(21 Total References)
Dr. João Martins Pisco, an ...
Dr. João Martins Pisco, an interventional radiologist at St. Louis Hospital in Lisbon, Portugal, stated that UFE will probably be a first-line treatment option in the future even for women who wish to conceive and are unable due to the presence uterine fibroids.
2012 Society of Interventional Radiology
Indeed, in a study of 152 patients presented during a session here on embolization techniques and procedures, Joao Martins Pisco, MD, director of interventional radiology at St. Louis Hospital (Lisbon, Portugal) reported "clinical success" for 83% of the patients who had a one-year follow-up.
Pisco noted that in patients with symptomatic BPH and failed drug therapy, "PAE appears safe and provides good short and medium term results."
"Benign prostatic hyperplasia or BPH is ...
"Benign prostatic hyperplasia or BPH is so common that it's been said that all men will have an enlarged prostate if they live long enough, said João Martins Pisco, M.D., chief radiologist at Hospital Pulido Valente and director of interventional radiology at St. Louis Hospital, both in Lisbon, Portugal.
"I believe that a minimally invasive interventional radiology treatment-prostatic artery embolization or PAE-will be the future treatment for benign prostatic hyperplasia or men's noncancerous enlarged prostates."
Today's most used therapy is surgical transurethral resection of the prostate (or TURP).
"While the gold standard treatment for enlarged prostates has been TURP, minimally invasive prostatic artery embolization is safe, performed under local anesthesia and has comparable clinical results-without TURP's limitations and risks," said Pisco
TURP can be performed only on prostates smaller than 60 cubic centimeters (cc); there is no size limitation for PAE treatment, said Pisco, who is also a professor at the Faculty of Medical Sciences, New University of Lisbon.
"The best results are obtained on patients with prostates larger than 60 cubic centimeters and with very severe symptoms," he
"Pelvic arterial embolization may be the only feasible and effective treatment for benign prostatic hyperplasia in those men who cannot have TURP due to the size of their prostate (80+ cubic centimeters) or because it is inadvisable for them to undergo general anesthesia," said Pisco
"Such symptoms can have significant negative impact in quality of life, leading many men to seek treatment," said Pisco
"We need innovative technologies, such as prostatic artery embolization, to continue to improve outcomes and minimize patient discomfort and morbidity when managing enlarged prostates," he
The men were followed for more than nine months (on average), and PAE was found to be technically successful in 98.5 percent of the patients-with 77 men showing "excellent" improvement, six men "slight improvement" (but needing no medications) and one experiencing no improvement (due to receiving an incomplete embolization), Pisco
Two hours after PAE, most men were passing urine less frequently.
It was impossible to embolize both prostate arteries in the men showing "slight improvement" due to advanced atherosclerosis, said Pisco
"There is no sexual dysfunction following prostatic artery embolization, and a quarter of our patients report that sexual function improved after the procedure," added Pisco
How TURP is performed
BPH can be treated by TURP, a procedure in which a scope is inserted through the penis and the prostate is removed piece by piece, or surgery through an abdomen incision (prostatectomy).
During surgery, a man generally undergoes general anesthesia and needs to spend several days in a hospital.
Major complications are frequent, such as blood loss, severe pain, sexual dysfunction, impotence, retrograde ejaculation, urinary incontinence, pain, infections and urethral stricture, said Pisco
Other treatments for enlarged prostate
Other treatments for enlarged prostrates-besides prostatic artery embolization, TURP and prostatectomy-include watchful waiting, drugs (to relax muscles near prostate to ease symptoms or help shrink the prostate) and other minimally invasive therapies (such as transurethral needle ablation and laser surgery), which have major disadvantages, such as providing less effective improvement in symptoms, poorer durability of symptomatic benefit, and greater risk of continued catheterization and reoperation.
"Additional research is needed to explain why some patients improve better than others," said Pisco
The treatment -- called prostatic artery ...
The treatment -- called prostatic artery embolization, or PAE -- is ready to be used in certain patients, namely those with a prostate larger than 60 cubic centimeters, "with severe lower urinary tract symptoms and a weakened urinary stream," said Dr. Joao Martins Pisco, lead author of a study slated to be presented March 29 at the annual meeting of the Society of Interventional Radiology in Chicago.
Another drawback is that few doctors are trained in PAE so far, said Pisco, chair of radiology at Hospital Pulido Valente and professor in the Faculty of Medical Sciences at New University of Lisbon in Portugal.
UFE in the News
The complication rates of the pregnancies in the study were surprisingly similar to the rates of the general population, said Joao Martins Pisco, MD, St. Louis Hospital, Lisbon, Portugal.
"UFE is not a contraindication for patients who want to conceive," Dr. Pisco
said on March 14.
"UFE may be the single effective treatment in some patients with uterine fibroids."
The study included 743 women who underwent UFE procedures, mainly after failure of a myomectomy or because hysterectomy was suggested as the only other option.
The fertility rate of the women was 58.1%, which is comparable to the rates for those who undergo myomectomy the -- gold standard for symptomatic fibroids in women who want to get pregnant, Dr. Pisco