Purpose The purpose of this study was to evaluate the predictive value of a 'Modified Karnofsky Scoring System' on outcomes and provide real-world data regarding the UK practice of biliary interventions. Materials and Methods A prospective multi-centred cohort study was performed. The pre-procedure modified Karnofsky score, the incidence of sepsis, complications, biochemical improvement and mortality were recorded out to 30 days post procedure. Results A total of 292 patients (248 with malignant lesions) were suitable for inclusion in the study. The overall 7 and 30 day mortality was 3.1% and 16.1%, respectively. The 30 day sepsis rate was 10.3%. In the modified Karnofsky 'high risk' group the 7 day mortality was 9.7% versus 0% for the 'low risk' group (p = 0.002), whereas the 30 day mortality was 28.8% versus 13.3% (p = 0.003). The incidence of sepsis at 30 days was 19% in the high risk group versus 3.3% at the low risk group (p = 0.001) Conclusion Percutaneous biliary interventions in the UK are safe and effective. Scoring systems such as the Karnofsky or the modified Karnofsky score hold promise in allowing us to identify high risk groups that will need more careful consideration and enhanced patient informed consent but further research with larger studies is warranted in order to identify their true impact on patient selection and outcomes post biliary interventions.

Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel's proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed

To establish factors predictive of success prior to Prostate Artery Embolization (PAE) with MRI imaging. A prospective cohort study of 50 patients with Benign Prostatic Hyperplasia (BPH) were treated with PAE in a single institution. Patients had moderate to severe symptoms of BPH refractory to medical management for at least 6 months. Patients were imaged with multiparametric MRI imaging pre-PAE and at 3 months, 12 months and 24 months post-PAE. Clinical success was measured with IPSS, IIEF and EQ-5D-5L quality of life questionnaires. The technical success was 48/50 (96%).The mean age of the group was 67 (range 54–83). The mean IPSS score pre-PAE was 21 and at 24 months was 8 (p < 0.001). There was no deterioration in erectile function. The mean volume of the prostate post-PAE was reduced at 3 and 12 months post-PAE but not significantly different at 24 months. This did not correlate with the IPSS score. Patients with median lobe enlargement has similar symptomatic improvement as those without median lobe enlargement. Internally within the prostate patients with adenomatous-dominant BPH initially did better than patients with stromal enlargement; however, at 24 months patients with stromal enlargement of the prostate improved greatest. Initial volume of the prostate was not a good predictor of clinical success. PAE is a safe and effective treatment strategy for treating men with BPH. Patients with Adenomatous BPH clinically do better until 12 months but not at 24 months. Initial prostate volume does not affect outcome, and patients with median lobe enlargement do as well as those without.

Predicting patients that will pose procedural technical challenges in prostate artery embolisation (PAE) remains difficult, with prolonged procedural times impacting on both patient dose and resource planning. Understanding the factors that influence these parameters as well as the likelihood of technical success is therefore important in effective patient selection and procedural planning. Data were collected retrospectively for 75 consecutive patients who underwent PAE. Multiple patient predictor variables available from planning computed tomography angiography (CTA) were identified and measured objectively. The vessel angles navigated during the procedure, prostate volume, prostate artery (PA) diameter, PA origin, aortic atheroma, iliac tortuosity and baseline demographics were correlated with outcome variables (fluoroscopy time, air kerma (AK), dose area product (DAP), the number of cone beam CTs (CBCTs)) performed and whether bilateral embolisation was possible (technical success). Data were analysed using linear regression, ANOVA, t tests and chi-squared tests. Aortic atheroma severity significantly increased fluoroscopy time (p = 0.004), whilst air kerma (AK) was significantly greater in patients with smaller prostatic arteries (p = 0.009) and smaller pre-procedural prostate volumes (p = 0.038). Increased vascular tortuosity and prostatic artery origin were not shown to significantly affect fluoroscopy time or DAP. Smaller prostate artery size (p = 0.007) also increases the likelihood of either unilateral embolisation or technical failure. Pre-operative prediction of technical outcome measures in PAE remains challenging. However, vascular calcification, prostatic artery diameter and prostate volume are likely to be important factors when considering the risk/benefits of PAE. • Increased severity of atheroma and the presence of small prostate arteries increase fluoroscopy time and AK respectively during prostate artery embolisation. • Lower pre-procedural prostate volume increases the AK during procedures. • Smaller prostate artery size increases the likelihood of either unilateral embolisation or technical failure.

BackgroundProstate artery embolization (PAE) is safe and effective at improving lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). PurposeTo assess the effectiveness of PAE on allowing successful voiding in patients with obstructive BPH (>90 cc) necessitating a urethral catheter for complete urinary retention. Material and MethodsTen consecutive patients with urethral catheters for obstructing BPH were included in the prospective study. Prostate arteries were embolized (Embosphere 300–500 um) and they had an attempted trial without catheter (TWOC) at two weeks and then at two-week intervals thereafter, if unsuccessful. They were clinically reviewed; an MRI was performed three and 12 months after PAE. Quality of life (QOL) questionnaires, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF) were also performed. ResultsAll cases were technically successful (100%). Eight patients had their catheters removed by their three-month follow-up (80%). The two cases that failed their TWOC by three months remained with a urethral catheter at 12-month follow-up. Seven of ten patients had their PAE procedure < 3 months following insertion of the urethral catheter and 100% of these had a successful TWOC before their three-month follow-up. Of the three patients that had their urethral catheter inserted > 3 months before their PAE (range 6–24 months), only 1/3 (33%) became catheter-free by 12 months after PAE. There was a dramatic reduction in LUTS and improvements in QOL indices, IPSS, and IIEF. There was no associated sexual dysfunction. ConclusionPAE is very successful in allowing spontaneous voiding in men with obstructing BPH requiring a urethral catheter. However, the PAE should be performed as soon as possible after the urethral catheter is inserted. Direct referral from acute urology services or emergency departments once the catheter is inserted are warranted.

Prostate artery embolization (PAE) has been shown to be beneficial in treating men with benign prostatic hypertrophy (BPH). Here we describe treating four patients with prostate cancer (two with organ-confined and two with metastatic prostate cancer) with prostatic bleeding with PAE. Patients had other causes of hematuria excluded and were followed up at 3, 12, and 18 months after PAE. All four cases were technically successful and all cases of hematuria had resolved by the three-month follow-up (100%). There was one case of recurrence at 13 months after PAE which was successfully treated. PAE is useful for controlling significant prostatic bleeding in patients with prostate cancer and improves quality of life. Patients may, however, need repeated treatments to control the bleeding.

To assess the effectiveness of prostate artery embolization (PAE) in the control of haematuria and in patients with benign prostatic hyperplasia (BPH) and normal upper urinary tracts.

Here we report a case of successful prostatic artery embolization (PAE), with successful 1-year follow-up, after failure of a UroLift device (NeoTract, Inc., Pleasanton, California) to improve lower urinary tract symptoms (LUTSs). PAE and the UroLift device have recently been used to treat benign prostatic hyperplasia (BPH) and LUTSs. The UroLift device is a transurethral device that lifts and anchors the prostate tissue, permitting easier urination, whereas PAE involves transarterial particulate embolization of the gland, which then gradually reduces in size. Ethical approval to perform PAE at our institution was granted for the case described here.

PURPOSE:To determine the effects of sublingual glyceryl trinitrate (GTN) on the quality of planning computed tomography (CT) angiography performed prior to prostate artery embolization (PAE). MATERIALS AND METHODS:A retrospective cohort study was performed on patients who had previously undergone CT angiography before a procedure for PAE at our institution. Early CT angiography studies for PAE at our single center had initially been performed without GTN. These were compared to subsequent CT angiography studies that had been performed with GTN, after a previously implemented change in practice. Prostate arteries were examined by 2 blinded observers for peak enhancement (Hounsfield units [HU]) and lumen diameter. In addition, assessors' interpretation of the prostate artery origin from CT angiography was compared with the true anatomy demonstrated at the time of procedure. RESULTS:A total of 16 patients, corresponding to 32 prostate arteries, were examined on CT angiography. Mean diameter of the prostate artery was found to be significantly greater in those receiving GTN (2.2 mm vs. 1.6 mm, P < .001). Peak prostate artery enhancement was also greater in the GTN group (218 HU vs 173 HU, P = 0.042). Observers correctly identified the prostate artery origin more frequently in the GTN group; however, this difference was not statistically significant (56% vs 25%, odds ratio = 3.9, P = .149). CONCLUSIONS:The administration of sublingual GTN immediately prior to CT angiography is associated with a significant increase in prostate artery diameter and peak opacification. This was not associated with a statistically significant increase in the ability of observers to correctly identify the origin of the prostate artery.

Varicocele embolisation is an excellent treatment option for symptomatic scrotal varicosities. The purpose of this study was to assess the current practice of the endovascular treatment of left‐sided varicoceles at our institution, to compare the findings to international standards and to identify which access site reduces screening time and radiation dose.

PURPOSE:To assess the safety, success, and complications associated with retrograde ureteric stent insertion via the ileal conduit. MATERIALS AND METHODS:The study population comprised 35 consecutive patients (17 men and 18 women; mean age, 55 y; age range, 40-75 y) requiring primary (20 stents) and exchange (70 stents) retrograde ureteric stent insertion via the ileal conduit over a 3-year period. Patient demographic data, procedural and technical data, and clinical follow-up data were collected. RESULTS:Technical success was 90% (18 of 20) for primary stent placement and 100% (70 of 70) for stent exchange. There were two immediate complications (< 24 h) of sepsis and ureteric injury and one early complication (> 25 h but < 30 d) of sepsis requiring observation and medical management. Difficult procedures (defined as a fluoroscopy screening time > 31 min) and technical failures were found to be associated with encrusted stents visualized on prior computed tomography (P = .012), increased length of ileal conduit (> 20 cm) (P = .023), and ileal conduit kink (< 90 degrees) (P = .032). Only the occurrence of encrusted stents visualized on prior computed tomography (P = .022) was associated with complications. CONCLUSIONS:Retrograde placement of ureteric stents via the ileal conduit is safe and effective. Retrograde stent placement should be considered the treatment option of choice for a first-time occurrence of obstructive uropathy at the ureteroileal anastomosis.

We describe two cases of retrograde ureteric stent exchange of heavily encrusted ureteric stents (JJ) via tortuous ileal conduits. The blocked ureteric stents were snared from inside the conduit so they could be accessed and a wire inserted. The lumens of the stents were unblocked with a wire but the stents could not be withdrawn due to heavy encrustation of the ureteric stent in the renal pelvis. A stiff wire was inserted to provide support and a 9 French peel away sheath was used to remove the encrustations allowing the stents to be withdrawn and exchanged. This is a safe and successful technique allowing ureteric stents to be removed when heavily encrusted.

A 70-year-old woman presented to our department with a nonproductive ileal conduit, acute renal failure, and sepsis following a recent laparotomy for bowel obstruction at another institution. Computed tomography (CT) revealed bilateral hydroureter and hydronephrosis. A transition point was identified where the ileal conduit was compressed by a large parastomal hernia (Fig 1). The patient was treated with fluid resuscitation, intravenous antibiotic therapy, and intravenous paracetamol. Surgical decompression was considered to pose high risk as a result of the recent laparotomy and difficult access caused by the large parastomal hernia. In addition, supine antegrade drainage would have been difficult to perform and would have required general anaesthesia as a result of the recent surgery to the anterior abdominal wall and large parastomal hernia. A decision was therefore made to relieve the obstruction via the ileal conduit in a retrograde direction.