RPS 1809 - What's new in genitourinary and female health interventions?

Author Block: G. Ferrillo, D. Poretti, N. Buffi, P. Casale, M. Francone, V. Pedicini; Milan/IT
Purpose: There is a lack of internationally validated scores for the assessment of outcomes in percutaneous ablation of kidney tumours. We designed the P-RENAL score and compared it to the surgical standard score (RENAL).
Methods or Background: We performed a retrospective analysis of 146 patients treated with RFA (N=90) or MWA (N=56) between 01/01/2016 and 31/03/2021 (minimum follow up of 6 months). RENALand p-RENAL were calculated in both populations. Primary outcomes were recurrence (presence of vital tumour >1 cm in the treated area) and complications (according to the CIRSE complications score). P-RENAL is derived from RENAL, it consists of 6 parameters, each assigned a value from 1 to 3: radius (<2 cm, 2-3cm, >3cm), exophytic area and nearness to the collecting system (identic to RENAL score), location (1 interpolar mass; 2 lower polar; 3 apical tumours), side (1 posterior lateral; 2 medial posterior; 3 medial anterior), proximity of external structure(>3 cm from an high risk structureas ileal or colic wall,renal artery, spleen or liver); 2 from 3 to 1 cm; 3 points if <1 cm.
Results or Findings: P-RENAL showed higher sensitivity than RENAL score in predicting recurrence after ablation of kidney tumours expecially with MWA (AUC 0.86). There was no association of the RENAL score with complications, while we observed an independent positive correlation between p-RENAL and the presence of grade > 2 complications.
Conclusion: P-RENAL has higher sensitivity than RENAL in detection of recurrence and complications in percutaneous ablation.
Limitations: Retrospective monocentric study.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Retrospective study board review.

Author Block: N. M. A. Attia¹, M. A. El Hamid², M. Abd El Wahab², A. Salah²; ¹Assiut/EG, ²Cairo/EG
Purpose: To compare the postoperative and functional outcomes of thulium laser enucleation of the prostate (ThuLEP) and prostatic artery embolization (PAE) for the treatment of large-volume benign prostate hyperplasia (BPH) > 80 ml.
Methods or Background: We performed a retrospective, multicentric study of 120 patients consecutively treated with THuLEP (60 patients) or PAE (60 patients) for symptomatic large BPH >80gms between March 2022 and March 2023. These two groups were compared by treatment response, postoperative recovery period and complication rate at baseline, 1, 3 and 6 months.
Results or Findings: Intraoperative complications were significantly higher in the THULEP group (13.5% vs 0%, p=0.006). There was no statistically significant difference in the postoperative complications between the two groups (10% vs 8.4%, p=0.287). There was significant delay of catheter removal in the PAE group with subsequent delay in hospital stay (25% vs 5%, p=0.002).
International Prostate Symptom Score (4.4±0.9SD vs 10.7±1.5SD, p<0.001) and PSA (1.4±0.6SD vs 4.3±5.1SD, p<0.001) were significantly lower in the THuLEP versus PAE group after 6 months. Postvoid residual (PVR) was higher in the PAE group from baseline till 6months (12.5±3.9SD vs 20.35±4.8SD, p<0.001). Maximum urinary flow rate (Qmax) was significantly higher in the THULEP group from baseline (37.93 ±4SD vs 27.3±8.1SD, p<0.001). Erectile dysfunction was significantly lower in the PAE group after 3 months.
Conclusion: Both ThuLEP and PAE relieve lower urinary tract symptoms with high efficacy and safety, however ThuLEP was superior to PAE in improving the functional outcomes in the first 6months while PAE had lower intraoperative complications and erectile dysfunction.
Limitations: The quality of life was not assessed being a retrospective study. The sample size was relatively small. Longer follow-up time is needed to compare the durability of the symptomatic improvement from each procedure.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Committee of Medical Ethics of the Faculty of Medicine Assiut University with IRB no: 04-2024-300429

Author Block: M. Ni Mhiochain De Grae¹, M. Alkhattab¹, A. Alkadhimi², M. Springael², G. O' Sullivan¹; ¹Galway/IE, ²Dublin/IE
Purpose: Varicoceles are vascular lesions of the pampiniform plexus, affecting 10-20% of the population and found in 40% of men with primary infertility and 80% with secondary infertility. (1-4) Pain occurs in 2-10% of cases. (1,5) Treatment options include conservative management, percutaneous embolization, or surgery. (6) Percutaneous embolization, introduced in the late 1970s, has a technical failure rate of around 13% and recurrence rates ranging from 0.6% to 45%. (7,8)
This study evaluates success and recurrence rates of percutaneous varicocele embolizations at Galway University Hospital and Galway Clinic between 2009-2022, with a minimum follow-up of 18 months.
Methods or Background: Data collected included patient age, procedure date, access site, side of occurrence, previous interventions, treatment method, need for re-intervention, and recurrence rates. Technical success was defined as successful access to the gonadal vein and insertion of coil/sclerosant. Clinical success was assessed through follow-up consultations and ultrasound when available.
Results or Findings: The technical success rate was 94.7%, with 98.1% of successful embolizations achieving clinical success. Of 225 patients, 3.12% had prior failed surgeries, all treated successfully with IR, and 0.89% required surgical intervention. Telephone follow-ups (42.7% response rate) revealed a recurrence rate of 10.7% with an average follow-up of 8.03 years. The complication rate was 1.78%. Fertility outcomes showed 51.35% of patients had successful pregnancies, while 6.9% experienced ongoing fertility issues.
Conclusion: Our study of 225 patients is the largest to date, showing higher success rates (technical 94.7%, clinical 98.1%) and a 10.7% recurrence rate with long-term follow-up.
Limitations: This is a single centre retrospective review. 42.7% response to telephone consultation follow up.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Local ethics approval in Galway University Hospital.

Author Block: Q. Zhang; Shanghai/CN
Purpose: Objective: To investigate the safety and efficacy of Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgFUS) treatment on adenomyosis.
Methods or Background: After receiving approval from local Ethics Committee, 62 patients with adenomyosis underwent MRgFUS treatment from October 2018 to March 2021. The 62 patients with adenomyosis were evaluated for adverse reactions during and after MRgFUS treatment. The lesion volume was measured before and after treatment using T2-weighted MRI images. Non-perfused volume (NPV) was calculated using T1-weighted contrast-enhanced images, then the ablation rate was calculated by dividing NPV by the lesion volume. Visual analogue scale (VAS) was used to score dysmenorrhea in adenomyosis patients before and after treatment.
Results or Findings: All 62 patients successfully underwent MRgFUS treatment without severe adverse reactions, achieving an average ablation rate of 69.12%±17.64%. The average lesion volume before ablation was 83.72±84.02 cm³. At 3 months post-ablation, the average lesion volume was 62.66±66.31 cm³, at 6 months it was 56.09±66.67 cm³, and at 12 months it was 68.53±87.04 cm³. There were statistically significant differences in lesion volume (p<0.05) before and after ablation treatment.
The preoperative VAS score for the 62 patients was 6.68±2.13. At 3 months post-treatment, the average dysmenorrhea score was 3.69±1.95, at 6 months it was 2.72±1.40, and at 12 months it was 3.38±1.45. Post-treatment dysmenorrhea scores showed statistically significant decrease compared to pre-treatment (p<0.05).
Conclusion: MRgFUS is a safe, feasible and effective technique in treatment for adenomyosis.
Limitations: Serological examinations were not performed in patients with adenomyosis to assess changes in serologic markers after treatment in this study.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee of Huashan Hospital affiliated to Fudan University

Author Block: C. Intrieri, C. Lanza, S. A. Angileri, J. Tintori, C. Ercolino, A. M. Ierardi, G. Carrafiello, V. Chiarpenello; Milan/IT
Purpose: The aim of this retrospective study is to evaluate the efficacy and the safety of the treatment of cesarean scar pregnancy (CSP) based on a single or cyclic systemic methotrexate (MTX) injection followed by intra-arterial MTX injection and uterine arteries embolization (UAE).
Methods or Background: A pregnancy’s ectopic implantation on a uterine scar tissue following a previous cesarean section is defined as CSP. Because of its possible complication in uterine rupture, massive hemorrhage, placenta accreta spectrum, fetal and maternal death, CSP is considered a life-threatening condition. Therefore, treatment is fundamental.
The cooperating group of Radiologists and Gynecologists at our institution evaluated all patients affected by CSP from 2013 to 2023 (n=21) treated with systemic MTX injection followed by intra-arterial MTX injection and UAE with gelatin sponge. The inclusion criteria were: laboratory tests (levels of beta-human chorionic gonadotropin and beta-HCG over the normal threshold), ultrasound diagnosis of CSP, gestational age ≤8 weeks, stable hemodynamic, at least one previous pregnancy and at least one delivery through cesarean section. Exclusion criteria were: contraindications to MTX administration, the presence of abdominal hemorrhage and significant shock.
Results or Findings: Technical success of UAC and clinical success (reduction of the the sac size, lack of active vaginal re-bleeding and declining beta-HCG values) was achieved in all procedures (100%).
No peri-procedural complications were recorded.
Conclusion: In our experience, the use of systemic MTX and intra-arterial injection of MTX plus UAC proved to be effective and safe to achieve CSP termination. The use of gelatin sponge after intra-arterial MTX administration proved to be effective also in preventing massive bleeding in case of successive uterine curettage.
Limitations: Controlled randomized trial with a larger sample is needed to assess the efficacy and the safety of treatment.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: All subjects gave their consent for inclusion in the present study. The study was conducted in accordance with the World Medical Association (WMA) Declaration of Helsinki [WMA].

Author Block: F. Taylor, K. Sehgal, M. Van Wees, K. Li, D. W. De Boo, L-A. Slater; Melbourne/AU
Purpose: To investigate the timing, type, and severity of complications following percutaneous, image-guided renal biopsy and to determine if the current observation period of 4 hours can be safely reduced.
Methods or Background: Consecutive image-guided percutaneous targeted and non-targeted renal biopsies performed between 2017-2022 in adult patients by radiology medical staff were included. The PACS imaging system and electronic medical records (EMR) were accessed to obtain relevant patient information and procedural reports. Retrospective analysis of the type and timing of complications was performed against patient demographics and biopsy-related variables. Probabilities were calculated for a range of observation periods to assess the proportion of complications identified by shortening the observation period from 4 hours.
Results or Findings: 332 percutaneous renal biopsies were included and 44 (13%) complications identified within the 4-hour observation. 29 complications were post-operative bleeding, of which 2 developed macroscopic haematuria, 25 peri-nephric haematoma and 2 had hemodynamic instability with either haematuria or peri-nephric hematoma. 64% of all complications occurred within the first hour, 86% occurring within 2 hours. Of the 6 complications occurring after 2 hours, 2 were post-operative bleeding in non-targeted renal biopsies requiring admission, the other 4 did not require additional observation/procedures.
Conclusion: The vast majority of complications after targeted and non-targeted renal biopsies tend to occur within the first 2 hours of observation. Complications that occurred after 2-hour observation were often pain related, something that can be overcome with a standardised post-operative analgesic regime. It may be possible to safely reduce observation times following image-guided targeted renal biopsies.
Limitations: Single institute dataset, including targeted and non-targeted biopsies. Biopsies were performed by Radiologists with varied experience and supervision, not ascertained during retrospective data collection. The low number of complications limits our analysis of associated factors.
Funding for this study: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was not supported by any funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Ethical approval was obtained from the local Human Research Ethics Committee (HREC), reference number: RES-23-0000-015Q and the need for informed consent was waived.

Author Block: T. Lauenstein, K. Scherschel, J. Boddenberg, F. Verfürth, N. Ziayee; Düsseldorf/DE
Purpose: To assess if factors including patients’ age, prior history of cardiovascular disease or prostate size have an impact on the technical success rate of PAE.
Methods or Background: Data of 163 consecutive patients undergoing PAE was analyzed. Technical success rate was defined as full when arteries of both prostate lobes could be probed, as partial (one lobe) or as absent . These findings were correlated with patients’ age (range 53-93 years; mean 72 years), prior history of cardiovascular disease (present in 88 patients) and size of the prostate gland (range 36-265ml; mean 84ml).
Results or Findings: Bilateral PAE could be achieved in 125 patients. In 29 patients only one lobe was embolized and PAE failed to be successful in 9 patients. Patient’s age failed to show a statistically significant difference between these groups (71.4±8.4 years for successful vs. 72.4±9.2 years for unsuccessful procedures, P=0.5576, unpaired ttest), as well as prior history of cardiovascular disease (52% for successful vs. 60% for unsuccessful procedures, P=0.4576. Fishers ttest). In contrast, prostate size was significantly higher in patients with successful bilobar PAE: 88±40ml for successful vs. 68±39ml for unsuccessful procedures (Mann -Whitney-test; p=0.0021). A consecutive ROC analysis revealed a prostate size of 79ml as a cut-off value for the success rate of bilobar PAE.
Conclusion: Prostate size was found to be the only predictor for a successful completion of PAE. Patients with volumes of the prostate gland <79ml should be informed to have a higher risk of technical therapy failure.
Limitations: Limitations of this study are related to the retrospective nature of data analysis.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: G. Ferrillo, E. Baldassarre, T. Sirugo, E. Lanza, S. Romano, N. Buffi, P. Casale, M. Francone, V. Pedicini; Milan/IT
Purpose: To determine the outcomes (Primary efficacy and safety) of RF ablation of hystologically proven renal cell neoplasms using a new single tip internally cooled RF probe.
Methods or Background: After ethical commettee approval we performed a retrospective analyisis of data reguarding the first patients (N= 85)treated with a new RF system whose electrode has an active tip (1-5 cm) that erogates high energies (400-2500mAs) with a pulsing algorithm optimized efficiency. This allows fast ablation times, comparable to MW, with a higher safety due to lower peak temperature reached (< 100 °C).
Minimum follow up was 6 months, on average 12.3 months
The outcomes were clinical outcome (success, partial success or failure) and safety.
Tecnichal success was defined as complete ablation evaluated at any follow up CT-scan; partial success if any area of suspicious recurrence > 1 cm was identified anytime during follow up.
Safety was assessed according to the CIRSE complications classification
Results or Findings: The primary success rate was 91%; secondary success rate of 100 % (7 patient retreated). Reguarding safety there was one case of a CIRSE >2 complication (grade 3, bleeding needing embolization), and a total of 16% of CIRSE grade < 2 complications (N = 14). There was no mortality.
Interestingly, tumours were divided by location and there was a high percentage of central (N= 10) or endophytic lesions (N = 29), with superimposable outcomes of the peripheral lesions.
Conclusion: RFA performed with this new modality resulted safe and effective and it is associated with short procedural times
The automatic energy-delivery controlled system might overcome limitations due to long procedural times and heat-sink effect in RFA
Future studies are needed to confirm these results on larger populations
Limitations: The study is etrospective and monocentric
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Regional ethical committee

Author Block: C-Y. Huang, J-A. Hong, N-W. Chang, C-C. Li, C-A. Liu, S-H. Shen; Taipei City/TW
Purpose: Cryoablation has been shown to be a safe and effective treatment for renal cell carcinoma (RCC); however, there is currently no consensus on the predictors for local tumour control. The aim of this study was to implement automatic segmentation of renal structures on pretreatment CT images, extract relevant image features, and identify potential predictors for local tumour control in RCC after cryoablation.
Methods or Background: A total of 124 patients with RCC managed with cryoablation were included. Pretreatment abdominal CT in nephrographic phase were obtained and segmented into masks of the kidney, tumour, cyst, and renal sinus using deep learning segmentation models and post-processing. Relevant image features were extracted, and logistic regression was utilized to assess the correlation between these image features and response to cryoablation.
Results or Findings: Among the 124 patients included, failure of local tumour control occurred in 15 (12.1%). Tumour volume (P = .005) and the contact area between the tumour and the renal sinus (P = .001) were significantly associated with local tumour control according to univariable logistic regression. A multivariable logistic regression demonstrated that higher tumour volume (P=.051, OR=1.038, 95% CI=1.000-1.079) and a larger contact area between the tumour and the renal sinus (P=.005, OR=1.316, 95% CI=1.088-1.591) were associated with failure of local tumour control. The area under the ROC curve to predict local tumour control after cryoablation was 0.76.
Conclusion: This study demonstrated that volumetric image features, including tumour volume and the contact area between the tumour and the renal sinus, significantly increase the risk of failure of local tumour control in RCC after cryoablation.
Limitations: This study was subject to the inherent shortcomings of its retrospective design. Additionally, it was conducted at a single centre, so external validation is warranted.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Institutional Review Board of Taipei Veterans General Hospital (2023-09-014CC).

Author Block: A. Tinney, K. Lau, J. Dorey; Clayton/AU
Purpose: The aim of this single centre retrospective study was to evaluate the QCA false negative prevalence during AVS.
Methods or Background: Primary aldosteronism is the most common cause of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for subtyping primary aldosteronism and guiding treatment.
Quick cortisol assay (QCA) has proven to be a useful tool to confirm correct catheter position within the adrenal vein, increasing procedure success rates.
All consecutive AVS procedures on adult patients at our institution from July 2022 until March 2024 utilising intraoperative QCA were included. AVS without QCA were excluded. QCA analysis was performed in accordance with manufacturer recommendations. Correct catheter position was confirmed with dedicated angiographic techniques, and with formal biochemical analysis.
Results or Findings: 158 successful and 7 unsuccessful procedures were included. No QCA false positive result was found in unsuccessful AVS. 37 (23.4%) procedures produced a false negative result on QCA analysis despite correct catheter. 23/37 (62.2%) of these procedures had a bilateral false negative QCA, and 14/37 (37.8%) had an asymmetrical unilateral false negative QCA result. There was no significant difference in patient demographics across cohorts.
Of the false negative QCA tests, 10 individual test kits (3.2%) provided a negative result despite laboratory cortisol results returning a value above the manufacturer reference value of 828nmol/L.
Conclusion: QCA has been shown to be a useful tool intra-operatively in increasing AVS sampling success rates. Our results demonstrate that false negative QCA results not infrequently occur and proceduralists must remain vigilant. Detailed patient history, dedicated angiographic techniques and correlation with preoperative CT remain vital when interpreting QCA results. Ongoing research is required to assess patient factors which may contribute to false negative results.
Limitations: Retrospective data availability.
Funding for this study: N/A
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Local institute low risk ethics approval.