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Embolization > Prostate > Flashcards

Prostate Flashcards

1
Q

what is normal PSA level

A

<4 ng/mL

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2
Q

PSA is increased by

A
  1. ejaculation
  2. infection
  3. TRUS/trans-rectal examination
  4. age
  5. prostate volume
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3
Q

first step in treating BPH

A
  1. alpha blockers then 5 alpha reductase inhibitors
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4
Q

Morbidity of transurethral resection of the prostate

A

7-12 %

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5
Q

good candidates for PAE

A
  1. large prostate (>50 mL)
  2. Young patients
  3. Patients with high IPSS
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6
Q

bad candidates for PAE

A
  1. atherosclerotic symptoms

2. very mild symptoms (IPSS <8)

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7
Q

most common complications of TURP

A
  • urinary retention (5.8%) and urinary tract infection (3.6%)
  • retrograde ejaculation 75%
  • sexual dysfunction with impotence (12%)
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8
Q

the three anatomical regions of the prostate

A
  • peripheral zone
  • central zone
  • transitional zone
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9
Q

is there a correlation between prostate volume and clinical outcome after PAE

A

no

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10
Q

should PAE be performed to improve Qmax

A

no

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11
Q

LUTS (lower urinary tract symptoms) are due to at least which two reasons

A
  1. bladder outlet obstruction from enlarged prostatic tissue (the “static component”
  2. increased smooth muscle tone and resistance (the “dynamic component”)
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12
Q

Storage symptoms of BPH
Voiding Symptoms of BPH
Postmicturition symptoms of BPH

A

Storage: urgency, frequency, nocturia, urge incontinence, stress incontinence

voiding: hesitancy, poor flow, straining, dysuria
postmicturition: dribbling, incomplete emptying

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13
Q

definition of

  1. urgency
  2. frequency
  3. urge incontinence
  4. stress incontinence
A
  1. urgency: sudden urge to urinate due to involuntary contractions of the bladder muscle
  2. frequency: the need to urinate often
  3. urge incontinence: urine leakage from bladder spasm
  4. stress incontinence: urine leakage after sudden pressure (sneezing, coughing, etc)
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14
Q

amount of time to reach baseline activity after PAE

A

amount of time to reach baseline activity after PAE

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15
Q

unique side effect of Pyridium and Azo

A

will turn urine dark orange or red color

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16
Q

side effect of Vesicare and oxybutynin

when Vesicare and oxybutynin are contraindicated

A
  • dry mouth and constipation

- contraindicated in untreated or uncontrolled narrow-angle glaucoma

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17
Q

intra-prostatic artery anastomoses to look out for

A
  1. prostate to pudendal/penile (coil it)
  2. prostate to accessory pudendal (coil)
  3. prostate to rectum (coil or upsize particles)
  4. rectoprostate trunk (coil or position catheter deeper)
  5. prostate to bladder (coil)
18
Q

most common origins of the prostatic artery

A
  1. Internal Pudendal artery (34.1%)
  2. Superior Vesical artery (20.1%)
  3. Common anterior gluteal-pudendal trunk (17.8%)
  4. Obturator artery (12.6%)
  5. Rectal branches (8.4%)
  6. Inferior gluteal artery (3.7%)
  7. Accessory Pudendal Artery (1.9%)
  8. Superior Gluteal artery (1.4%)
19
Q

does prostate enhancement go below the pubic symphysis

A

usually no

20
Q

options you have if you see a collateral but you can’t coil embolize

A
  1. wedge your catheter to act like balloon occlusion catheter
  2. use balloon occlusion catheter
  3. upsize particles if collateral is small
  4. change flow dynamics by pulling catheter back and injecting nitroglycerin or verapamil
21
Q

arterial supply of the prostate

A

Via the inferior vesical artery

  1. Urethral branches - run parallel to the urethra, supply the transition zone (BPH)
  2. Capsular branches - posterolateral aspects of the prostate gland (peripheral zone)
    * capsular branches may pass to the rectum and anal canal
22
Q

ideal candidates for PAE

A
  1. self referred
  2. large prostates
  3. patients who are coagulopathic or can’t come off Plavix
  4. hematuria
  5. surgical contraindications
23
Q

should alpha blockers be taken during the day or at night

A

night, because of the side effects - low BP, dizziness, weakness

24
Q

good candidates for urolift

A
  1. preserving ejaculatory function
  2. prostate less than 70 mL
  3. no middle lobe
25
Q

what is the upper limit prostate volume recommended for Rezum (water vapor therapy)

A

80 cc

26
Q

IPSS score does not apply to which patients

A

patients with a Foley catheter and who self- cath

27
Q

how can you determine if LUTS is due to BPH

A

Calculate the IPSS voiding/storage ratio

the higher the IPSS V/S ratio, the more indicative of obstruction consistent with BPH - from the CIRSE webinar

https://cvirendovasc.springeropen.com/articles/10.1186/s42155-019-0049-1

28
Q

IPSS questions related to voiding

A
  1. incomplete emptying
  2. intermittency
  3. weak stream
  4. straining

“the two I’s and the stream and strain”

29
Q

IPSS questions related to storage

A
  1. frequency
  2. urgency
  3. nocturia
30
Q

Durability of PAE clinical success rates

A

1 year 85%
30 months 82%
78 months 76%

https://www.jvir.org/article/S1051-0443(16)31482-8/fulltext
https://pubmed.ncbi.nlm.nih.gov/33612376/

31
Q

what is the PSAD and what does it mean

A

Prostate specific density - PSAD helps to adjust PSA levels based on the size of the prostate gland. A high PSAD may suggest an increased risk of prostate cancer
PSAD = PSA/Prostate volume

32
Q

PSAD value that warrants further evaluation with biopsy

A

greater than 0.2

33
Q

arterial supply to the bladder

A

70% superior vesicular artery
30% inferior vesicular artery

**KEY POINT: You will not have bladder ischemia if you embolize just the inferior vesicular arteries

CIRSE PAE webinar

34
Q

symptoms of non-target embolization to the bladder

A

hematuria (self-limited)

35
Q

symptoms of non-target embolization to the middle rectal artery

A

mild - usually asymptomatic
moderate - blood in stool and pain (self-limited)
severe - ischemia (rare < 0.1%)

*CIRSE PAE Webinar

36
Q

symptom of non-target embolization of the penis

A

mild/moderate = balanoposthitis (0.7%)

37
Q

treatment of balanoposthitis

A

oral and topical antibiotics, dressing

38
Q

most common origins of the accessory pudendal artery

A
  1. Obturator artery (48.9%)
  2. Inferior vesical artery (29.6%)
  3. Internal iliac artery (5.2%)
39
Q

estimated percentage of PAE non-responders and relapsers

A

non-responders around 10%
relapsers around 10%

40
Q

does non-target embolization to the penis cause erectile dysfunction

A

No, non-target embo to the penis causes skin lesions but does not induce erectile dysfunction

-Tiago Bilhim from CIRSE webinar

Embolization (6 decks)

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