Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH).

BACKGROUND: This study evaluated nontarget embolization (NTE) during prostatic artery embolization (PAE) with ethylene vinyl alcohol copolymer (EVOH). RESULTS: Ten consecutive patients treated by PAE with EVOH for the presence of disabling benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) between June 22 and January 2023 were included in this prospective study. The inclusion criteria were as follows: LUTS attributed to BPH, LUTS duration ≥ 6 months, failure to respond to standard pharmacotherapy, IPSS > 18 or QoL score > 2, and prostate volume > 40 mL. Embolization was performed under general anaesthesia. According to established techniques, a microcatheter was positioned bilaterally within the feeding arteries, and EVOH was injected slowly under X-ray control. Unenhanced pelvic computed tomography scans were carried out before and after embolization to assess the NTE. The safety of the prostatic embolization procedure with EVOH was assessed by collecting adverse effects over 3 months of evaluation that included the International Prostate Symptom Score (IPSS) and quality of life (QoL) score.-up evaluations, occurring at 3, 6, and 12months, included International Prostate Symptom Score. Bilateral PAE was technically successful in 9 patients, and unilateral injection was performed in one patient. The postoperative scanner showed a distribution of the embolization material in the two lobes of the prostate in all patients. The procedure time varied from 120 to 150 (mean: 132) minutes. Eight out of 10 patients developed pollakiuria within 24 h; none of the patients had postoperative pain. Two patients required catheterization for postoperative urinary retention. Catheters were removed successfully at the end of the first day for one of these patients and on the tenth day for the other. At the 3-month follow-up, patients showed significant improvement in the International Prostate Symptom Score (n = 10; mean = -11,5; P < 0.01) and quality of life score (n = 10; mean = -3,40; P < 0.01). Only one patient presented one asymptomatic muscular NTE. CONCLUSIONS: PAE with EVOH is safe, effective, and associated with few NTEs and no postoperative pain. Prospective comparative studies with longer follow-ups are warranted. TRIAL REGISTRATION: IDRCB, 2021-AO29-56-35. Registered 27 May 2022, http://clinicaltrials.gov/study/NCT05395299?cond=embolization&term&rank=1 .

[Persistent hematuria after embolization for hemorrhagic complication following percutaneous nephrolithotomy: value of the study of red blood cell volume in urine]. / Hématurie persistante après embolisation pour complication hémorragique d'une néphrolitotomie percutanée: intérêt de l'étude du volume des globules rouges dans les urines.

Percutaneous nephrolithotomy is associated with a high risk of complications, particularly bleeding, which makes it a potentially invasive technique. Management of haemorrhagic complications sometimes requires the use of embolization. Recurrence after embolization can occur as a result of revascularization or recanalization of vessels, but post-embolization infarction can also lead to persistent haematuria. The authors report the clinical case of a 36-year-old patient presenting with recurrence of severe haematuria after two successive highly selective embolizations. Analysis of the mean corpuscular volume of red cells in the urine confirmed the parenchymal and non-vascular origin of the bleeding, corresponding to a post-embolization syndrome. This analysis therefore constitutes a simple way to avoid repeated embolization or surgical exploration.

[Value of laser ureteroscopy with semi-rigid ureteroscope in the treatment of stones less than 2 cm situated above the iliac vessels : Report of a retrospective series of 460 consecutive cases]. / L'urétéro-rénoscopie laser dans le traitement des calculs de moins de 2 cm situés au-dessus des vaisseaux iliaques: à propos de 460 cas consécutifs.

OBJECTIVE: To evaluate the value of retrograde ureteroscopy in the treatment of stones less than 2 cm situated above the iliac artery. MATERIAL AND METHOD: Between September 1989 and December 1998, 460 consecutive patients, aged 14 to 86 years, presenting with stones situated above the iliac vessels and measuring less than 2 cm were initially managed by fine (7.5 F) semi-rigid ureteroscopy with CANDELA laser fragmentation in the majority of cases. All operations were performed under general anaesthesia with continuous muscle relaxation. The operation was performed by the same operator in every case. In 50 cases (10.65%), a complementary extracorporeal lithotripsy session was performed following the operation and in 13 cases (2.82%) a second ureteroscopy was necessary. RESULTS: 352 patients (76.5%) were free of any residual fragments after a single laser ureteroscopy session. 415 patients (90.21%) were free of any stone fragments at the 3rd postoperative month. Complications consisted of 28 cases of ureteric perforations, which were all cured by double J stenting, and 7 cases of minor haematuria during the operation. No long-term complication was observed. CONCLUSION: Ureteroscopy with laser lithotripsy using a fine, semi-rigid instrument, is a reliable technique to treat stones situated above the iliac vessels, provided appropriate anaesthesia and continuous muscle relaxation are ensured. This procedure is associated with a low morbidity and therefore constitutes an effective alternative in the case of failure of ESWL for the treatment of stones less than 2 cm situated above the iliac vessels.

[TVT: prospective study comparing pre- and postoperative clinical, urodynamic and quality of life criteria]. / La bandelette TVT: étude prospective comparant des critères cliniques, urodynamiques et de qualité de vie pré et post-opératoire.

INTRODUCTION: This prospective study on TVT compared preoperative and postoperative urodynamic in order to evaluate the effects of TVT on the detrusor-sphincter synergy, and quality of life criteria by means of a validated questionnaire. MATERIAL AND METHOD: From August 2000 to March 2002, the authors conducted a prospective study on two sites, Nice and Marseille, on 37 patients. The inclusion criteria were clinical and urodynamic. A questionnaire evaluating the severity of incontinence and its impact on daily life was completed preoperatively and postoperatively. Thirty TVTs were placed under local anaesthesia and seven TVTs were placed under general anaesthesia. Patients were reviewed at least 6 months (mean: 9 months; range: 6 to 19 months) after the operation. Statistical analysis was based on a test for paired series, patient by patient, with an a risk of 5%. RESULTS: Eight cases of unilateral bladder perforation (21.6%) were treated by catheterization for 48 hours and 6 cases of transient acute urinary retention (16.2%) were also treated by catheterization. No haemorrhagic or infectious complications were observed. Thirty one (83.7%) patients were completely cured of their incontinence, 5 (13.5%) were improved and there was one failure. Six (75%) of the 8 patients with a urethral closing pressure less than 30 cm H2O, 6 were cured and 2 (25%) obtained a marked improvement. All criteria were compared in the same patient preoperatively and postoperatively. The maximum flow rate on uroflowmetry was significantly lower postoperatively, but no difference was observed for preoperative and postoperative detrusor sensitivity, urodynamic bladder capacity or urethral closing pressure. No de novo detrusor instability was observed. Mean severity scores and impact of incontinence scores were much lower postoperatively. CONCLUSION: The efficacy of TVT does not appear to be correlated with the severity of sphincter incompetence and did not modify the detrusor-sphincter synergy of the patients of our study. The use of a questionnaire appears to be useful and should be recommended in order to more accurately evaluate the efficacy of the surgical procedure and the improvement of the patient's quality of life.