833 - EMBOKARE
This recent landmark position paper by the Society of Interventional Radiology, published in the Journal of Vascular and Intervention Radiology, May, 2019, supported adoption of prostate artery embolization (PAE) for symptomatic benign prostate hyperplasia (BPH) in patients in whom medical therapy is ineffective and who are poor surgical candidates. The prevalence of BPH increases with age, affecting more than 70% of men older than 70 years with a quarter of men suffering moderate to severe urinary obstruction symptoms that impair their quality of life. Drug treatment may be associated with retrograde ejaculation, orthostatic hypotension, loss of libido, and erectile dysfunction. TURP prostate glands as large as 80–100 cm 3. Transurethral resection of the prostate (TURP) has been the gold standard for treatment of BPH, but it may produce significant morbidity, including retrograde ejaculatory, erectile dysfunction, urethral stricture, urinary retention, urinary tract infection, transfusion requirement, and incontinence. Also, TURP is generally ineffective for prostates larger than 90 ml in volume. Based on published data for more than 2,000 patients with BPH and urinary obstructive symptoms, PAE has proven to be effective and safe, with fewer than 0.5% of patients experiencing major complications. PAE provides durable relief of urinary obstructive symptoms at midterm follow-up, and, in cases of clinical failure after PAE, patients still have the option of any urologic treatment or repeat PAE. PAE appears to be particularly well suited for treatment of symptomatic BPH when the patient is dependent on an indwelling bladder catheter, for very large prostates with volumes of 80-100 ml or greater, in cases of hematuria, due to biopsy, surgery, or even caused by BPH itself. In reviewed scientific studies, PAE was extremely effective at stopping such bleeding.
This article from World Neurosurgery, February 2019, presents further evidence that minimally-invasive, transcatheter embolization of the middle meningeal artery results in a significantly lower rate of reaccumulation of chronic blood collections between the dura and arachnoid matter surrounding the brain, when compared with invasive surgical drainage. These hemorrhages occur in approximately 200,000 Americans annually, and can be life-threatening if large enough. They are usually the result of head trauma but can occur spontaneously.
Increasing age, blood-thinning drugs (e.g., Coumadin), and alcohol abuse all increase the risk of occurrence. Traditional therapy involves surgical drainage of the blood collection, although the use of steroids may also be beneficial. However, both of these therapies have associated risks. In this article, the authors reported a recurrence of subdural blood collections in 2.1% of patients vs. 27.7% of patients undergoing conventional surgical hematoma drainage. Middle meningeal artery embolization is usually a low-risk procedure that can be performed in most patients under IV sedation on an outpatient basis.
Article from Medical News Today, explaining the meaning and calculation of Body Mass Index, and also provides the table listing BMI values associated with normal weight, as well as with the various degrees of obesity.
