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Liu J, Gong YY, Ran C, Liu HJ, Zeng DS, Feng YG. Case report of avascular necrosis of the glans penis after PAE embolization. BMC Urol 2023; 23:31. [PMID: 36870955 PMCID: PMC9985851 DOI: 10.1186/s12894-023-01201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Prostate 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 PRESENTATION An 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. CONCLUSION Penile glans ischemic necrosis after PAE is rare. The symptoms include pain, congestion, swelling, and cyanosis in the glans.
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Affiliation(s)
- Jun Liu
- Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China
| | - Yang-Yang Gong
- Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China
| | - Can Ran
- Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China
| | - Hong-Jian Liu
- Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China
| | - Ding-Sheng Zeng
- Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China.
| | - You-Gang Feng
- Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China
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Frandon J, Belaouni A, Pellerin O, Thiounn N, Serrand C, Droupy S, Petitpierre F, Vernhet-Kovacsik H, Murez T, Vidal V, Ghelfi J, Pagnoux G, Codas R, de Forges H, Beregi JP, Sapoval M. Efficacy and safety of prostate artery embolization for patients with lower urinary tract symptoms and indwelling urinary catheter: A retrospective multicenter study. Diagn Interv Imaging 2022; 103:601-606. [PMID: 35963778 DOI: 10.1016/j.diii.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this multicenter study was to evaluate the clinical success at three months of prostate artery embolization (PAE), assess PAE safety in centers with various experiences and identify factors associated with PAE success. PATIENTS AND METHODS This multicenter, retrospective study included patients who underwent PAE for lower urinary tract symptoms (LUTS) including those with indwelling urinary catheter. PAE clinical success was defined as either 25% improvement of the International Prostate Symptom Score (IPSS) or 1-point improvement of quality of life (QoL) score, or catheter removal at three months. Multivariable analyses were performed using a logistic regression adjusted on patient variables, technical parameters and center experience in PAE. RESULTS A total of 383 men (mean age, 68.4 ± 9.7 [standard deviation] years; range: 46-94) with LUTS, including 99 (25.8%) patients with indwelling urinary catheter, were included in seven centers from January 2017 to March 2019. Five patients reported major complications (1.3%), three (0.8%) penile ulceration, three (0.8%) acute urinary retention, one (0.3%) prostatic abscess, and 56 (14.6%) minor complications. Follow up data were available for 271 patients (center 1: n = 159; other centers: n = 112). Clinical success was reported in 232 patients (85.6%). In multivariable analyses, presence of cardiovascular comorbidities (diabetes, stroke history, myocardial infarction and lower limb artery disease) was the single independent variable inversely associated with PAE clinical success (odds ratio = 0.396; 95% confidence interval: 0.17-0.91; P = 0.029). There was no center effect. CONCLUSION Our results show that PAE is safe and effective in centers with various PAE experiences. Cardiovascular comorbidity is the single independent variable associated with PAE failure.
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Affiliation(s)
- Julien Frandon
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France.
| | - Asmaa Belaouni
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Olivier Pellerin
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, INSERM U970, Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Nicolas Thiounn
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 75006 Paris, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), CHU Nîmes, 30029 Nîmes France
| | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - François Petitpierre
- Department of Diagnostic and Interventional Imaging, Groupe Hospitalier Pellegrin, 33000 Bordeaux, France
| | - Hélène Vernhet-Kovacsik
- Department of Radiology, CHU de Montpellier, Arnaud de Villeneuve Hospital, University of Montpellier, 34090 Montpellier, France
| | - Thibaut Murez
- Department of Urology, CHU de Montpellier, Lapeyronie Hospital, University of Montpellier, 34295 Montpellier, France
| | - Vincent Vidal
- Department of Diagnostic and Interventional Imaging, AP-HM, Hôpital de La Timone; Université Aix-Marseille, CERIMED, Faculté de Médecine, EA 4264, Laboratoire d'Imagerie Interventionnelle Expérimentale, 13005 Marseille, France
| | - Julien Ghelfi
- Department of Diagnostic and Interventional Imaging, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U 1209, 38700 La Tronche, France
| | - Gaele Pagnoux
- Service d'Imagerie Urinaire et Vasculaire, Hospices Civils de Lyon; Faculté de Médecine Lyon Est, 69002 Lyon, France
| | - Ricardo Codas
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon; Faculté de Médecine Lyon Est, 69002 Lyon, France
| | - Hélène de Forges
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Marc Sapoval
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, INSERM U970, Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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Pellerin O, Déan C, Reb P, Chaix C, Floch F, Tierny D, Sapoval M. Prostate artery chemoembolization in prostate cancer: A proof of concept study in spontaneous prostate cancer in a canine model. Diagn Interv Imaging 2021; 102:709-715. [PMID: 34391716 DOI: 10.1016/j.diii.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to assess the feasibility and efficacy of docetaxel-loaded bead chemoembolization in spontaneous prostate cancer in a canine model. MATERIALS AND METHODS Five pet dogs with histopathologically proven prostate cancer were referred for prostate artery chemoembolization (PACE). After PACE, all animals were followed, including pharmacokinetic study and clinical and biological evolution, until death. Pelvic contrast-enhanced computed tomography examination was performed at one and two months. Animals were subjected to pathological examination after death. RESULTS Both prostate arteries were successfully chemoembolized in all dogs. A median dose of 18 mg (Q1, Q3; 11.8, 20 mg) docetaxel loaded in 3 mL of 50-100 µm super absorbent polymer beads was injected into each dog. At one month, four of the five dogs were still alive and the median prostate volume was 51% lower (prePACE median prostate volume, 18.4 mL [Q1, Q3; 12, 32.1 mL] vs. postPACE median prostate volume, 6.2 mL [Q1, Q3; 6.2, 11 mL]). At two months, three dogs died because of disease progression. The two remaining dogs showed a 70% median decrease in prostate volume. Prostate pathological examination showed 73% of necrosis. No worsening of urinary symptoms was observed. Pharmacokinetic analysis showed limited systemic passage of docetaxel. All dogs died of metastatic spread at nine months. CONCLUSION This study suggests that PACE is feasible and safe for the treatment of spontaneous prostate cancer in a canine model and may provide a new approach to treat selected patients with prostate cancer.
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Affiliation(s)
- Olivier Pellerin
- Université de Paris, PARCC, INSERM, 75006 Paris; Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75015 Paris, France.
| | - Carole Déan
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75015 Paris, France
| | - Philippe Reb
- Biosphere Medical, Parc des Nations-Paris Nord 2, 95700 Roissy-en-France
| | - Celine Chaix
- Biosphere Medical, Parc des Nations-Paris Nord 2, 95700 Roissy-en-France
| | - Franck Floch
- ONCOVET, Avenue Paul Langevin, 59650 Villeneuve d'Ascq, France
| | - Dominique Tierny
- ONCOVET, Avenue Paul Langevin, 59650 Villeneuve d'Ascq, France; OCR, Parc Eurasanté Lille Métropole, F-59120 Loos, France
| | - Marc Sapoval
- Université de Paris, PARCC, INSERM, 75006 Paris; Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75015 Paris, France
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Reduced nontarget embolization and increased targeted delivery with a reflux-control microcatheter in a swine model. Diagn Interv Imaging 2021; 102:641-648. [PMID: 34099436 DOI: 10.1016/j.diii.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the potential differences in non-target embolization and vessel microsphere filling of a reflux-control microcatheter (RCM) compared to a standard end-hole microcatheter (SEHM) in a swine model. MATERIALS AND METHODS Radiopaque microspheres were injected with both RCM and SEHM (2.4-Fr and 2.7-Fr) in the kidneys of a preclinical swine model. Transarterial renal embolization procedures with RCM or SEHM were performed in both kidneys of 14 pigs. Renal arteries were selectively embolized with an automated injection protocol of radio-opaque microspheres. Ex-vivo X-ray microtomography images of the kidneys were utilized to evaluate the embolization by quantification of the deposition of injected microspheres in the target vs. the non-target area of injection. X-ray microtomography images were blindly analyzed by five interventional radiologists. The degree of vessel filling and the non-target embolization were quantified using a scale from 1 to 5 for each parameter. An analysis of variance was used to compare the paired scores. RESULTS Total volumes of radio-opaque microspheres injected were similar for RCM (11.5±3.6 [SD] mL; range: 6-17mL) and SEHM (10.6±5.2 [SD] mL; range: 4-19mL) (P=0.38). The voxels enhanced ratio in the target (T) vs. non-target (NT) areas was greater with RCM (T=98.3% vs. NT=1.7%) than with SEHM (T=89% vs. NT=11%) but the difference was not significant (P=0.30). The total score blindly given by the five interventional radiologists was significantly different between RCM (12.3±2.1 [SD]; range: 6-15) and the standard catheter (11.3±2.5 [SD]; range: 4-15) (P=0.0073), with a significant decrease of non-target embolization for RCM (3.8±1.3 [SD]; range: 3.5-4.2) compared to SEHM (3.2±1.5 [SD]; range: 2.9-3.5) (P=0.014). CONCLUSION In an animal model, RCM microcatheters reduce the risk of non-target embolization from 11% to 1.7%, increasing the delivery of microspheres of 98% to the target vessels, compared to SEHM microcatheters.
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Young S. Prostate artery embolization for benign prostatic hyperplasia: The hunt for the ideal patient population. Diagn Interv Imaging 2021; 102:119-120. [PMID: 33518450 DOI: 10.1016/j.diii.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shamar Young
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420, Delaware ST SE, MMC 292, 55455 Minneapolis, MN, USA.
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Boeken T, Di Gaeta A, Moussa N, Del Giudice C, Dean C, Pellerin O, Sapoval M. Association between intravesical prostatic protrusion and clinical outcomes in prostatic artery embolization. Diagn Interv Imaging 2021; 102:141-145. [PMID: 33423975 DOI: 10.1016/j.diii.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the influence of intravesical prostatic protrusion (IPP) on clinical outcomes after prostatic artery embolization (PAE) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS All consecutive patients who underwent PAE for lower urinary tract symptoms between January 2017 and January 2019 were retrospectively included. IPP was evaluated on pre-treatment magnetic resonance imaging examination and symptoms were assessed at follow-up consultations using the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. IPPs were classified as grade 1 (<5mm), grade 2 (5-10mm), or grade 3 (>10mm). RESULTS A total of 160 consecutive men (mean age 65±7.8 [SD] years; range: 45-89 years), underwent PAE. The mean IPSS was 21±7.3 (SD) (range: 5-35) and prostate volume 87±38 (SD) mL (range: 30-200mL). The IPP grade was 1 for 28 (28/160; 18%), 2 for 52 (52/160; 33%), and 3 for 80 (80/160; 50%) patients. There were no significant differences in IPSS at baseline between the three IPP grades. Patients with severe (grade 3) IPP had a significantly higher reduction in IPSS than those with non-severe IPP (grade 1 or 2), with estimated mean reductions of 12±2.5 (SD) (range: -4-28) and 8.3±1.9 (SD) (range: -8-21) (P=0.02), respectively. The mean reduction in the QOL score was 3.0 for grade 3 and 2.0 for grade 1 or 2 IPP (P=0.02). CONCLUSIONS The degree of IPP does not limit the efficacy of PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.
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Affiliation(s)
- Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France.
| | - Alessandro Di Gaeta
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Nadia Moussa
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Constantino Del Giudice
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Carole Dean
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Olivier Pellerin
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France; INSERM URM 970 équipe 2 Imagerie de l'Angiogenèse, 75015 Paris, France
| | - Marc Sapoval
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France; INSERM URM 970 équipe 2 Imagerie de l'Angiogenèse, 75015 Paris, France
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