Therapeutic Arterial Therapeutic Arterial Embolisation in UrologyEmbolisation in Urology

Embolisation for malignant Embolisation for malignant conditionsconditions

Embolisation for non-malignant Embolisation for non-malignant conditionsconditions

Embolisation for malignant Embolisation for malignant conditioncondition

Embolisation is the occlusion of Embolisation is the occlusion of arterial supply of the tumorarterial supply of the tumor

IschemiaIschemia Tumor necrosisTumor necrosis Arrest tumor growthArrest tumor growth

Embolisation- Intra arterial delivery of Embolisation- Intra arterial delivery of particular materials / sclerosantsparticular materials / sclerosants

Occlusion - collateral formationOcclusion - collateral formation

Closer the occlusion to tumor - less Closer the occlusion to tumor - less collateralcollateral

Embolic materials-Embolic materials- Autologous clot and Autologous clot and

tissuestissues EACAEACA Duramater Duramater Gelfoam Gelfoam Oxycel Oxycel Detachable ballonsDetachable ballons Metallic coils (stainless Metallic coils (stainless

steel, platinum)steel, platinum)

Poly vinyl alcohol Poly vinyl alcohol foamfoam

CyanoacrylatesCyanoacrylates Polymeric siliconePolymeric silicone Resin microspheresResin microspheres Microfibrillar collagenMicrofibrillar collagen Sod.tetadecyl Sod.tetadecyl

sulphatesulphate AlcoholAlcohol

Indications Indications 1.1. To control Hemorhage, Polycythemia, To control Hemorhage, Polycythemia,

Hypercalcemia, CHF – AV shunt, HTHypercalcemia, CHF – AV shunt, HT

2.2. Preoperatively – Facilitate surgeryPreoperatively – Facilitate surgery

3.3. Inhibit tumor growthInhibit tumor growth

4.4. PalliationPalliation

5.5. Decrease tumor bulk - Better chemo-effect on Decrease tumor bulk - Better chemo-effect on metsmets

Chemo EmbolisationChemo Embolisation Kato – 1981Kato – 1981 Combination of intra arterial infusion of Combination of intra arterial infusion of

chemotherapeutic agent & embolisationchemotherapeutic agent & embolisation

M/AM/A1.1. Prolongs transit timeProlongs transit time2.2. Anoxia - Increased tissue permeabilityAnoxia - Increased tissue permeability3.3. Higher concentration drugHigher concentration drug4.4. Decreased side effectsDecreased side effects

RENAL CARCINOMARENAL CARCINOMA

STAGESTAGE 5 YR 5 YR SURVIVALSURVIVAL

Stage IStage I 30%30% 60-65%60-65%

Stage II,IIIStage II,III 30-55%30-55%

Stage IVStage IV 25-57%25-57% 8-11%8-11%

SiteSite %% Survival (mo)Survival (mo)

Lung Lung 6969 66

Bone Bone 4343 1515

LiverLiver 1414 33

BrainBrain 77 2-52-5

LNLN 55

Stage I-III – Radical NephrectomyStage I-III – Radical Nephrectomy

Stage IV - Palliative nephrectomyStage IV - Palliative nephrectomy

Renal artery embolisationRenal artery embolisation1.1. Locoregionally advanced RCCLocoregionally advanced RCC2.2. Isolated metastasisIsolated metastasis3.3. Palliative embolisationPalliative embolisation

Embolisation in Embolisation in RCC with renal vein and RCC with renal vein and IVC thrombosisIVC thrombosis

Facilitates thrombectomy – Facilitates thrombectomy – decreasing the decreasing the bulk and extent of thrombusbulk and extent of thrombus

Surgery is done 24-48 hrs later – Surgery is done 24-48 hrs later – edematous rim around tumor facilitates edematous rim around tumor facilitates dissectiondissection

Embolisation agentEmbolisation agent

Peripheral embolisation – GelfoamPeripheral embolisation – Gelfoam

Central embolisation - CoilsCentral embolisation - Coils

Complications –Complications – Post embolisation syndrome Post embolisation syndrome (Flank pain, Fever, Leucocytosis & Raised (Flank pain, Fever, Leucocytosis & Raised

LDH)LDH) Paralytic ileusParalytic ileus HypertensionHypertension Renal failureRenal failure Unintentional embolisation – Lt colon Unintentional embolisation – Lt colon

necrosisnecrosis

Embolisation of Embolisation of skeletal mets-skeletal mets-

Bone mets – 30-45% Bone mets – 30-45% Lumbar and pelvis – MCLumbar and pelvis – MC Preoperative / palliative embolisationPreoperative / palliative embolisation

Embolisation for Non-Malignant Embolisation for Non-Malignant ConditionCondition

IndicationIndication

To control bleeding & treatment of To control bleeding & treatment of vascular malformationvascular malformation

Ablation of renal functionAblation of renal function

Control of BleedingControl of Bleeding AV FistulaAV Fistula AngiomyolipomaAngiomyolipoma HematuriaHematuria TraumaTrauma Renal artery aneurysmRenal artery aneurysm

Control of BleedingControl of Bleeding

AV Fistula –KidneyAV Fistula –Kidney

CongenitalCongenital - Cirsoid , rare , multiple - Cirsoid , rare , multiple communicating vessel.communicating vessel.

SpontaneousSpontaneous AcquiredAcquired - MC - MC

Acquired AV Fistula-Acquired AV Fistula-

MCMC Trauma, surgery, Renal biopsyTrauma, surgery, Renal biopsy Heals spontaneouslyHeals spontaneously C/F – CHF, Hematuria, C/F – CHF, Hematuria,

Retroperitoneal hemorrhage, HT - Retroperitoneal hemorrhage, HT - BruitBruit

Diagnosis – Doppler/AngiographyDiagnosis – Doppler/Angiography

TreatmentTreatment – Embolisation as distal as – Embolisation as distal as possiblepossible

Renal traumaRenal trauma

Bleeding is commonBleeding is common Fortunately-stops spontaneouslyFortunately-stops spontaneously Treated conservativelyTreated conservatively Selective embolisation Selective embolisation Venous bleeding cannot be controlledVenous bleeding cannot be controlled

Intractable bleeding from bladder Intractable bleeding from bladder and post prostatectomy bleeding- and post prostatectomy bleeding- EmbolisationEmbolisation

Ablation of Renal functionAblation of Renal function To achieve total renal infarction –To achieve total renal infarction –

alcoholalcoholIndicationsIndications Urinary fistulas – palliation in Urinary fistulas – palliation in

terminally ill patientsterminally ill patients To prevent excessive protein loss To prevent excessive protein loss

from failing kidneyfrom failing kidney Uncontrollable HTUncontrollable HT

VaricoceleVaricocele Incidence -10%Incidence -10% In infertile men – 30%In infertile men – 30%

MC – MC – Left sideLeft side --Incompetent valvesIncompetent valves – reflux down – reflux down

the Internal spermatic veinthe Internal spermatic vein --Proximal compressionProximal compression of left renal of left renal

vein Between SMA & Aorta vein Between SMA & Aorta

Engorged pampiniform plexus –Engorged pampiniform plexus –Raised scrotal temperatureRaised scrotal temperature

Abnormal sperm motilityAbnormal sperm motility Abnormal sperm morphologyAbnormal sperm morphology Oligospermia Oligospermia

Indication for Transcatheter Indication for Transcatheter EmbolisationEmbolisation

Varicocele with infertilityVaricocele with infertility Varicocele with testicular atrophyVaricocele with testicular atrophy Rec.varicoceleRec.varicocele

Femoral / Jugular approachFemoral / Jugular approach

Coils / Detachable ballonCoils / Detachable ballon

Common sites of coil placement –ISVCommon sites of coil placement –ISV Internal inguinal ringInternal inguinal ring Upper third of SI jointUpper third of SI joint 2 cm from left renal vein2 cm from left renal vein

ResultsResults 30-35% - Pregnancy rate30-35% - Pregnancy rate Simillar to surgical repairSimillar to surgical repair Less morbidLess morbid

PriapismPriapism Low flowLow flow – Venous – surgical – Venous – surgical

emergencyemergency High flowHigh flow – Arterial – Arterial

High flow priapismHigh flow priapism Caused by perineal traumaCaused by perineal trauma

TreatmentTreatment Mechanical compression and Mechanical compression and

pharmocological pharmocological

Surgery/ Trans catheter embolisationSurgery/ Trans catheter embolisation

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