ABSTRACT
Objective: To observe the value of preoperative enhanced MSCT before interventional treatment of iatrogenic hemorrhage in different positions of urinary system. Methods: Data of 27 patients underwent interventional therapy for iatrogenic bleeding in different positions of the urinary system were retrospectively analyzed. The detection rate of bleeding responsible vessels were compared between preoperative enhanced MSCT and the first time intraoperative DSA. CT and DSA findings were also studied. Results: Bleeding responsible vessels were identified in 26 patients (26/27, 96.30%) with preoperative enhanced MSCT, mainly manifested as arterial plaque contrast agent extravasation, contrast agent concentration and early developing of renal vein. Sign of arteriovenous fistula detected with the first time intraoperative DSA was observed in 1 patient without a clearly responsible vessel for bleeding using preoperative enhanced MSCT. In 24 patients (24/27, 88.89%), the responsible vessels for bleeding were identified with the first time intraoperative DSA, mainly manifested as contrast agent extravasation, pseudoaneurysm and renal arteriovenous fistula. Responsible vessels for bleeding were not detected with the first time intraoperative DSA in 3 patients who had characteristic findings of preoperative enhanced MSCT, including contrast agent extravasation in 2 patients and early developing of renal vein in 1 patient. With the reference of preoperative MSCT manifestations, bleeding responsible vessels were clearly detected with the second time DSA during operation. There was no significant difference of the detection rate of bleeding responsible vessel between preoperative enhanced MSCT and the first time intraoperative DSA (χ2=1.08, P=0.29). Conclusion: Bleeding responsible vessels of iatrogenic hemorrhage in different positions of urinary system can be detected accurately with preoperative enhanced MSCT. Enhanced MSCT images can also be used as the references for patients without clearly responsible vessel for bleeding using the first time intraoperative DSA of interventional therapy, so as to embolize the responsible vessel rapidly and effectively.
ABSTRACT
Objective To evaluate the efficacy and safety of prostatic arterial embolization (PAE) and transurethral resection of prostate (TURP) in treatment of benign prostatic hyperplasia (BPH).Methods Totally 40 patients with BPH from Jan 2016 to Oct 2016 were selected.All patients were divided into PAE (n=20) and TURP (n=20) group by random number table method.The curative effect indexes (international prostate symptom score [IPSS],quality of life score [QOL],prostate volume [PV],postvoid residual [PVR],maximum urinary flow rate [Qmax] and prostate-specific antigen [PSA]),the complications and side effects,as well as the incidence of sexual dysfunction were analyzed and compared between the two groups.Results No statistical difference of IPSS,QOL,PV,PVR,Qmax nor PSA was found between the two groups before operation (all P＞0.05).IPSS,QOL,PV,PVR and PSA were significantly lower than those before operation 3,6 and 12 months after operation (all P＜0.05),while Qmax was obviously higher than that before operation (P＜0.05).Three months after operation,the curative effect indexes were statistically different between the two groups (all P＜0.05),while no statistical difference was found 6 and 12 months after operation (P＞0.05).The incidence of postoperative complications in TURP group was higher than that in PAE group (x2 =4.329,P=0.037).There was no statistical difference in the incidence of sexual dysfunction between the two groups (x2=2.105,P=0.147).Conclusion PAE and TURP can significantly alleviate clinical symptoms of patients with BPH.Three months after operation,the efficacy of TURP is better than PAE,but PAE is more minimally invasive and has fewer complications.