by Eleonora Pedron
MONACO. As part of the meetings organized by the Italian Embassy in Monaco, with the meticulous and punctual organization of His Excellency Ambassador Cristiano Gallo in collaboration with Kaster Srl and MVS Srl, a medical symposium on minimally invasive treatments for benign pelvic pathology took place on last April 2019.
The reports were presented by Dr. Roberto Cianni (Director of Complex Surgical Radiology Unit of San Camillo Forlanini Hospital in Rome) and his collaborators, Dr. Silvia Giuliani and Dr. Enrico Pampana.
It was an important moment during which guests had a glimpse of alternative treatments to surgery for diseases of the male and female pelvic area and in particular for the treatment of uterine fibroids, benign prostatic hypertension and hemorrhoidal disease. A few years ago, women with uterine fibroids who had symptoms of pelvic obstruction or massive blood loss during the cycle had to undergo to myomectomy (surgical removal of individual fibroids) and often hysterectomy (removal of the uterus). Many men of 55 to 60 years of age have benign prostatic hypertrophy, with very debilitating symptoms (feeling of volume, urge to urinate at often very short intervals, low urine output, stimulus urinate several times a night). And hemorrhoids have recently undergone endovascular treatment which avoids the troublesome surgical treatment, the only intervention applied to this pathology until now. Let’s look briefly at the applicability of procedures in treatment: ENDOVASCULAR TREATMENT OF UTERINE FIBROMES: Arterial embolization, one of the most brilliant therapeutic solutions of the end of the last century with regard to the “self-image” of the woman: it represents the alternative to surgery for symptomatic uterine fibroids. First reserved for women aged 38 to 48 who no longer wanted to be pregnant, the indication is now extended to young women who wish to preserve their fertility. Arterial embolization is a minimally invasive treatment for uterine fibroids. During embolization of the uterine artery (uterine fibroid), the doctor uses a thin flexible tube (catheter) to inject small particles into the uterine arteries, which supply fibroids with blood.
The goal is to block the small vessels that feed fibroids, under-feed them and kill them. It is the interventional radiologists who perform this type of examination. The doctor uses imaging techniques to guide impossible procedures with traditional or laparoscopic surgery. The procedure usually involves two nights of hospitalization, but the day after the procedure, the patients get up, feed themselves, have no points or suffer procedural wounds. Both nights post-intervention are necessary for the management of pelvic pain after the procedure. This requires an appropriate analgesic treatment. The efficacy of the treatment is evaluated by radiological investigations (comparison between the magnetic resonance before and after the intervention), but especially by the immediate clinical improvement of the metrorrhagia (menstrual cycle) by the feeling of space which disappears and by spontaneous correction of anemia related to abundant menstrual discharge. From the literature and our experience, it can be said that arterial embolization with microparticles represents a real alternative to invasive surgery; compared to hormonal therapy, embolization avoids long protocols, with significant side effects; the psychological and sexual consequences are null and possible pregnancies; according to several studies, this technique could eliminate 90% of hysterectomies and 70% of conservative interventions for uterine fibroids. ENDOVASCULAR TREATMENT OF PROSTATIC HYPERTROPHY: benign prostatic hypertrophy (or adenoma of the prostate) occurs after the age of 50; beyond this age, it is observed in 70% of men and 80% after 80 years. The prostate is located under the male bladder and its main functions are the production of seminal fluid and that of preserving the vitality of spermatozoa. Let’s see what are the main signs of prostate hypertrophy: increasing difficulty urinating; decreased urinary output; need to urinate, especially during the night; difficulty in retaining urine with possible unintended losses; intermittent urination, that is, a non-continuous flow of urine; feeling of not having emptied the bladder; drop by drop after urination; sexual dysfunction. Currently, the most commonly performed intervention is transurethral endoscopic resection (RTUP) or removal of the adenoma from the prostate by traditional surgery. Patients who do not intend to perform a traditional endoscopic resection of the prostate or who wish to stop taking drugs dedicated to this disease may receive a less invasive alternative therapeutic solution, such as percutaneous embolization selective prostatic arteries. This is the same procedure that is used in women on the uterine arteries, whereas in men, it is performed on the prostatic arteries: the result is to completely reduce the volume of the prostate and thus significantly reduce the symptoms related to hypertrophy.
The intervention is superimposable on the embolization of uterine fibroids: with a small microcatheter, it enters the prostatic arteries and reduces blood flow to the prostate. This allows this volume reduction which significantly reduces the symptoms of hypertrophy. Above all, we avoid the side effects that often occur after the traditional TURP procedure. It is important to emphasize that embolization is completely painless, avoids retrograde ejaculation of the bladder (inevitable complication of surgery) and impotence, a complication that is not uncommon after surgery and requires recovery time much shorter. Embolization represents a major revolution in the treatment of the prostate. In no case can you have retro-ejaculation, no postoperative bleeding, no risk of incontinence or sexual dysfunction. After embolization of the prostatic arteries, the vascularization of structures adjacent to the prostate is increased due to a “dam effect” and, for this reason, some patients report a significant improvement in sexual function. Unlike fibroid embolization, patients treated for prostatic hypertension can be evacuated even after a day of hospitalization, usually without pain. From the literature and our experience, we can say that: arterial embolization with microparticles represents a real alternative to traditional surgery (TURP); it allows to suspend the pharmacological treatment of hypertrophy already in itself with undesirable and disabling side effects, the consequences on the sexual sphere are null and indeed, it is described by some a significant implementation of sexual functionality. According to various studies, this technique could eliminate many highly invasive surgical procedures of the prostate (TURP or prostatectomy), but the latest studies suggest the possibility of performing an embolization procedure, even at an early stage, to prevent symptomatic sinus hypertrophy. of the prostate. ENDOVASCULAR TREATMENT OF HEMORROIDS: This is the most recent technique involving embolizing the distal branches of the inferior mesenteric artery (upper rectal arteries) with microspirals which contribute to the vascularization of the hemorrhoidal plexus which is then “deflated”. In addition, this procedure is devoid of major complications and does not cause any trauma to the anorectal intestinal wall.
We conclude by observing that the audience participation was exciting with many questions to speakers, a sign of great interest. For information and contacts:
Director: Dr. Roberto Cianni roberto_cianni@fastwebnet.it
Dr. Silvia Giuliani silvia.giuliani63@gmail.com Dr.Enrico Pampana enricopampana@hotmail.com