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An Interventionalist’s Guide to Urology Consultations

2021; Radiological Society of North America; Volume: 41; Issue: 7 Linguagem: Inglês

10.1148/rg.2021210064

1527-1323

Ryan Mann, Joshua Ladner, Korey A. Leafblad, Juan D. Mendoza, Benjamin Jabara, Charles Kitley,

Pelvic and Acetabular Injuries

HomeRadioGraphicsVol. 41, No. 7 PreviousNext Vascular and Interventional RadiologyFree AccessRadiographics FundamentalsAn Interventionalist’s Guide to Urology ConsultationsRyan D. Mann , Joshua R. Ladner, Korey A. Leafblad, Juan D. Mendoza, Benjamin J. Jabara, Charles A. KitleyRyan D. Mann , Joshua R. Ladner, Korey A. Leafblad, Juan D. Mendoza, Benjamin J. Jabara, Charles A. KitleyAuthor AffiliationsFrom the Department of Radiology, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431-5000.Address correspondence to R.D.M. (e-mail: [email protected]).Ryan D. Mann Joshua R. LadnerKorey A. LeafbladJuan D. MendozaBenjamin J. JabaraCharles A. KitleyPublished Online:Nov 1 2021https://doi.org/10.1148/rg.2021210064MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.TEACHING POINTS■ Interventional radiologists can play a leading role on the multidisciplinary genitourinary team when they understand the indications, techniques, and clinical management of common genitourinary interventions.■ Percutaneous and endovascular genitourinary procedures utilize the full spectrum of image-guided interventions and techniques.■ Clinical history, physical examination, laboratory analysis, and imaging interpretation are critical when approaching a urology consultation with the interventional radiology service.Interventional radiology services frequently receive consults from urologists for a wide range of genitourinary conditions. These pathologic conditions lend many opportunities to the interventionalist to provide unique and innovative patient-centered care to treat both acute and chronic disease processes.In this case-based online presentation, we highlight a number of pathologic genitourinary processes. To approach these conditions and develop an informed decision with the referring urologist, the interventionalist must understand the anatomy and pathophysiology of the genitourinary system. In addition, we describe a universal approach to urology consultations that includes taking a genitourinary-specific history, evaluating bleeding risk and appropriate antibiotic therapy for genitourinary procedures, and performing appropriate clinical follow-up.Percutaneous Urinary DiversionPercutaneous urinary diversion is by far the most common reason for urologists to consult the interventional radiology service. One of the most urgent of the indications discussed in the online presentation is pyonephrosis, so-called pus under pressure, which carries a high mortality risk. Emergent placement of a percutaneous nephrostomy is an essential skill for all interventionalists. Efficient and timely pelvicalyceal access and subsequent management of nephrostomy drains are essential skills for an interventionalist (Fig 1). In addition, urinary diversion therapies play a significant role in oncologic care, as outlined in case 3 in the presentation.Figure 1. Axial CT image with maximum intensity projection (MIP) reconstruction depicts optimal access into the renal collecting system through a posterior calyx (red dashed line).Figure 1.Download as PowerPointOpen in Image Viewer Percutaneous Tumor AblationRadiofrequency ablation, microwave ablation, and cryoablation are safe and effective techniques that provide durable nephron-sparing treatment of renal cell carcinoma. The 2019 consensus statement from the Society of Interventional Radiology concludes that ablation is an acceptable treatment of tumors measuring less than 4 cm. Ablation continues to be an emerging therapy, with new data suggesting that it may be a viable option for treatment of more advanced and even metastatic disease.Renal Artery InterventionsRenal artery embolization has multiple applications, the most common being treatment of malignant tumors, renal angiomyolipomas and trauma injury (Fig 2). These indications, as well as embolization agents, techniques, and clinical follow-up, are discussed. Renal artery angioplasty and stent placement are discussed in the treatment of renovascular hypertension in the setting of atherosclerotic disease and fibromuscular dysplasia.Figure 2. Digital subtraction angiogram in a patient with trauma injury depicts a large pseudoaneurysm (arrowhead) and multiple sites of active bleeding (arrows). A combination of coils, glue, and gelatin sponge was used to control bleeding.Figure 2.Download as PowerPointOpen in Image Viewer Renal Vein InterventionsSymptomatic compression of the left renal vein between the aorta and superior mesenteric artery (nutcracker syndrome) is a rare anatomic pathologic condition. Patients with nutcracker syndrome often undergo multiple negative urologic and gynecologic diagnostic workups for nonspecific clinical symptoms. Interventional radiologists play a critical role in the diagnosis and management of this disease.Prostatic Artery EmbolizationLower urinary tract symptoms associated with benign prostatic hypertrophy occur in 75% of men by the age of 70 years. Prostatic artery embolization (PAE) provides a minimally invasive alternative to medical or surgical management of this disease. Although technically challenging, PAE can provide significant improvement in symptoms that is comparable to that of conventional therapies.Image-guided percutaneous and endovascular procedures play a critical role in the management of a wide array of genitourinary pathologic conditions. Interventionalists should have an understanding of genitourinary anatomy, diseases, and image-guided procedures to foster informed conversations with the referring urologist. This online presentation describes how to approach a urology consultation and reviews a number of common genitourinary interventional procedures.Presented as an education exhibit at the 2020 RSNA Annual Meeting.All authors have disclosed no relevant relationships.The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government.Work of the U.S. Government published under an exclusive license with the RSNA.Suggested Readings1. Durack JC, Covey AM, guest eds. Genitourinary Interventions. Tech Vasc Interv Radiol. 2016;19(3):169–244. Crossref, Medline, Google Scholar2. Carnevale FC, Moreira AM, de Assis AM, et al. Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years’ Experience. Radiology 2020;296(2):444–451. Link, Google Scholar3. Kaufman J, Lee M. Vascular and Interventional Radiology. 2nd ed. Philadelphia, Pa: Elsevier, 2014. Google Scholar4. Partin A, Dmochowski R, Kavoussi L, Peters C. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, Pa: Elsevier, 2021. Google Scholar5. Patel IJ, Rahim S, Davidson JC, et al. Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions—part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 2019;30(8):1168–1184.e1. Crossref, Medline, Google Scholar6. Picel AC, Hsieh TC, Shapiro RM, Vezeridis AM, Isaacson AJ. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment. RadioGraphics 2019;39(5):1526–1548. Link, Google ScholarArticle HistoryReceived: Mar 18 2021Revision requested: July 20 2021Revision received: Aug 6 2021Accepted: Aug 7 2021Published online: Nov 01 2021Published in print: Nov 2021 FiguresReferencesRelatedDetailsAccompanying This ArticleAn Interventionalist’s Guide to Urology ConsultationsNov 1 2021Default Digital Object SeriesRecommended Articles Case-based Review of Endovascular Renal Interventions: Primer for Radiology Residents and Fellows RadioGraphics Fundamentals | Online PresentationRadioGraphics2018Volume: 38Issue: 4pp. 1284-1285Radiologic Assessment of Native Renal Vasculature: A Multimodality ReviewRadioGraphics2017Volume: 37Issue: 1pp. 136-156The Renal Vasculature: What the Radiologist Needs to KnowRadioGraphics2021Volume: 41Issue: 5pp. 1531-1548Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting SystemRadiology2017Volume: 285Issue: 1pp. 293-301Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality ReviewRadioGraphics2019Volume: 39Issue: 5pp. 1327-1355See More RSNA Education Exhibits An Interventionalist's Guide to Urology ConsultationsDigital Posters2020Complications of an Ileal Conduit after Radical Cystectomy: Interventional Radiologic ManagementDigital Posters2019Interventional Radiology and Childbirth: From Conception through Delivery and BeyondDigital Posters2022 RSNA Case Collection Venous pseudoaneurysm and portoenteric fistulaRSNA Case Collection2020Rassmusen's PseudoaneurysmRSNA Case Collection2022Traumatic Pseudoaneurysm RSNA Case Collection2021 Vol. 41, No. 7 Slide PresentationMetrics Altmetric Score PDF download