Golzarian has been a supporter of ours for years. I've had an opportunity to hear several different lectures from him on a multitude of different subjects, and he does an outstanding job. Golzarian comes from the University of Brussels.
As he came back over here, he is now at the University of Minnesota Medical Center, and he's actually the Director. He's also, uniquely enough, which is henceforth why you'll find his expertise in this subject, he's the Chief Medical Officer of EmboMedics, and an inventor of the company's technology.
He's truly an interventional radiologist. He gold standard TURP everything to the gold standard TURP, and he's considered in his group and in the SIR community, and within this community, one of the experts in embolization. He's performed multiple first-time procedures. He is author in 60 different peer reviewed articles, and currently still, as I indicated just shortly ago, the Director of Vascular Interventional Radiology.
One of the other highlights. If you ever have an opportunity to go to that meeting, or certainly if gold standard TURP have interest in embolization, I would say don't miss that meeting. It's a mandatory meeting to get to. For right now, let's welcome Dr.
It is an honor to be here. And you guys are so generous with your comments. I didn't recognize all the things you said. But one thing I have to say is that I was honored with the gold medal from your society too, which is really a great honor. Gold standard TURP, as you know, a prostate. That's the area right around the urethra that can be compressed by hyperplasia. The prevalence increases with age.
Unfortunately, the cost in the U. That's the extreme symptoms of obstructive gold standard TURP. And then irritative symptoms that are frequency, urgency, nocturia and urge incontinence. It's a score sheet that is gold standard TURP very obvious to understand at the beginning, but you just need to answer the question and see how often those symptoms happen.
It ends with the quality of life related to urinary symptoms. Usually, we consider that any IPSS score of one to seven is mild symptoms, eight to 19 is moderate symptoms, and 20 and above is severe symptoms.
So that's something we have to have in every patient, to make sure we understand the degree of gold standard TURP. So what are the gold standard TURP They are a lot of options, but the first option, usually, is to try to change the lifestyle. So, the pharmacology therapy is now the next step, which would include two types of drugs. Those materials come with their own limitations and side-effects. They are some major side-effects, and a lot of patients don't like it. Of gold standard TURP, then there is surgical approach.
I didn't even add the last two-three procedures that were added. Gold standard TURP when you see a lot of procedures for the same disease, that means none of them really works very well. And that's important. If you had a very good procedure that was working, you wouldn't create 10 different procedures.
But the gold standard is TURP. It used to be surgical prostatectomy for larger prostate. It's now mostly a transurethal resection of the gold standard TURP, but some centers now they are doing more of laser.
These are some of the complications of TURP, beside the fact that you have gold standard TURP put a very large tube through penile tissues that are scary for men. There's a lot of other complications, such as incontinence, UTI, hematuria. So it's scary for many of the patients. Even urologists recognize that they are needs for newer or better procedures. Prostatic artery embolization is not new because we have been gold standard TURP embolization. But what is new is actually the indication for BPH.
It is a minimally invasive procedure. It's outpatient procedure. It can be applied to patients with contraindication to surgery or limitation of surgery, like patients with low platelets, patients with bleeding, large prostate, patients that need general anesthesia.
And it's well-tolerated in general. So how does that work? Gold standard TURP think that by reducing or stopping the blood flow gold standard TURP the prostate, you will have a shrinkage of the gland, and changing the consistency of the prostate from a solid organ to a more softer organ.
Animal studies have been done. A lot of them. In general, what we've found with animal studies is that PAE induces gold standard TURP volume reduction. In general, there is no injuries to other organs. We see evidence of cystic changes, and some gold standard TURP of glandular necrosis. Here is one example showing a cystic change in the prostate after embolization in an animal model. And this is an example of one of our patients. After embolization, you see this area of necrosed glandular tissues.
So the first case, like a lot of things we do, was an accidental finding. DeMeritt published a case of a patient with BPH that had bleeding, and when they treated the BPH they realized that the patient symptoms went away.
A few years later, Francisco Carnevale worked on a two-patient. Pisco published their first experience in 15 patients. This is the first patient, and we see with this that the majority of patients decreased their IPSS scores significantly. They had a better quality of life, and the prostate volume reduction was about average of Carnevale also published their result in patients with indwelling catheter. It's really a painful thing to have a catheter for long-term.
So more studies, and I'm gold standard TURP going over those data quickly, showing that the success rate varies from 80 to 70 percent. And these are the improvements gold standard TURP the quality of life and IPSS score and prostate volume.
It's a prospective randomized trial. They show overall that, even though they said they were more clinical failures with the PAE group compared to the TURP group, but with time the outcome of clinical success was the same. We have published here a letter to editor against this paper, because they didn't consider things like bleeding, transfusion after the TURP as a complication.
So this data, even though it was biased against PAE, end up to be a very good result. Another study from Dr. Kurbatov studying eight patients with larger prostate, and the result at one year show significant improvement. You see all this data showing IPSS score in average dropped. The quality Qmax, which is the flow rate, maximum flow rate, increased. PVR, post-void residual, dropped. And then PSA, which is a marker of inflammation, at the beginning was higher and then dropped with time.
There are discussions about the small size of particle. It seemed that with smaller particle you may get more necrosis to the prostate, but the outcome, in terms of clinical outcome, was similar. And then Carnevale also studied different techniques of embolization. They describe a technique where you embolize at the origin of the prostatic artery, and then you go more distally and then embolize more distally. With that technique it seemed that they had a better outcome in general.
So how to start PAE? How many of you are working in divisions that have a PAE program? If we would have asked that two years ago, there were almost nobody. There are more and more people doing that. I think the first thing you really need to be convinced that this is something that works.
InI was hesitant, so I went to see Pisco's group in Lisbon. They did four cases on a Saturday after 4p. No, sorry. After, yeah, after 4p. Four cases. I just flew from Minnesota, I was jet-lagged, and watched four cases on a Saturday. Nobody was in the hospital. And then at midnight I was almost dead, and he said, "Let's gold standard TURP and have dinner". Curiously, every restaurant was open.