Antonio Sergio Zafred Marcelino

Quality of Life and Clinical Symptom Improvement Support Prostatic Artery Embolization for Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia

PURPOSE To show that prostatic artery embolization (PAE) improves quality of life (QoL) and lower urinary tract symptoms in patients with acute urinary retention caused by benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This was a single-center prospective study of PAE in 11 patients with BPH managed with indwelling urinary catheters. International Prostate Symptom Score (IPSS), ultrasound, magnetic resonance (MR) imaging, QoL, and urodynamic tests were used to assess outcomes. Prostate size ranged from 30 to 90 g, and embolizations were performed with 300-500-μm Embosphere microspheres. RESULTS The rate of technical success (ie, bilateral PAE) was 75%, and the rate of clinical success (ie, catheter removal and symptom improvement) was 91% (10 of 11 patients). Postembolization syndrome manifested as mild pain in the perineum, retropubic area, and/or urethra. Ten of 11 patients urinated spontaneously after Foley catheter removal 4-25 days after PAE (mean, 12.1 d). No major complications were observed. Follow-up ranged from 19 to 48 months. In an asymptomatic patient, a discrete area of hypoperfusion suggesting small ischemia of the bladder was observed on 30-day MR imaging follow-up, but the bladder was normal on 90-day MR imaging. After 1 year, mean prostate volume reduction was greater than 30%, symptoms were mild (mean IPSS, 2.8 ± 2.1; P = .04), no erectile dysfunction was observed, and QoL improved significantly (mean, 0.4 ± 0.5; P = .001) using the paired t test. CONCLUSIONS Patients with severe symptoms and acute urinary retention caused by BPH can be treated safely by PAE, which improves clinical symptoms and QoL.

Midterm Follow-Up After Prostate Embolization in Two Patients with Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in men [1, 2]. Transurethral resection of the prostate (TURP) is still the ‘‘gold standard’’ surgical treatment for prostates. Due to the relative morbidity of TURP, minimally invasive techniques have been developed as alternatives for treatment for BPH, such as transurethral microwave thermotherapy and other laser ablations, but surgery (accomplished by transurethral or open means) constitutes the traditional treatment for BPH. Taking into account the patients’ comorbidities, surgical intervention in this age group may be considered high risk [3]. We report the radiological and clinical midterm follow-up of PAE in two patients with acute urinary retention due to BPH. Two patients with acute urinary retention due to BPH were selected for the study. Both patients were been previously described in this same journal in 2010 [4]. Prostatic artery embolization was performed under local anesthesia in both patients. One underwent bilateral embolization and the other had a unilateral embolization procedure. After PAE procedure, ultrasonography (US) and magnetic resonance imaging (MRI) were used for evaluation of effectiveness at 1, 3, 6, and 18 months. International prostate symptom score (IPSS), quality of life score (QUOL), and international index of erectile function score (IIEF) were evaluated until the last 24 month follow-up.

Portal vein obstruction after liver transplantation in children treated by simultaneous minilaparotomy and transhepatic approaches: Initial experience

Carnevale FC, Santos ACB, Seda‐Neto J, Zurstrassen CE, Moreira AM, Carone E, Marcelino ASZ, Porta G, Pugliese R, Miura I, Baggio VD, Guimarães T, Cerri GG, Chapchap P. Portal vein obstruction after liver transplantation in children treated by simultaneous minilaparotomy and transhepatic approaches: Initial experience.
Pediatr Transplantation 2011: 15: 47–52.

Linfonodos cervicais: um dilema para o ultra-sonografista

Ultrasound assessment of neck lymphadenopathy can be difficult as sometimes the same pattern is seen both in inflammatory (specific or not) and neoplastic diseases (lymphoproliferative or metastatic). An adequate follow-up of these lymphadenopathies requires evaluation of some important ultrasound features, and relies on the ability of localizing these nodes. We reviewed the literature with the aim of establishing the most significant ultrasonographic features on gray-scale ultrasound and Doppler ultrasound that can help in the study of the lymph nodes of the neck. We also describe the localization of lymph nodes based on computed tomography anatomic landmarks. The aspects analyzed on B-mode were: number (isolated nodule or conglomeration), shape, echotexture/echogenicity, calcification, cystic necrosis and/or hemorrhagic necrosis, size, contours and extra nodal extension. Doppler aspects reviewed were color mapping and spectral analysis (pulsatility index and resistive index). Some patterns usually described for malignant nodes are round morphology, marked hypoechoic, peripheral vascularization and high pulsatility index and resistive index. We concluded that an accurate diagnosis requires the evaluation of multiple aspects seen on B-mode and Doppler ultrasound.A analise dos linfonodos cervicais e um assunto complexo, na medida em que obtemos, por vezes, padroes de imagens superponiveis para os processos benignos - reacionais (infecciosos especificos e inespecificos) - e para os malignos - doencas neoplasicas (linfoproliferativas e metastaticas). O seguimento adequado das linfadenopatias tambem requer do examinador detalhamento topografico e descricao dos aspectos ecograficos relevantes. Realizamos revisao literaria com os objetivos de ressaltar os criterios ultra-sonograficos mais significantes (modo-B e duplex-Doppler colorido) e fazer analogia aos reparos anatomicos utilizados na tomografia computadorizada, para uniformizar a descricao topografica dos niveis linfonodais por meio da ultra-sonografia. Os aspectos avaliados ao modo-B foram: numero (se agrupados ou isolado), forma, hilo ecogenico central, ecotextura/ecogenicidade, presenca de calcificacoes, necrose e/ou hemorragia interna, dimensoes, contornos (disseminacao extracapsular). Ao duplex-Doppler colorido os aspectos avaliados foram: padrao de vascularizacao e analise espectral - indice de resistividade e indice de pulsatilidade. Existem padroes ultra-sonograficos frequentemente descritos nos linfonodos malignos como morfologia globosa, hipoecogenicidade marcada, vascularizacao predominantemente periferica e indice de resistividade elevado, porem a analise deve ser multifatorial, levando-se em conta os parâmetros ao modo-B e ao duplex-Doppler colorido.

Parâmetros dopplervelocimétricos na avaliação da perviedade da anastomose portossistêmica intra-hepática transjugular (TIPS)

A anastomose portossistemica intra-hepatica transjugular (TIPS) e um procedimento intervencionista minimamente invasivo realizado pela introducao de protese metalica auto-expansivel no parenquima hepatico, via transjugular. Tem por objetivo tratar as complicacoes da hipertensao portal, principalmente a hemorragia digestiva alta e a ascite refrataria. A estenose e complicacao frequente, embora o procedimento seja eficaz e com baixo indice de insucesso. O diagnostico precoce da estenose e de fundamental importância, pois interfere no tipo de tratamento a ser realizado e o reaparecimento dos sintomas pode ser grave. O ultra-som Doppler e entao utilizado para o seguimento dos pacientes portadores do TIPS, e varios parâmetros sao descritos na literatura para o diagnostico de estenose, como: as velocidades minima e maxima no interior da protese, a velocidade na veia porta, o gradiente de velocidade entre dois pontos da protese, e outros. Infelizmente nao ha consenso sobre qual parâmetro ou conjunto de parâmetros e mais eficaz no diagnostico, porque os protocolos de avaliacao variam de instituicao para instituicao. Os autores realizaram uma revisao dos parâmetros de estenose descritos na literatura e de outros aspectos de fundamental importância na compreensao do procedimento, como as indicacoes, as contra-indicacoes e a fisiopatologia da estenose.

Pediatric Liver Transplant: Techniques and Complications

Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. ©RSNA, 2017.

2027 URODINAMYC FINDINGS AFTER PROSTATIC ARTERY EMBOLIZATION FOR TREATMENT OF URINARY RETENTION RELATED TO BENIGN PROSTATIC HYPERPLASIA

INTRODUCTION AND OBJECTIVES: Prostatic artery embolization (PAE) has emerged as an option for treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Here we describe the urodynamic findings after PAE in 11 patients with urinary retention due to BPH. METHODS: We performed a prospective study including 11 patients with acute urinary retention (AUR) due to BPH who were waiting for surgical treatment. Patients underwent physical examination, PSA measurement, transrectal US and MRI. International Prostate Symptom Score (IPSS), QoL and urodynamic testing were used to assess the outcome. PAE was performed under local anesthesia through the femoral artery. Urodynamic analysis were performed after a median 12 months (1 – 15) follow-up period. Ages ranged from (59 to 78, median 68.5 years) and prostate size ranged from 30-90 grams (median 72 grams). RESULTS: Twelve PAE procedures using 300-500im Embosphere® Microspheres were performed in 11 patients, and clinical success (catheter removal and symptoms improvement) was 91% (10/11 patients). Patients urinated spontaneously from 4-25 days (mean, 12.1) after catheter removal. Urodynamic findings after PAE showed that maximum bladder capacity and maximum flow rates improved significantly. Bladder complacence and post-void residual (PVR) volume improved with marginally significant results. An overactive bladder was found in 63 and 45% of cases pre and post-PAE respectively (table). Bladder outlet obstruction index (BOOI) showed values 40 in 100% of cases pre-embolization. After PAE, only 36% of cases were 40, 27% were between 20 and 40, and 36% were 20 (graphic). CONCLUSIONS: PAE is an effective method for treatment of AUR due to BPH. Most urodynamic parameters are improved after treatment and a BOOI 40 can be observed in 76% of cases. Source of Funding: None