Potential improvements of lung and prostate MLC tracking ...
Prostate arterial embolization in benign prostate hyperplasia...Potential conflicts of interest...
Transcript of Prostate arterial embolization in benign prostate hyperplasia...Potential conflicts of interest...
Prostate arterial embolizationin benign prostate hyperplasia
Disclosure
Speaker name: Ulf Teichgräber, MD, MBA
Potential conflicts of interest related to the presentation:
o Research grant, honoraria: Boston Scientific
Potential conflicts of interest not related to the presentation:
o Consulting Fees, Honoraria, Research Grants, Advisory Boards: ab medica, Abbott, Angiodroid, Vascular, B.Braun Melsungen, Boston Scientific (Celonova), C.R. Bard, COOK, Endoscout, GE Healthcare, iVascular, Kimal, Maquet, Medtronic, Philips Healthcare, Siemens Heathcare, Spectranetics, W.L.Gore
o Master research agreements with Siemens Healthcare, GE Healthcare
BPH
• Transuethral resection of the prostate (TURP) isstill considered the standard surgical therapyfor the treatment of non-neurogenic male lower urinary tract symptoms (LUTS)
• A retrograde ejaculation, and sexual dysfunction are typical side effects of TURP
• Minimally invasive methods such as PAE arearising with the intention to provide fewercomplications
Pelvic vessels
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Quelle: Netter
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Typical anatomy?
1. Iliolumbar artery
2. Sacral internal artery
3. Superior gluteal artery
4. Inferior gluteal artery
5. Obturator artery
6. Umbilical artery
7. Superior vesical artery
8. Inferior vesical artery
9. Prostate artery
10.Medial rectal artery
11.Internal pudendal artery
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Anatomische Varianten
Prof. Dr. Herbert Lippert, Urban&Schwarzenberg 1968
Leipzig, 06.05.16 8
1) Commen trunk of superior vesical a. +
inferior vesical a.
2) Obturator a.
3) Prostate a.
4) Internal pudendal a.
5) Inferior gluteal a.
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Uncommon origin of the
prostate a. out of superior
gluteal artery
Technique
10Image source: www.competence-site.de
Material
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Material / Vorgehen
1. Access groin (4F sheath)
2. Acccess the contralateral internal iliac a. with a 4 F selektiv catheter(e.g. RIM Tempo, Cordis)
3. Advancing a mircrocatheter into the prostate a. (e.g. Progreat α 2.0 F, Terumo)
4. First embolisation with microspheres (e.g. Embozene 250 µm)
5. Access the der ipsilateral prostate a.
6. Second embolisation
Ajustment of the angiography
• Before embolisation: confirmation in two plains
• 1. a.p. projection
• 2. LAO/RAO 30°(ggf. 10° cc angulation)
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Prostata Arterienembolisation - Prof. Dr. U. Teichgräber
14Berlin, 14.01.17
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Challange
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180ml(76 x 58 x 78mm x π/6)
142ml(72 x 51 x 74mm x π/6)
- 21%
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Radiology: Volume 270: Number 3—March 2014
Postinterventional Symptoms
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Gao Y, Huang Y, Zhang R et al. Radiology 2014; 270(3):920-928
21Gao Y, Huang Y, Zhang R et al. Radiology 2014; 270(3):920-928
Kurbatov D, et al. Urology 2014; 84: 400-404
•88 patients (IPSS ≥ 12, PV ≥ 80cm3, Qmax < 15ml/s)
BPH & Prostate gland > 80g
Own results
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Conclusions
• Anatomic variations
(+arteriosclerosis)
• Risk of inadvertent
embolization of the rectum or
• Low acceptance of urologists
• No trauma to the urethra
• Alternative to TURP especially in
Prostate gland vol. >65 ml
• Alternative in patients at risk
(coagulopathy, general anesthesia)
PROS CONS
Prostate arterial embolizationin benign prostate hyperplasia