The Interventionalist Journal

RENAL ANGIOPLASTY IN A YOUNG HYPERTENSIVE PATIENT WITH RENAL ARTERY STENOSIS

2025-05-13T17:20:18+00:00

Renal artery stenosis (RAS) is a significant cause of secondary hypertension, particularly in younger patients. While more common in older adults, RAS can affect younger individuals, often due to fibromuscular dysplasia (FMD) or atherosclerotic disease. This case report discusses a 20-year-old man with hypertension secondary to RAS who was successfully treated with renal angioplasty, resulting in normalized blood pressure and symptom resolution. We also conducted a systematic review of the literature to evaluate the efficacy and safety of renal angioplasty in young patients with RAS, highlighting its potential benefits and limitations

Evaluation of Multiparametric MRI for Prostate Cancer Detection in Men with Intermediate PSA Levels (4–10 ng/mL)

2025-05-13T17:29:13+00:00

Background Prostate cancer is the third most common cancer among men in Malaysia. Due to the lack of a screening program, elevated PSA levels often raise suspicion of prostate cancer. PSA levels between 4 and 10 ng/mL, known as the "grey zone," lead to unnecessary biopsies in most of cases. Multiparametric MRI (mpMRI) with PI-RADS scoring is increasingly used as a prebiopsy tool to aid in screening within this range.

Material and methods We performed a retrospective study to assess the correlation between mpMRI in men with elevated PSA levels. Men with PSA concentrations between 4-10 ng/mL, who had not previously undergone a biopsy, underwent mpMRI, followed by TRUS biopsy if necessary. The primary outcome was the relationship between the PI-RADS score and the cancer diagnosis. Secondary outcomes focused on factors associated with the diagnosis of prostate cancer.

Result A total of 169 patients with PSA level of 4-10 ng/mL were included in this study. Sixty eight patients underwent mpMRI followed by TRUS biopsy. There was significant association between age and PI-RADS score in patient with prostate cancer. Prostate cancer patients are averagely older ,71-year-old compared to no cancer group,61-year-old, (p= 0.045). Significant difference between PI-RADS score and prostate cancer group with cancer patients had higher PI-RADS score (4-5) compared to non-cancer group (p< 0.001).

Conclusion Multi-parametric MRI with the PI-RADS scoring system can serve as a pre-biopsy tool for patients with PSA levels between 4 and 10 ng/mL. This approach helps prevent unnecessary biopsies, provides a more objective method for diagnosing prostate cancer, and assists clinicians in making decisions for patients in this grey zone.

Keywords: Prostate cancer, PSA, Multiparametric MRI

The First Preoperative Risk Score for Postoperative Ileus Following Robotic Radical Prostatectomy: Novel Thresholds for BMI, HbA1c, and Tumor Risk Stratification

2025-05-18T18:19:48+00:00

Background: Postoperative ileus (POI) remains a common complication following robotic-assisted radical prostatectomy (RARP), delaying recovery and increasing healthcare burden. Obesity and impaired glycemic control are recognized contributors to poor postoperative outcomes through mechanisms such as inflammation, delayed gut motility, and impaired healing. However, their role in predicting POI, particularly in RARP, remains underexplored. This study aims to evaluate and define preoperative cutoff values for BMI and HbA1c associated with POI and develop the first risk score combining metabolic and oncological predictors.

Methods: A retrospective analysis was conducted on 200 patients who underwent RARP between January 2020 and December 2023. Preoperative variables included BMI, HbA1c, clinical T stage, PIRADS score, prostate volume (MRI), and biopsy Gleason score. Optimal thresholds for BMI and HbA1c were determined using ROC analysis and Youden’s J statistic. A six-point scoring system was developed based on categorical cutoffs, with logistic regression and ROC analysis used to evaluate performance.

Results: The overall incidence of POI was 17%. Novel thresholds—BMI ≥31.0 kg/m² and HbA1c ≥8.0%—were independently associated with higher POI risk. The additive score (range 0–6) showed progressive increases in POI incidence with higher scores. While the model demonstrated modest discrimination (AUC = 0.55), it remains clinically valuable given its simplicity and exclusive reliance on preoperative data.

Conclusion: This is the first study to define actionable preoperative thresholds for BMI and HbA1c in predicting POI after RARP. The resulting score offers a practical, bedside tool to support early risk stratification and preoperative counseling. Its simplicity supports clinical integration, and future multicenter validation may enhance predictive accuracy and expand its utility in enhanced recovery protocols.