INTERVENTIONAL UROLOGY.

This Updated Text Provides A Concise Yet Comprehensive And State-of-the-art Review Of Evolving Techniques In The New And Exciting Subspecialty Of Interventional Urology. Significant Advances In Imaging Technologies, Diagnostic Tools, Fusion Navigation, And Minimally Invasive Image-guided Therapies Such As Focal Ablative Therapies Have Expanded The Interventional Urologists’ Clinical Toolkit Over The Past Decade. Organized By Organ System With Subtopics Covering Imaging Technologies, Interventional Techniques, Recipes For Successful Practice, Pitfalls To Shorten The Learning Curves For New Technologies, And Clinical Outcomes For The Vast Variety Of Interventional Urologic Procedures, This Second Edition Includes Many More Medical Images As Well As Helpful Graphics And Reference Illustrations. The Second Edition Of Interventional Urology Serves As A Valuable Resource For Clinicians, Interventional Urologists, Interventional Radiologists, Interventional Oncologists, Urologic Oncologists, As Well As Scientists, Researchers, Students, And Residents With An Interest In Interventional Urology. Preface Contents Contributors Editors Contributors 1: History of Interventional Urology X-Rays X-Rays and Urology Adding Contrast Percutaneous Interventions Ultrasound Computed Tomography and Magnetic Resonance Development of Interventional Urology and Uroradiology References 2: Imaging the Urinary Tract: Fundamentals of Ultrasound, Computed Tomography, and Magnetic Resonance Imaging Principles of Ultrasound Ultrasound in Tissue Impedance Refraction Attenuation Pulse-Echo Imaging Modes A-Mode (Amplitude Mode) M-Mode (Motion Mode) B-Mode (Brightness Mode) Transducers Linear Array Curvilinear Array Phased Array Types of Transducer Probes Image Resolution Lateral Resolution Axial Resolution Elevational Resolution Transmit Power Control Frequency Selection Doppler Pulsed Wave (Spectral) Doppler Color Doppler Power Doppler Contrast-Enhanced Ultrasound (CEUS) Ultrasound Applications for the Genitourinary System Normal Renal Anatomy Renal Masses Renal Failure Renal Transplant Urinary Bladder Prostate Penis Scrotal Ultrasound Varicocele Computed Tomography(CT): Physical Principles and Genitourinary Applications Physical Principles Dual-Energy CT Applications of CT in the Urinary Tract Kidneys Adrenal Glands Ureters and Bladder Dose Reduction Strategies in CT Automatic Exposure Control Iterative Reconstruction Tube Kilovoltage Reduction Urology Specific Low-Dose CT Strategies Renal Stone Disease CT Urography Dual-Energy CT Magnetic Resonance Imaging: Basic Physics and Genitourinary Applications Image Formation Pulse Sequences MR Urography Basic Exam Relative and Absolute Contraindications Applications of MRI in the Urinary Tract Kidney Adrenal Ureter and Bladder Prostate Scrotum Penis Female Urethra Pelvic Floor Dysfunction PET-CT Applications in the Urinary Tract Kidneys Prostate Cancer Recurrence References 3: Guide to Vascular Access: Femoral, Radial, and Venous Access Vessel Selection Common Femoral Artery Access Background and Access Hemostasis Benefits Contraindications, Risks, and Drawbacks Radial Artery Access History and Patient Selection Positioning Access and Sheath Placement Hemostasis Benefits Contraindications, Risks, and Drawbacks Venous Access Background, Anatomy, and Access Jugular Vein Access Common Femoral Vein Access Complications of Venous Access References 4: Image Fusion Principles: Theory History Basics Visualization and Application Three-Dimensional Image Visualization Registration Landmark-Based Surface-Based Voxel Intensity-Based Tracking (Localizers) Clinical Applications of Image Guidance Augmented Reality Targeted Prostate Biopsy Focal Therapy Computer-Aided Diagnosis Conclusion References 5: Role of MRI in Prostate Cancer Assessment Introduction MRI Acquisition Patient Preparation MRI Equipment Pulse Sequences mpMRI Interpretation Biopsy Guidance Indications for MRI Detection of Prostate Cancer Staging of Prostate Cancer Active Surveillance Challenges and Limitations Artificial Intelligence Conclusions and Summary References 6: Imaging of Benign Prostatic Conditions Benign Prostatic Hyperplasia Transabdominal Ultrasound Transrectal Ultrasound (TRUS) Magnetic Resonance Imaging (MRI) Computed Tomography (CT) Prostatitis TRUS MRI Prostatic Abscess TRUS CT MRI Prostatic Cysts TRUS/CT MRI Wolffian Duct Anomalies MRI CT Prostatic Calculi Imaging References 7: Prostate Biopsy: Ultrasound Introduction Developmental Anatomy Bladder and Urethra Prostate and Accessory Glands Vasculature Prostate Zonal Anatomy Prostate Orientation Clinical Interpretation Patient Concerns Equipment Maintenance and Preparation Normal Imaging The Adult Prostate Scanning Protocol TRUS Protocol Disinfection of Probes Indications for Prostate Ultrasound Measurement of Prostate-Specific Antigen Density (PSAD) Congenital Abnormality Prostatic Cysts, Urethral and Müllerian Cysts, and Seminal Vesicular Cysts Lower Urinary Tract Symptoms (LUTS) Chronic Prostatitis/Chronic Pelvic Pain Syndrome/Abscess Hematospermia Infertility: Azoospermia Prostate Biopsy for the Diagnosis of Prostate Cancer Indications Ultrasound Findings Patient Preparation Informed Consent Discontinue Anticoagulants Preparation of Rectal Vault Prophylactic Antibiotics Urinalysis Patient Position and Analgesia Position Analgesia Biopsy Technique Saturation Biopsies Sonoelastography-Guided Biopsies MRI-Targeted Biopsy Trans-perineal Prostate Biopsy Complications References 8: Fusion-Guided Prostate Biopsy Image Analysis and Planning Image Registration Tracking Approaches Mapping and Navigation Route of Biopsy Major Platforms Electromagnetic Tracking Mechanical Position Encoders Image-Based Tracking Discussion and Conclusions References 9: Template Mapping Biopsies: An Overview of Technique and Results Rationale and Background Overdiagnosis of Insignificant Cancers Systematic Inadequacy in Sampling Unrepresentative of True Cancer Volume Poor Localization, Including for MRI-Negative Patient Diagnostic Accuracy Regarding Minimally Ablative Techniques High Complication Rates Cost-Effective Analysis Template Mapping Biopsies: Technique Patient Preparation Patient and Equipment Setup Needle Deployment Assigning Zonal Anatomy to the Prostate Post-Procedure Care Complications and Side Effects The Diagnostic Performance of Template Mapping Biopsies Validation of Template Mapping Biopsies Future of Transperineal Biopsy Uptake in the UK Population Conclusion References 10: Contrast-Enhanced Ultrasound (CEUS) Contrast-Enhanced Ultrasound Ultrasound Contrast Agents Examination Technique CEUS in Urological Practice Prostate Diseases Renal Diseases Other Disorders Future Directions Conclusion References 11: Prostate Elastography Introduction Techniques Transrectal Strain Elastography Shear Wave Elastography Performance Strain Elastography Shear Wave Elastography Limitations Future Perspective References 12: Rationale for Focal Therapy Prostate Cancer—Active Surveillance, Whole-Gland Therapy Focal Therapy—Rationale and Concepts Appropriate Patient Selection Treatment of the Index Lesion Accurate Lesion Localization and Treatment Delivery Cost-Effectiveness of Focal Therapy Compared to Active Surveillance and Robotic-Assisted Laparoscopic Prostatectomy Functional Outcomes Following Focal Therapy Conclusion References 13: High-Intensity-Focused Ultrasound for Prostate Cancer The Technology Physical Principles HIFU Devices Primary High-Intensity-Focused Ultrasound: Development and Outcomes Whole-Gland HIFU Focal HIFU Salvage High-Intensity-Focused Ultrasound: Outcome Measures Post-Radiation Failure Post-Radical Prostatectomy Post-Brachytherapy Post-HIFU Follow-Up PSA Surveillance and HIFU Failure Post-HIFU Imaging Salvage Treatment Post-Primary Focal HIFU Tips and Tricks Dose Escalation Strategy for Focal HIFU Thick Fat Layer Between the Prostate and the Rectum Gland Size Calcification Patient Movement Heat Sink Effect Swelling of the Prostate Complications Rectal Wall Injury and Rectal Fistulae Future Perspectives References 14: Focal Laser Ablation for Prostate Cancer Introduction What Is Focal Laser Ablation? MRI Detection of Prostate Cancer MRI Shortcomings MRI-Targeted Biopsy of the Prostate How to Perform Prostate FLA Preventing Complications Advantages of FLA Clinical Trials Using Focal Laser Ablation of Prostate Cancer Complications of FLA Follow-Up after FLA Conclusion References 15: Cryotherapy for Management of Prostate Cancer Introduction Pathophysiology of Cellular Destruction After Cryotherapy Surgical Procedure Postoperative Follow-Up Indications and Outcomes of Cryotherapy Primary Prostate Cryotherapy Salvage Prostate Cryotherapy Oncological Outcomes After Primary Cryotherapy Oncological Outcomes After Salvage Cryotherapy Partial/Focal Primary Cryotherapy Patient Selection for Focal Therapy: Role of Modern Imaging Studies Outcomes After Primary Focal Therapy Salvage Focal Cryotherapy Complications of Primary Cryoablation Complications After Salvage Cryoablation Technical Challenges: Tips and Tricks Future Directions Conclusion References 16: Irreversible Electroporation (IRE) for Prostate Cancer Irreversible Electroporation (IRE) Device IRE in Prostate Cancer Advantages of IRE Compared to Current Ablative Treatment Options Procedure Technique Indications Tips and Tricks Outcomes Literature Conclusion References 17: Vascular-Targeted Photodynamic Therapy for Prostate Cancer Introduction VTP In Prostate Cancer PDT Components Photosensitizer Light Delivery System VTP Procedure Work-Up and Preparation of WST-11 Placement of Laser Fibers and Illumination Posttreatment Observation Patient Selection Oncologic Outcomes After VTP VTP Complications VTP Tips and Tricks Optimal Treatment Parameters Software Guidance Follow-Up After VTP Radical Prostatectomy After VTP Conclusion References 18: Radiation Therapy: Brachytherapy History of Brachytherapy Epidemiology PSA Screening Patient Evaluation Risk Stratification General Treatment Strategies Selecting Patients for Brachytherapy Prostate Gland Size Isotopes Common Treatment Strategies for Localized Prostate Cancer Role of Brachytherapy in Prostate Cancer Treatment Combination External Beam Radiation Therapy and Brachytherapy Focal Brachytherapy Imaging Correlations with Emphasis on Image Fusion Guidance Imaging Correlations Intraoperative Imaging Postoperative Dosimetry Techniques Outcomes Results of Combination Therapy with EBRT and Brachytherapy Brachytherapy in the Salvage Setting Toxicity Grading References 19: Selective Arterial Prostatic Embolization (SAPE/PAE): BPH Embolization Biography BPH Treatments Options Imaging Evaluation Pre-procedural Patient Evaluation Technique Vascular Anatomy Relevant for Embolization Tips and Tricks Results Posttreatment Follow-Up (Imaging Applications) Comparative Studies of PAE Versus Prostatic Surgery References 20: Treatments for Benign Conditions of the Prostate Gland Benign Prostatic Hyperplasia (BPH) Definitions Measuring the Severity of BPH The Burden of BPH and LUTS Indications for Surgical Treatment of BPH The Evolving Landscape of Surgery for LUTS Attributable to BPH Surgical Options for the Management of LUTS Attributed to BPH Transurethral Resection of the Prostate (TURP) Bipolar-TURP and Bipolar Vaporization of the Prostates Laser Treatment of BPH Contemporary Laser Systems Used in the Treatment of BPH KTP: Nd:YAG Lasers Holmium Lasers Holmium Laser Ablation of the Prostate (HoLAP) Holmium Laser Enucleation of the Prostate (HoLEP) Thulium Lasers Microwave Therapy of BPH Prostatic Urethral Lift (PUL) Water Vapor (RezūmTM) Thermal Therapy for BPH Aquablation Results Complications The Impact of BPH Surgery on Sexual Function Prostatic Artery Embolization Putting It All Together: Developing a Personalized Surgical Strategy for LUTS Attributable to BPH Prostatic Abscess Prostatic Utricular Cyst and Müllerian Duct Cysts References 21: Kidney Imaging Use of Imaging in Urology Imaging Modalities: Identification and Delineation of Renal Pathology Ultrasound (US): Standard, Contrast Enhanced Computerized Tomography (CT) Magnetic Resonance Imaging (MRI) Molecular Imaging: Positron Emission Tomography (PET) Fluorine-18-2-Fluoro-2-Deoxy-D-Glucose (18 F-FDG) 124I-cG250 Renal Pathology Renal Cysts Standardized Scoring Systems of Renal Masses Nephrometry Malignant Lesions: Renal Cell Carcinoma, Urothelial Carcinoma, Lymphoma, and Metastatic Disease Histologic Subtypes of Renal Tumors Clear Cell RCC Papillary RCC Chromophobe RCC Angiomyolipoma Oncocytoma Renal Pathology, Other Than RCC Urothelial Carcinoma Metastases to the Kidney Lymphoma Nephrolithiasis Renal Obstruction Follow-Up Imaging for Renal Pathology References 22: Renal Mass Biopsy Introduction Accuracy of Renal Mass Biopsy Renal Mass Biopsy Diagnosis of Malignancy Diagnosis of Histologic Subtype and Grade Biopsy Indications Established Indications Emerging Indications Complications of Renal Mass Biopsy Bleeding Risk Risk of Seeding Adjacent Organ Damage Biopsy Techniques FNA Versus Core Biopsy Imaging Modality Localization Assistance Conclusions References 23: Urinary Diversion and Drainage Introduction Anatomy Percutaneous Nephrostomy Indications Access for Interventions/Endourologic Procedures Diagnostic Testing Contraindications Relative Contraindications Pre-procedural Evaluation Imaging Laboratory Analysis Technical Aspects of Procedure Anatomic Considerations/Patient Positioning Antibiotics Sedation Access Approach Methods Ultrasound Fluoroscopy Combination Method Computed Tomography Cone Beam/Fluoroscopic Periprocedural Complications Minor Complications Major Complications Management Outcomes Nephroureteral Stents/Catheters/Tubes Catheter Exchange Ureteral Stent Placement and Management Catheter Exchange Transplant Kidney Interventions Antegrade Placement of Ureteral Stents via an Ileal Conduit Ureteral Stricture Treatment Ureteral Embolization Urinoma Drainage Renal and Perinephric Abscess Suprapubic Catheterization Pediatric Considerations Conclusion References 24: Renal Ablations Introduction Ablation Considerations Indications Contraindications Tumor Characteristics Technical Modalities Cryoablation Principles of Treatment Radiofrequency Ablation Principles of Treatment Microwave Principles of Treatment Irreversible Electroporation Principles of Treatment Techniques and Approaches Percutaneous Laparoscopic Tips and Tricks Oncologic Outcomes Local Recurrence-Free Survival (LRFS) Metastatic Recurrence-Free Survival (MRFS) Cancer-Specific Survival (CSS) and Overall Survival (OS) Complications New Ablative Approaches Conclusions References 25: Renal Angiography and Embolization Introduction Renal Arterial Anatomy Adrenal Vasculature Horseshoe Kidney Technical Issues Vascular Access Renal Artery Catheterization Embolization Materials Post-embolization Management Angiography and Embolization for Treatment of Traumatic and Iatrogenic Hemorrhage Angiography and Embolization of Renal Tumors Renal Angiomyolipomas Palliative Embolization of Symptomatic Renal Tumors Preoperative Embolization for Large Tumors Pediatric Renal Tumors Conclusion References 26: Nutcracker Syndrome: Renal Venous Intervention Introduction Pathophysiology Diagnostics History Ultrasound Computed Tomography Magnetic Resonance Imaging Venography with Pressure Measurements Treatment Indications and Goals of Treatment Medical Management Surgical Intervention Endovascular Interventions Conclusion References 27: Renal Artery Stenosis Techniques Patient Selection Clinical Criteria Anatomic Criteria/Screening Diagnostic Exams Physiologic Criteria: Catheter-Based Angiography with Pressure Measurements Renal Vein Renin Sampling Summary: Algorithms for Treatment Diagnostic Catheter-Based Aortography Pressure Gradient Measurements Angioplasty Stenting Specific Situations Bilateral Renal Artery Stenosis and/or Occluded Renal Artery Transplant Renal Artery Stenosis Pediatric Patients Tips Fluoroscopy Views Avoidance of Contrast-Induced Nephropathy Patients with Atherosclerotic Renal Artery Stenosis (aRAS) “No Touch” Technique The “Sos Flick” Technique Use of Embolic Protection Devices and Platelet Inhibitors Patients with Fibromuscular Dysplasia (FMD) Outcomes Conclusion References 28: Imaging and Interventional Diversion Techniques for Bladder and Ureteral Conditions Vesicoureteral Reflux Voiding Cystourethrogram Screening Ultrasound Magnetic Resonance Imaging Nuclear Studies Posttreatment Follow-Up Urinary Tract Infections Ultrasonography Computed Tomography Scan Magnetic Resonance Imaging Nuclear Medicine Posttreatment Follow-Up Ureteral Strictures Computed Tomography Scan Magnetic Resonance Urograms Nuclear Studies Interventional Ureteral Diversions Ureteral Stents Nephrostomy Tube Bladder Cancer Ultrasound Computed Tomography Magnetic Resonance Imaging Non-muscle-Invasive Bladder Cancer Follow-Up Muscle-Invasive Bladder Cancer Follow-Up References 29: Hemorrhagic Cystitis Introduction Categorizing and Grading HC Infectious Etiology Viral-Mediated HC Diagnosis Management Nonviral Infectious HC Noninfectious Etiology Radiation-Induced HC Chemically Induced HC Occupational Agents Management Overall Management Prevention Initial Bedside Management Irrigation and Clot Evacuation Continuous Bladder Irrigation Bedside Intravesical Instillations Procedural Interventions Cystoscopy and Fulguration Systemic Therapies Hyperbaric Oxygen Therapy Other Systemic Therapies Surgical and Interventional Procedures Urinary Diversion Nephrostomy Tubes Cystectomy Embolization Experimental Therapies GAG Layer Replenishment Stem Cell Therapy Viral-Specific T-Cells Platelet-Rich Plasma Fibrin Glue Conclusion References 30: Endovascular Management of Priapism and Erectile Dysfunction Relevant Anatomy and Physiology Priapism Low-Flow Priapism High-Flow Priapism Classification and Pathophysiology Presentation Diagnostic Evaluation Management Erectile Dysfunction Veno-occlusive Dysfunction Arterial Insufficiency References 31: Adrenal Imaging Anatomy Embryology Physiology Adrenal Incidentaloma Size and Growth Biopsy of Adrenal Masses Adrenal Mass Imaging Computed Tomography Magnetic Resonance Imaging Functional Imaging Biochemical Evaluation Testing for Cortisol Hypersecretion Testing for Aldosterone Hypersecretion Testing for Catecholamine Hypersecretion Adrenal Diseases Cushing’s Syndrome Primary Hyperaldosteronism Pheochromocytoma Adrenocortical Carcinoma Metastases Myelolipoma Adrenal Hemorrhage and Hematoma Adrenal Oncocytoma Adrenal Cysts Congenital Adrenal Hyperplasia Neuroblastoma Conclusion References 32: Interventional Urology for Adrenal Gland Diseases Introduction Adrenal Pathology Cortisol-Secreting Adenoma Aldosteronoma Myelolipomas Pheochromocytoma Adrenocortical Carcinoma Metastases Percutaneous Adrenal Biopsy Indications Workup Technique Ultrasound-Guided CT-Guided MRI-Guided Complications Outcomes Adrenal Venous Sampling Indications Workup Technique Complications Outcomes Percutaneous Image-Guided Adrenal Ablation Introduction Indications and Patient Evaluation Technical Considerations Complications Radiofrequency Ablation Cryoablation Microwave Ablation Chemical Ablation Other Ablation Techniques Irreversible Electroporation (IRE) Follow-Up Embolization Indications Workup Technique Complications Outcomes Summary and Conclusion References 33: Pelvic Congestion Syndrome and Male Varicoceles Pelvic Congestion Syndrome Introduction and Background Epidemiology Etiology and Pathophysiology Symptomatology, Physical Exam, and Screening Diagnostic Imaging Ultrasound Magnetic Resonance Imaging Venography Treatment Non-Interventional Radiology Treatment Interventional Radiology Embolization Venography and Embolization Discharge Post Treatment Follow-Up Complications Tips and Tricks Outcomes Limitations of Current Research Conclusion Male Varicoceles Epidemiology Etiology and Pathophysiology Symptomatology, Physical Exam, and Screening Diagnostic Imaging Ultrasound Venography Treatment Non-Interventional Radiology Treatment Interventional Radiology Embolization Discharge Complications Tips and Tricks Post Treatment Follow-Up Outcomes References 34: Retroperitoneal Biopsy Introduction Imaging Approach and Correlations Benign Retroperitoneal Tumors Malignant Retroperitoneal Tumors Indications Tips and Tricks for Biopsy Approach Coaxial Approach Biopsy Path Planning Complications Conclusion References 35: Immune Checkpoint Blockade for Genitourinary Malignancies and the Abscopal Response Introduction Immune Checkpoint Pathways Urothelial Cancer Renal Cancer Prostate Cancer Radiation Therapy and the Abscopal Effect Conclusion References Index