included body mass index, prostate volume, and indications for prostate artery embolization. Technical parameters recorded were air kerma, procedure time, fluoroscopy time, number of acquisitions, and intra-procedural imaging modalities. Fisher's t-test, ANOVA, and chi-square analyses were used as appropriate for statistical analysis (P < 0.05). Overall, 56 patients were included in the study. Body mass index (obesity; P = 0.0017) was a significant predictor of increased air kerma; prostate size and bilateral vs. unilateral prostate artery embolization were not significantly associated with increased air kerma despite the number of acquisitions being significantly different between bilateral and unilateral embolization (P = 0.0064). When evaluating radiation exposure during prostate artery embolization, increased body mass index significantly predicted increased air kerma. Contrary to the literature, the extent of embolization (bilateral vs. unilateral) was not associated with increased air kerma regardless of higher acquisitions and procedure time associated with bilateral prostate artery embolization. Increased radiation protection efforts should be considered for patients with higher body mass index to protect patients and practitioners.Health Phys. 124(0):000-000; 2023.

Inflammatory Complications of Prostatic Artery Embolization: an Up-to-Date Review

Inflammatory Complications of Prostatic Artery Embolization: an Up-to-Date Review

Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency

Endovascular simulation is a validated training method, allowing residents to improve technical skills with interventional equipment in a risk-free environment. The purpose of this study was to assess the utility and efficacy of supplementing the IR/DR Integrated Residency training program with a dedicated 2-year endovascular simulation curriculum. Trainees participated in a 2-year curriculum that included the completion of 8 modules using a high-fidelity endovascular simulator (Mentice AB, Gothenberg, Sweden). Procedural modules included IVC filter placement, transarterial chemoembolization, trauma embolization, uterine artery embolization, prostate artery embolization, and peripheral arterial disease interventions. Each quarter, two trainees were filmed while completing an assigned module. Sessions led by IR faculty were held with film footage review and didactics on the assigned topic. Pre- and postcase surveys were collected to evaluate trainee comfort and confidence and assess the validity of the simulation. At the conclusion of the 2-year period, a postcurriculum survey was sent to all trainees to determine how residents viewed the utility of the simulation sessions. Eight residents participated in the pre- and postcase surveys. The simulation curriculum significantly increased trainee confidence for these 8 residents. A separate postcurriculum survey was completed by all 16 IR/DR residents. All 16 residents felt that simulation was a helpful addition to their education. A total of 87.5% of all residents felt that the sessions improved their confidence in the IR procedure room. A total of 75% of all residents believe that the simulation curriculum should be incorporated into the IR residency program. Adoption of a 2-year simulation curriculum can be considered for existing IR/DR training programs with access to high-fidelity endovascular simulators using the described approach.

Abstract No. 513 What’s Trending? Analysis of TikTok Results for Prostate, Uterine, and Genicular Artery Embolization

Abstract No. 513 What’s Trending? Analysis of TikTok Results for Prostate, Uterine, and Genicular Artery Embolization

Abstract No. 288 Prostate Artery Embolization in Prostate Glands Greater than 80 g: A Single Center Experience

Abstract No. 288 Prostate Artery Embolization in Prostate Glands Greater than 80 g: A Single Center Experience

Abstract No. 144 Cone-Beam CT with Dedicated Planning Software Improves Optimal Gantry Angle Selection for Prostate Artery Embolization

Abstract No. 144 Cone-Beam CT with Dedicated Planning Software Improves Optimal Gantry Angle Selection for Prostate Artery Embolization

Abstract No. 602 Real World Radiation Exposure During Prostate Artery Embolization with Mobile Angiography: A Review of Over 700 Procedures

Abstract No. 602 Real World Radiation Exposure During Prostate Artery Embolization with Mobile Angiography: A Review of Over 700 Procedures

Abstract No. 599 Comparison of Safety and Feasibility of Prostate Artery Embolization via Transradial Access versus Transfemoral Access: A Single-Center Experience

Abstract No. 599 Comparison of Safety and Feasibility of Prostate Artery Embolization via Transradial Access versus Transfemoral Access: A Single-Center Experience