Interventional Lifestyle Treatments
Using new percutaneous and transcatheter techniques, our Specialists are able to help patients treat the following conditions in the most minimally invasive way.
BARIATRIC ARTERY EMBOLIZATION
Bariatric artery embolization is the latest technique to help patients with high body mass index (> 35) to achieve weight loss. The expected weight loss is about 10-15% of existing body weight. This procedure may be suitable for patients who are facing serious health conditions as a result of their high body mass index and have found a) weight loss unsuccessful with lifestyle modification, diet change and medication or b) are unsuitable candidates for metabolic weight loss surgery.
This is a minimally invasive day procedure done under light sedation or local anaesthesia depending on patient preference. A catheter is inserted from the radial artery in the wrist and is navigated under image guidance into the arteries supplying the part of the stomach that is responsible for producing hormones that make a person hungry. These arteries are then blocked with the catheter system such that the hunger hormone production is reduced.
THYROID NODULE RADIOFREQUENCY ABLATION
Thyroid nodules are fairly common and are seen in approximately 30% of adults undergoing ultrasound scan of the neck. While majority of these modules are benign in nature, some can be malignant. An ultrasound scan followed by fine needle aspiration sampling (FNAC) is done to determine the nature of the nodule. While surgical resection is the standard treatment for malignant nodules, benign nodules are usually monitored and if they grow in size, show atypical features on ultrasound scan or pose symptoms, the patient may consider treatment.
One of the recent techniques introduced for treatment is radiofrequency ablation (RFA) of such benign thyroid nodules. This is a minimally invasive technique that involves introducing a small special needle under ultrasound guidance into the nodule. Heat energy is applied to the nodule using this needle with the destruction of cells from within. The nodules gradually shrink in size or become stable and are smaller in size on follow-up.
This procedure is well tolerated, and is usually performed as a day surgery procedure under light sedation. Patients are usually discharged the same day after monitoring and there is no surgical scar. The
normal thyroid tissue adjacent to the nodule is also preserved by this procedure.
PROSTATE ARTERY EMBOLISATION (PAE)
PAE is a non-surgical way of treating BENIGN PROSTATIC HYPERTROPHY (BPH) which is a non-cancerous condition affecting men caused by an enlarged prostate gland.
The enlarged prostate compresses on the urine channel leading from the bladder outwards – the urethra, and as a result affects the flow and passage of urine. Patients suffering from BPH may have symptoms affecting their lifestyle considerably. Some of these symptoms include:
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder
- Urinary tract infection
- Inability to urinate
- Blood in the urine
There are many treatment options for BPH currently. These include:
- Oral medication to reduce the size of the prostate – this may require long-term or lifelong use of the medication.
- Balloon and Microwave therapy to enlarged the urethral passage – there may be the possibility of re-narrowing of the passage as well as risk of urinary incontinance.
- Special implanted devices to widen the urethra – there may be the risk of implant failure and risk of recurrence of symptoms.
- TURP surgical procedure – this is surgery to “shave off” the enlarged prostate compressing on the urethra – this is the most routinely done operation but carries a risk of urinary incontinence and also impotence.
PAE treats the enlarged and troublesome prostate by blocking off the arteries that feed the gland and making it shrink. It is an alternative to the treatments discussed above. PAE was first performed in 2009, and since then many men worldwide have been treated successfully with this method. In PAE, a puncture is made in the groin artery under local anaesthesia and a guidewire and catheter is passed under X-ray guidance to the arteries that supply the prostate. Tiny microspheres/ particles are then injected into the very small arteries that supply the prostate to block off the blood supply to the prostate. As a result, the prostate shrinks and the urethra is less compressed.
PAE can be done as a day surgery procedure under local anaesthesia and some mild sedation. Most patients experience minimal pain and discomfort from the procedure and recover within 4 – 6 hours post procedure and are able to be discharged home well.
PAE does not have any risk of urinary incontinence or impotence. Studies have shown that after PAE is done, the majority of patients report an improvement in their troublesome symptoms due to an increased urine flow rate. Many men also are able to stop taking oral medication long term. PAE may be cost-effective for such patients.
Am I suitable for PAE?
Certain patient groups are particularly suitable for PAE. These include the following:
1) Patients who are taking oral medication and are still having symptoms
2) Patients have undergone other procedures (see above) and have not seen improvement in their symptoms
3) Elderly patients with severe symptoms and who are consider at significant risk for general anaesthesia and surgery
4) Patients who are not suitable for TURP due to bleeding risks
5) Patients who wish to maintain their urinary continence and sexual potency