Prostate

Question 1

what is normal PSA level

Answer 1

<4 ng/mL

Question 2

PSA is increased by

Answer 2

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

Question 3

first step in treating BPH

Answer 3

1. alpha blockers then 5 alpha reductase inhibitors

Question 4

Morbidity of transurethral resection of the prostate

Answer 4

7-12 %

Question 5

good candidates for PAE

Answer 5

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

Question 6

bad candidates for PAE

Answer 6

1. atherosclerotic symptoms

2. very mild symptoms (IPSS <8)

Question 7

most common complications of TURP

Answer 7

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

Question 8

the three anatomical regions of the prostate

Answer 8

• peripheral zone
• central zone
• transitional zone

Question 9

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

Answer 9

no

Question 10

should PAE be performed to improve Qmax

Answer 10

no

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

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

Question 13

definition of

1. urgency
2. frequency
3. urge incontinence
4. stress incontinence

Answer 13

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)

Question 14

amount of time to reach baseline activity after PAE

Answer 14

amount of time to reach baseline activity after PAE

Question 15

unique side effect of Pyridium and Azo

Answer 15

will turn urine dark orange or red color

Question 16

side effect of Vesicare and oxybutynin

when Vesicare and oxybutynin are contraindicated

Answer 16

• dry mouth and constipation

- contraindicated in untreated or uncontrolled narrow-angle glaucoma

Question 17

intra-prostatic artery anastomoses to look out for

Answer 17

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)

Question 18

most common origins of the prostatic artery

Answer 18

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%)

Question 19

does prostate enhancement go below the pubic symphysis

Answer 19

usually no

Question 20

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

Answer 20

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

Question 21

arterial supply of the prostate

Answer 21

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

Question 22

ideal candidates for PAE

Answer 22

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

Question 23

should alpha blockers be taken during the day or at night

Answer 23

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

Question 24

good candidates for urolift

Answer 24

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

Question 25

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

Answer 25

80 cc

Question 26

IPSS score does not apply to which patients

Answer 26

patients with a Foley catheter and who self- cath

Question 27

how can you determine if LUTS is due to BPH

Answer 27

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

Question 28

IPSS questions related to voiding

Answer 28

1. incomplete emptying 2. intermittency 3. weak stream 4. straining "the two I's and the stream and strain"

Question 29

IPSS questions related to storage

Answer 29

1. frequency 2. urgency 3. nocturia

Question 30

Durability of PAE clinical success rates

Answer 30

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/

Question 31

what is the PSAD and what does it mean

Answer 31

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

Question 32

PSAD value that warrants further evaluation with biopsy

Answer 32

greater than 0.2

Question 33

arterial supply to the bladder

Answer 33

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

Question 34

symptoms of non-target embolization to the bladder

Answer 34

hematuria (self-limited)

Question 35

symptoms of non-target embolization to the middle rectal artery

Answer 35

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

Question 36

symptom of non-target embolization of the penis

Answer 36

mild/moderate = balanoposthitis (0.7%)

Question 37

treatment of balanoposthitis

Answer 37

oral and topical antibiotics, dressing

Question 38

most common origins of the accessory pudendal artery

Answer 38

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

Question 39

estimated percentage of PAE non-responders and relapsers

Answer 39

non-responders around 10% relapsers around 10%

Question 40

does non-target embolization to the penis cause erectile dysfunction

Answer 40

No, non-target embo to the penis causes skin lesions but does not induce erectile dysfunction -Tiago Bilhim from CIRSE webinar