This noninvasive procedure can address several life-disruptive conditions in women and men.
By Deborah Skolnik
As seen in the September 2020 Issue of Advancing Care.
At Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth), a noninvasive procedure is revolutionizing the treatment and control of a host of conditions, including benign tumors, abnormal bleeding — even aneurysms.
Embolization is a process that places medications or synthetic materials through a catheter into a blood vessel to block blood flow to an area of the body. Here’s a look at how this procedure can treat two common conditions, which, until recently, required traditional surgery or long-term medication to correct.
“Fibroids are simply benign tumors,” explains Shekher Maddineni, MD, an interventional radiologist at Westchester Medical Center. Many women, especially African American women, start developing these benign tumors in their uterus once they reach their 30s, and there is no known way to prevent them.
Though they aren’t cancerous, uterine fibroids can cause a host of problems. “When they grow, they can cause prolonged menstrual bleeding, pelvic pain, constipation and urinary-frequency symptoms,” Dr. Maddineni says. “Some women bleed so heavily during their periods that they end up needing a blood transfusion.”
Some physicians recommend treating uterine fibroids with a hysterectomy, the surgical removal of the uterus.
Uterine fibroid embolization offers a far less invasive alternative, where very small beads made of gelatin are injected into the arteries that supply blood to the uterus, making them shrink dramatically, resolving pain and other problematic symptoms.
To perform a uterine fibroid embolization, a physician first gives the patient intravenous antibiotics to reduce risk of infection. “Then, we do the procedure under either moderate sedation or anesthesia, to help the patient relax,” Dr. Maddineni says. The procedure takes only 30 to 60 minutes.
What to Expect Next
Patients typically stay in the hospital overnight and return home the next day with prescriptions for antibiotics and pain medication. After five to 10 days of taking it easy (no heavy lifting or physical activity), the patient can resume her normal lifestyle.
“We follow up with patients a couple of times in the first month after the procedure, and at the three or six-month mark, the patient has a follow-up MRI,” Dr. Maddineni says. “In a matter of months, the fibroid’s volume is expected to reduce by 50 percent; as time goes by, they get smaller and smaller.”
Most people aren’t aware of fibroid embolization as an option for treating uterine fibroids — but they should be, Dr. Maddineni says. “It’s a quick and effective procedure.”
As men age, their prostate glands grow in size. In fact, by their 60s, more than half of all men will have an enlarged prostate. This enlargement can cause lower-urinary-tract problems, since the urethra — the duct that transmits urine out of the body — runs through the middle of the prostate and ends up becoming compressed.
Men who have an enlarged prostate may need to use the bathroom frequently or dribble urine at the end of urinating. They may also be unable to completely empty the bladder, experience incontinence or have difficulty starting to urinate.
Traditionally, an enlarged prostate has been treated with medications — which are not always effective — or by surgery, which can cause permanent incontinence and sexual dysfunction.
Prostate embolization offers fewer complications than these options, says Dr. Maddineni. It’s been performed in the U.S. for roughly seven years, and, he adds, it’s a minimally invasive way of shrinking the prostate, lessening compression on the urethra.
“To begin, we give patients an antibiotic before the procedure to decrease risk of infection, then we give them moderate sedation,” Dr. Maddineni explains. The procedure takes one to two hours.
Guided by an X-ray procedure called an angiogram, he views the pelvic blood vessels and locates the artery that supplies blood to the prostate. “With a very small catheter, we go in and inject small beads of gelatin to block blood flow to the prostate,” Dr. Maddineni says. Patients can return home the same day and resume normal activities within two days.
What to Expect Next
Lacking its blood supply, the prostate gradually shrinks, alleviating compression of the urethra. “In a few months, most patients notice their symptoms have improved dramatically,” says Dr. Maddineni.
Patients follow up with their physicians one month post-procedure; by that point, about 80 percent of patients experience a marked improvement in symptoms. They also undergo an MRI after one to three months, to evaluate the prostate’s size.
Based on the anatomy of prostates and blood vessels, not all men are candidates for prostate embolization. A preoperative pelvic CT scan is performed to check if these factors are present.
“Prostate embolization,” says Dr. Maddineni, “is very a good option for some patients who have a very large prostate and wish to preserve sexual function, and for patients on blood thinners or with a severe cardiac history who cannot undergo an invasive operation.”
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