UIJ UroToday International Journal® Table of Contents: October, 2012 Review • Review of Current Outcomes of Prostate Artery Embolization to Treat Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia Francisco Cesar Carnevale, Alberto A Antunes, Joaquim M da Motta-Leal-Filho, Ronaldo H Baroni, Antonio SZ Marcelino, Luciana MO Cerri, Giovanni G Cerri, Miguel Srougi Benign Prostatic Hyperplasia • Correlation of Age, Prostate Volume, Serum Prostate-Specific Antigen, and Serum Testosterone in Indian, Benign Prostatic Hyperplasia Patients Sasanka K Baruah, Simanta Jyoti Nath, Rajeev T Puthenveetil, Saumar J Baruah, Phanindra Mohan Deka, Bikash Bawri Lower Urinary Tract Symptoms • The Role of Ultrasound-Estimated Bladder-Wall Thickness In the Prediction of Detrusor Overactivity in Patients with Irritative Lower Urinary Tract Symptoms Sabri M Khaled, Mahmoud M Ali, Bahaa Elmenshawy, Hamdy Abozeid, Mostafa E AbdelMagid Prostate Cancer • Prostate Cancer Detection via Transrectal Ultrasound Biopsy: Vienna Nomogram Versus Sextant/Octant Biopsy Methods Praveen Singam, Badrulhisham Bahadzor, Azlina Abas, Tan Guan Hee, Christopher Ho, Goh Eng Hong, Zulkifli M Zainuddin Stone Disease • Non-Contrast Computed Tomography Scan as a Predictor of Shock-Wave Lithotripsy Outcomes for the Treatment of Renal Stones Ehab Mohamad Galal, Tarek Khalaf Fathelbab, Amr Mohamad Abdelhamid Trauma and Reconstruction • Antegrade and Retrograde Endoscopic Manipulation of a Complete Posterior Urethral Stricture Tawfik Al-Ba’adani, Salah Ahmed, Shukri I Alfalah, Khaled Telha, Shehab Al-Germozi, Ibrahim Al-Nadhari, Ismail Al-Meslemi, Nabil Al-Gonaid, Mohammed Al-Ezi, Ibraheim El-Nono • The Role of Sonourethrography In the Evaluation of Anterior Urethral Strictures: A Correlation with Retrograde Urethrography Vinod Priyadarshi, Mahendra Singh, Vijoy Kumar, Rajesh Tiwari, Sanjay Kumar Gupta, Nidhi Sehgal ©2012 Digital Science Press, Inc. / UIJ / Vol 5 / Iss 5 / October http://www.urotodayinternationaljournal.com ISSN 1944-5792 (print), ISSN 1944-5784 (online) Case Reports • Adrenal Oncocytoma Presenting as Cushing Syndrome: A Rare Clinical Entity Shajidul Mazumder, Rajeev T Puthenveetil, Bikash Bawri, Debanga Sarma, Sasanka Barua, Saumar J Baruah • A Rare and Late Complication of an Appendectomy: Distal Ureteral Fistula with Stenosis Sallami Satáa • Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report Keat Seong Poh, Christopher Chee Kong Ho, Zulkifli Md Zainuddin • Isolated Renal Hydatid Cyst: A Rare Occurrence Vishwajeet Singh, Rahul Janak Sinha, Dheeraj Kumar Gupta, Ajay Singh, Mohit Pandey, Sanjay Bhat • Labial Nodular Fasciitis: A Rarity with Benignity Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha • Nephrogenic Adenoma In the Prostatic Urethra and In the Ureter: Urothelial Lesions Associated with Chronic Infections and Injures In the Urinary Tract Ricardo LR Felts de La Roca, Guilherme B Lamacchia, Luiz Fernando G da Silva, Emilio M Pereira • Open Ureterolithotomy In an Era of Endoscopic Surgery for a Patient with Spina Bifida: Was It an Appropriate Decision? Justius Kok Hui Teo, Eng Hong Goh, Boon Wei Teoh, Kah Ann Git • Rupture of the Renal Pelvis of a Ureteropelvic Junction Hydronephrosis After Blunt Abdominal Trauma Sallami Satáa, Ben Rhouma Sami, Hmidi Mohamed, Chtourou Meher • Yeast Mannan Oligosaccharide Dietary Supplement In the Treatment of Acute Urinary Tract Infections: A Case Series Clair Brown, Richard Katz, Michael McCulloch ©2012 Digital Science Press, Inc. / UIJ / Vol 5 / Iss 5 / October http://www.urotodayinternationaljournal.com ISSN 1944-5792 (print), ISSN 1944-5784 (online) UIJ UroToday International Journal® Review of Current Outcomes of Prostate Artery Embolization to Treat Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia Francisco Cesar Carnevale, Alberto A Antunes, Joaquim M da Motta-Leal-Filho, Ronaldo H Baroni, Antonio SZ Marcelino, Luciana MO Cerri, Giovanni G Cerri, Miguel Srougi Submitted March 29, 2012 - Accepted for Publication August 3, 2012 ABSTRACT The standard management of benign prostatic hyperplasia (BPH) is based on the overall health of the patient, on the severity of the lower urinary tract symptoms (LUTS), and on quality-of-life (QoL) considerations. Voiding difficulties attributable to BPH can be quantified with the American Urological Association Symptom Index score (AUA-SI) or International Prostate Symptom Score (IPSS). Various medications can decrease the severity of voiding symptoms secondary to BPH. Impotence, decreased libido, and ejaculatory disorders are known side effects. The AUA guidelines indicate that patients with mild LUTS secondary to BPH (AUA-SI score < 8) and patients with moderate or severe symptoms who are not bothered by their LUTS should be managed using a strategy of watchful waiting. If the patient elects interventional therapy and there is sufficient evidence of obstruction, the patient and urologist should discuss the benefits and risks of the various interventions. Transurethral resection of the prostate (TURP) is the most common interventional treatment, but it can be associated with bleeding, erectile dysfunction, and ejaculatory disorders in up to 10 to 65% of patients. The high prevalence rate of BPH has a tremendous impact on the health and quality of life of men. Increasingly, BPH therapy trends are moving away from the gold standard operation of TURP and toward less invasive pharmacological options and minimally invasive procedures provided in an outpatient setting. Prostatic artery embolization (PAE) is a new BPH treatment under clinical investigation. PAE is a minimally invasive procedure that blocks the blood flow to the prostate, causing shrinkage of the gland. PAE is performed under local anesthesia as an outpatient procedure. A team of interventional radiologists, diagnostic radiologists, and urologists at the University of Sao Paulo Medical School are pioneers of the procedure, which has been widely reported since 2008. The multi-disciplinary team is encouraged by the data demonstrating PAE is a safe and effective minimally invasive treatment for patients with LUTS. KEYWORDS: Benign prostate enlargement, benign prostatic ACRONYMS AND ABBREVIATIONS hyperplasia, bladder outlet obstruction, transurethral resection of the BPE: benign prostate enlargement prostate, prostatic artery embolization, lower urinary tract symptoms BPH: benign prostatic hyperplasia CORRESPONDENCE: Francisco Cesar Carnevale, Chief, Interventional TURP: transurethral resection of the prostate Radiology Section, Radiology Institute, Hospital das Clinicas, University PAE: prostatic artery embolization of Sao Paulo Medical School, Rua Teodoro Sampaio, Sao Paulo, Sao LUTS: lower urinary tract symptoms Paulo, 05406-000, Brazil ([email protected]) PSA: prostate specific antigen QoL: quality of life CITATION: UroToday Int J. 2012 October;5(5):art 45. http://dx.doi. IPSS: International Prostate Symptoms Score org/10.3834/uij.1944-5784.2012.10.04 IIEF: International Index of Erectile Function ©2012 Digital Science Press, Inc. http://www.urotodayinternationaljournal.com UIJ / Vol 5 / Iss 5 / October / http://dx.doi.org/10.3834/uij.1944-5784.2012.10.04 ISSN 1944-5792 (print), ISSN 1944-5784 (online) REVIEW INTRODUCTION to treat prostate bleeding after TURP or biopsy [10-15]. DeMeritt and colleagues reported the early clinical observation Symptomatic benign prostatic hyperplasia (BPH) typically occurs of prostate volume reduction after embolization for persistent in the beginning of the sixth decade, with more than 40% of hematuria in 2000. A 76-year-old man with a history of men aged 60 and older presenting clinical manifestations [1]. As moderately symptomatic BPH developed acute urinary the world’s population ages, the prevalence of BPH is expected retention and was treated with transurethral catheter drainage to increase, calling for a therapy that reduces and maintains for 2 weeks, after which he presented with severe gross reductions in prostate volume, provides lasting improvements hematuria, which failed to respond to multiple attempts at of symptoms, and minimizes the risk for adverse outcomes. conventional therapy. The patient’s condition was successfully managed with super-selective transarterial embolization using Despite the advances in effective drug treatment and polyvinyl alcohol particles (PVA). The patient stopped bleeding minimally invasive procedures, transurethral resection of immediately after embolization, and his voiding significantly the prostate (TURP) remains the treatment of choice when improved after the procedure. At 12 months after treatment, medical management fails [1]. TURP is performed under direct prostate reduction was almost 40% [16]. endoscopic visualization with an electrocautery tool to remove prostate tissue. While considered a safe technique with a Similarly, embolization of the uterine arteries was originally mortality rate below 0.25%, it is not without adverse events. used to treat heavy bleeding after childbirth. Embolization The most frequent complications are ejaculatory disorders (up of fibroids was also done presurgically to decrease blood to 65%), early urinary incontinence (30 to 40%), acute urinary loss during myomectomy, after which it was recognized that retention caused by blood clots (2 to 5%), sexual impotence (up many patients had spontaneous resolution of their fibroid to 5%), and the need for blood transfusions (0.4 to 7%). Patients symptoms and no longer