Luciana Mendes de Oliveira Cerri

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.

Estudo Doppler na hipertensão portal

Ultrasonography and Doppler ultrasonography have dramatically improved the diagnosis of portal hypertension thanks to the noninvasive visualization of the liver, spleen and splanchnic blood flow. In this article the authors discuss some important issues raised by the use of ultrasound and Doppler in the evaluation of portal hypertension.

Diagnostic accuracy of color Doppler sonographic study of the ureteric jets in evaluation of hydronephrosis

OBJECTIVE Hydronephrosis (HN) and obstruction are closely associated, but upper urinary tract dilatation can occur without significant obstruction. Despite some pitfalls, conventional ultrasonography and diuretic renography (DR) are the main means of evaluation of HN in children. Recent reports have demonstrated color Doppler ultrasonography (CDUS) to reliably identify ureteric jets in the bladder. The aim of this study was to evaluate this method as a diagnostic tool to distinguish obstructive from non-obstructive dilatations of the upper tract. METHODS We evaluated 51 patients (37 boys and 14 girls), aged 3 months to 14 years (median 4 years), who presented with unilateral grade III and IV hydronephrosis with suspicion of pyeloureteral junction obstruction. All patients underwent DR and evaluation of ureteric jets by transverse CDSG of the bladder within a maximum of 2 weeks. Obstruction was considered in the DR when the hydronephrotic unit showed a differential renal function of less than 40%, or when symptomatic intermittent renal colic was present in older children. The number of ureteric jets was counted over a 5-min period and the frequency calculated for each ureteral orifice. Relative jet frequency (RJF) was defined as frequency of the hydronephrotic side divided by total ureteric jet frequency. Receiver-operating characteristic (ROC) plots were constructed to determine the best cut-off for RJF, in order to identify renal units with obstructive hydronephrosis. RESULTS Twenty-three (45.1%) hydronephrotic units were considered obstructed. The mean RJF differed between obstructive (0.09+/-0.15) and non-obstructive hydronephrosis (0.42+/-0.11) (p<0.001). ROC analysis revealed that RJF <0.25 was the best threshold, and correctly discriminated obstruction in 91.2% of the children with a sensitivity of 87% (95% CI 78.6-98.2%) and specificity of 96.4% (95% CI 87.8-99%). The positive likelihood ratio was 24.3 and the area under the ROC curve was 0.92 (95% CI 0.86-0.98). CONCLUSIONS RJF <25% was found to be a good indicator of obstruction in children with unilateral hydronephrosis. CDUS evaluation of ureteric jets is an easy and non-invasive method that can be used as an initial diagnostic tool, and in follow-up cases, to differentiate obstructed from non-obstructed hydronephrosis in the pediatric population.

Intraoperative ultrasonography of liver, bile ducts and pancreas

The use of intraoperative ultrasonography (IOUS) to evaluate liver, bile ducts and pancreatic disease, as compared to the results of preoperative ultrasonography and CT, is discussed. Forty-two patients who underwent abdominal surgery for suspected hepatobiliary and/or pancreatic diseases were studied. The intraoperative study was carried out with a portable apparatus (Aloka 500, Japan), using 5.0 MHz and 7.5 MHz linear sterile transducers. The main indications for IOUS were the search for and/or evaluation of primary hepatic masses, hepatic abscesses or metastases, obstructive jaundice, or neuroendocrine tumors. In 5 cases (38.5 percent) from the hepatobiliary group and in 7 cases (58.3 percent) from the pancreatic group, a difference between preoperative and intraoperative findings was observed. The main difference was observed in relation to the number and size of hepatic and pancreatic lesions. The relationship between the lesions and the vascular structures was evaluated through IOUS. The method was also used to guide surgical procedures such as biopsies, the alcoholization of nodules, and the drainage of abscesses. IOUS plays an important role in detecting small hepatic and pancreatic nodules. In the assessment of anatomical relationships between the lesions and the vascular structures, and in the performance of interventionist procedures.

Clinically low-risk prostate cancer: evaluation with transrectal doppler ultrasound and functional magnetic resonance imaging

OBJECTIVES: To evaluate transrectal ultrasound, amplitude Doppler ultrasound, conventional T2‐weighted magnetic resonance imaging, spectroscopy and dynamic contrast‐enhanced magnetic resonance imaging in localizing and locally staging low‐risk prostate cancer. INTRODUCTION: Prostate cancer has been diagnosed at earlier stages and the most accepted classification for low‐risk prostate cancer is based on clinical stage T1c or T2a, Gleason score ≤6, and prostate‐specific antigen (PSA) ≤10 ng/ml. METHODS: From 2005 to 2006, magnetic resonance imaging was performed in 42 patients, and transrectal ultrasound in 26 of these patients. Seven patients were excluded from the study. Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml. The examinations were analyzed for tumor identification and location in prostate sextants, detection of extracapsular extension, and seminal vesicle invasion, using surgical pathology findings as the gold standard. RESULTS: Sixteen patients (45.7%) had pathologically proven organ‐confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for localizing low‐risk prostate cancer were 53.1%, 48.3%, 63.4%, 37.8% and 51.3% for transrectal ultrasound; 70.4%, 36.2%, 65.1%, 42.0% and 57.7% for amplitude Doppler ultrasound; 71.5%, 58.9%, 76.6%, 52.4% and 67.1% for magnetic resonance imaging; 70.4%, 58.7%, 78.4%, 48.2% and 66.7% for magnetic resonance spectroscopy; 67.2%, 65.7%, 79.3%, 50.6% and 66.7% for dynamic contrast‐enhanced magnetic resonance imaging, respectively. Sensitivity, specificity, PPV, NPV and accuracy values for detecting extracapsular extension were 33.3%, 92%, 14.3%, 97.2% and 89.7% for transrectal ultrasound and 50.0%, 77.6%, 13.7%, 95.6% and 75.7% for magnetic resonance imaging, respectively. For detecting seminal vesicle invasion, these values were 66.7%, 85.7%, 22.2%, 97.7% and 84.6% for transrectal ultrasound and 40.0%, 83.1%, 15.4%, 94.7% and 80.0% for magnetic resonance imaging. CONCLUSION: Although preliminary, our results suggest that imaging modalities have limited usefulness in localizing and locally staging clinically low‐risk prostate cancer.

História da ultra-sonografia intra-operatória

A ultra-sonografia intra-operatoria foi realizada especialmente a partir de 1960, com alguns relatos de experiencias iniciais nos anos 50. Inicialmente foram avaliados tumores cerebrais, posteriormente estudando-se tambem calculos de vias biliares e calculos renais. Entretanto, a ultra-sonografia intra-operatoria em modo A ou modo B estatico nao adquiriu grande aceitacao no meio medico. Nao obstante, os primeiros estudos forneceram as bases para o desenvolvimento da moderna ultra-sonografia intra-operatoria, com a utilizacao dos equipamentos ultra-sonograficos em modo B em tempo real. Os autores discorrem sobre a utilizacao da ultra-sonografia intra-operatoria desde o seu inicio ate os dias atuais.

Ressonância magnética da próstata: uma visão geral para o radiologista

O adenocarcinoma prostatico e o segundo tumor em incidencia e mortalidade dentre as neoplasias malignasmasculinas. Para adequada programacao terapeutica e importante a distincao entre tumores confinados aprostata e aqueles com extensao extraprostatica. Diferentes estudos tem demonstrado que a ressonânciamagnetica da prostata com bobina endorretal auxilia no estadiamento local destes pacientes. Este artigoapresenta informacoes sobre a anatomia prostatica, o aspecto tumoral a ressonância magnetica, sinais deextensao tumoral extraprostatica e invasao de vesiculas seminais, sugestoes de protocolo, principios geraise importância da espectroscopia de protons, do estudo perfusional e da difusao, indicacoes da ressonânciamagnetica na investigacao de recidiva pos-operatoria e pos-radioterapia, seu papel na deteccao de lesoessuspeitas em pacientes com suspeita clinico-laboratorial de adenocarcinoma prostatico, alem de apresentaros diagnosticos diferenciais e limitacoes do metodo.Unitermos: Neoplasias da prostata; Adenocarcinoma; Imagem por ressonância magnetica; Estadiamento deneoplasias.Prostate adenocarcinoma is the second tumor in incidence and mortality among malignant neoplasms in men.The differentiation between tumors confined to the organ and those with extraprostatic extension is criticalfor an appropriate therapeutic planning. Different studies have demonstrated that magnetic resonance imagingof the prostate with endorectal coil is useful in the local staging of these tumors. The present article presentsinformation on the prostate gland anatomy, the tumor aspect at magnetic resonance imaging, specific signsof extracapsular extension and seminal vesicles invasion, protocol suggestions, general principles and relevanceof proton spectroscopy, perfusion and diffusion imaging, role of magnetic resonance imaging in thepostoperative and post-radiotherapy detection of local tumor recurrence, and also in the detection of lesionsin patients with clinical/laboratory suspicion of prostate adenocarcinoma. Additionally, the present articledescribes differential diagnoses and limitations of the method.Keywords: Prostate cancer; Adenocarcinoma; Magnetic resonance imaging; Cancer staging.Prostate adenocarcinoma is the second tumor in incidence and mortality among malignant neoplasms in men. The differentiation between tumors confined to the organ and those with extraprostatic extension is critical for an appropriate therapeutic planning. Different studies have demonstrated that magnetic resonance imaging of the prostate with endorectal coil is useful in the local staging of these tumors. The present article presents information on the prostate gland anatomy, the tumor aspect at magnetic resonance imaging, specific signs of extracapsular extension and seminal vesicles invasion, protocol suggestions, general principles and relevance of proton spectroscopy, perfusion and diffusion imaging, role of magnetic resonance imaging in the postoperative and post-radiotherapy detection of local tumor recurrence, and also in the detection of lesions in patients with clinical/laboratory suspicion of prostate adenocarcinoma. Additionally, the present article describes differential diagnoses and limitations of the method.

Rabdomiossarcoma prostático em adulto: relato de caso

Prostatic rhabdomyosarcoma is an aggressive tumor predominantly found in children. The present paper reports a case of a 27-year-old-patient who had an extensive lesion invading periprostatic planes, with distant metastases found at the moment of the diagnosis. Imaging findings on ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography were evaluated and correlated with the ones already described in the literature.

Análise evolutiva e perspectiva histórica da ultra-sonografia intra-operatória (USIO) nas afecções pancreáticas

Intraoperative ultrasonography influences surgical strategy in a significant number of patients operated due to benign or malignant conditions, and is the most sensitive technique for the detection of small lesions, particularly in the liver and in the pancreas. In pancreatic surgery, intraoperative ultrasonography is helpful in the localization of islet cell tumors and in the assessment of the resectability of adenocarcinomas. The technique may also play a role in chronic pancreatitis surgery. The authors present an up-to-date review of the evolution of intraoperative ultrasonography in pancreatic surgery.