As a National Leader in Comprehensive Urologic care, Anne Arundel Urology is proud to offer the newest in minimally invasive treatment options for the treatment of BPH, Uterine Fibroids, Varicocele and Hemorrhoids. These conditions can now be treated in our office-based, outpatient Interventional Radiology lab located adjacent to our Annapolis offices and surgery center. Procedures are performed without general anesthesia, allowing patients go home within hours and resume most normal activities within a day or two.
To schedule an appointment or a procedure or for questions:443-423-1879
In an emergency after 5 p.m. or on the weekend, please call: 443-602-4273
What is Interventional Radiology?
Interventional radiology (IR) is a medical specialty that performs minimally invasive treatments using radiologic imaging for procedure guidance. Interventional radiology treatments have become the primary method of care for a variety of conditions, offering less risk, less pain and less recovery time, compared to open surgery.
Interventional radiologists use x-rays, CT, MRI or other imaging guidance to navigate small instruments, like catheters and needles, through blood vessels and organs to treat a variety of diseases. Examples of treatments administered by interventional radiologists include angioplasty, stenting, thrombolysis, embolization, image-guided thermal ablation, and biopsies. These minimally invasive treatments can cure or alleviate symptoms of vascular disease, stroke, uterine fibroids, or cancer. They are also experts at reading x-rays, ultrasounds, CTs, MRIs, and other forms of medical imaging.
What are the Advantages of Interventional Radiology?
The advantages of these minimally invasive techniques include reduced risks, faster recovery, greater comfort, and a quicker return to work. The effectiveness of treatment is often better than with traditional treatments. IR is particularly relevant for patients who are in frail health or who have already undergone numerous surgeries.
Prostate Artery Embolization for BPH
What is PAE?
Prostatic artery embolization (PAE) is a minimally invasive treatment that helps improve lower urinary tract symptoms caused by a Benign Prostatic Hyperplasia (BPH).
PAE is performed by an Interventional Radiologist through a small catheter inserted into the artery in your wrist or groin. The interventional radiologist will then guide the catheter into the vessels that supply blood to your prostate.
Tiny round microspheres (particles) are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply
Following this procedure, the prostate will begin to shrink, relieving and improving symptoms usually within days of the procedure.
What are the advantages of PAE?
No surgical incision or device inserted into the urethra
Performed in an outpatient setting under “twilight sleep” with no general anesthesia
Painless procedure lasting approximately 1 hour
Very low complication rate and no reports of impotence or incontinence after PAE
Symptom improvement occurs 2-3 weeks after the procedure
Return to full activity within one week
By the numbers
As many as 14 million men in the United States have symptoms of BPH
80-90% effective in reduction of symptoms
5-7 years durability for relief of symptoms
By age 60, 50% of men will have some signs of BPH
Hemorrhoid Artery Embolization
What are Hemorrhoids?
Hemorrhoids are cushions of fibrovascular tissue in the anus helping to seal the anus and maintain anal continence. They can be easily irritated, become enlarged and form into swellings, often caused by straining and constipation.
Hemorrhoidal disease describes the swollen or inflamed state of these vascular structures inside or around the anal canal. It is the most frequent anorectal disease with 5%-40% occurrence in the population.
Hemorrhoids can be located internal at the upper part of the anal canal in the rectum or external under the skin around the anus.
What are Typical Symptoms Caused by Hemorrhoids?
Bleeding is the most common presenting symptom as hemorrhoidal tissue has increased blood supply.
When internal hemorrhoids prolapse through the anal canal the tissue can become traumatized leading to bleeding that is bright red in color
Internal Hemorrhoids may cause itching and perineal irritation
Prolapsing tissue can lead to “fecal soiling” by impeding the ability of the anal verge toseal
External Hemorrhoids are typically asymptomatic unless they become thrombosed orinflamed
External thrombosed Hemorrhoids cause a painful perianal swelling
How are Hemorrhoids Diagnosed?
Medical History + Physical Examination
A visual inspection of the peri-anal area will allow for the description of any external abnormalities.
Digital Rectal Examination
Colonoscopy: Allows the endoscopic examination of the entire colon
Flexible Sigmoidoscopy: Endoscopic examination of the large intestine from the rectum up to the sigmoid (distal colon)
Anoscopy: An anal speculum (anoscope) is used for internal inspection of the lower rectum
An Interventional Radiologist performs this minimally invasive procedure under local anesthesia and moderate sedation in patients with internal hemorrhoids of grade one, two or three. Internal hemorrhoids are composed of a dense arteriovenous network called Corpus Cavernosum Recti (CCR). The embolization of the hemorrhoidal artery aims to reduce the blood flow in the CCR, thus reducing the venous pressure and symptoms.
The procedure is performed through a needle hole in the wrist or the groin through which a thin catheter is inserted into the rectal artery under x-ray guidance. The catheter is guided through the superior rectal artery tree to the terminal branches while the Interventional Radiologist watches the progress of the procedure using a moving x-ray (fluoroscope).
Small coils and/or microspheres are placed into the terminal branches of the arteries to seal the vessels. It may be necessary to repeat the embolization for hemorrhoids on the opposite side, through the same opening and using the same catheter and microcatheter combination.
Hemorrhoidal artery coil embolization is a painless technique. The procedure is approx. 45 minutes. After the procedure, patients can return home on the same day and back to work the following day in most circumstances.
What are The Treatment Options for Hemorrhoids?
There are several suggested treatments, according to the severity of the symptoms:
Dietary and lifestyle changes
Non-surgical minimally invasive treatments
Rubber Band Ligation
Surgery: Minimally invasive surgery
Doppler-guided hemorrhoidal ligation (DGHAL)
Alternative non-surgical treatment
Hemorrhoidal Embolization of the Superior Rectal Arteries
Advantages of The Embolization Technique
Leaves hemorrhoidal tissue in place
No general anesthesia needed
Preserves anal continence
Does not involve the creation of rectal wounds
Good short-term results
Uterine Fibroid Embolization
What is UFE?
Uterine Fibroid Embolization is a nonsurgical procedure that blocks blood flow to the fibroids, causing them to shrink and alleviate associated symptoms
A tiny tube called a catheter is inserted into the femoral artery at the top of the leg or into the radial artery accessed through the wrist. The patient is under sedation or in a ‘twilight sleep’ during the procedure.
The catheter is then guided into the left and right uterine artery using x-ray and a contrast dye to visualize and map the arteries feeding the fibroids.
Tiny embolic particles are then injected through the catheter and into the uterine arteries that feed the fibroids, cutting off their blood supply
With the blood supply blocked, the fibroids begin to shrink, but the uterus and ovaries are spared
Advantages of the Embolization Technique
The uterus is spared
No Incision or Scar
Less Risk than surgery
Quicker recovery time (1-2 weeks vs 6 weeks for Surgery)
Treat the Entire Uterus and Multiple fibroids at once
The whole procedure usually lasts about 30-45 minutes with a 2-hour recovery. After the procedure, patients can return home on the same day. Patients can be moderately active immediately after the procedure and return to full activity after 7 day
Up to 25% of all women may be affected by symptomatic uterine fibroids and up to 30-40% in perimenopausal aged women
African American women are at an increased risk for fibroids
Symptoms can begin as early as 14 years old
Experts do not fully understand what causes fibroids
What is a Varicocele?
Male infertility caused by a varicose vein of the testicle and scrotum – called varicoceles – is a very common occurrence, affecting approximately 10 percent of all men.
The varicose vein – very similar to those located on legs – happens when the vein valve fails and blood pools, enlarging the veins around the testicle and causing a varicocele. When this condition occurs, not only does it cause infertility, but it may also cause pain and testicular atrophy.
What are Typical symptoms Caused by Varicoceles?
Scrotal pain caused by varicoceles varies from person to person. The pain is generally mild to moderate, and has been described as dull, congestive‚ “toothache” like. The pain worsens with long periods of sitting, standing or physical activity, especially for long periods of time. The pain is typically relieved by lying down.
With time, varicoceles may enlarge and become more noticeable. In young men, the presence of a varicocele impairs sperm production and can often be improved with treatment.
How are Varicoceles Treated?
The preferred method of treatment is the nonsurgical Varicocele Embolization procedure. It is performed in our office-based, minimally invasive IR lab.
The physician inserts a small catheter into a tiny incision in the groin area, accessing the femoral vein.
Using x-ray, the physician then guides the catheter from the femoral vein, directly to the testicular vein
Once in the testicular vein, contrast is injected in order to map out the problem area so it can be embolized – or “blocked” – using coils or particles.
By BruceBlaus – Template:Town, CC BY-SA 4.0, commons.wikimedia.org/w/index.php?curid=44969448
Once the vein is blocked, the damaged vein is shut off and the blood flow is redirected to the surrounding, healthier veins.
Pressure is eased on the varicocele, restoring normal function and eliminating pain.
The patient is sent home shortly after the procedure and is back to normal activities the next day.
The whole procedure usually lasts about 30-45 minutes with a two hour recovery and the patient is back to moderate activity withing 24-48 hours.