Often there is a road in between. It starts with a conversation, and it goes in through a puncture the width of a pen tip.
A question costs you a message. Nothing is decided today.
The trip you stopped planning around a bleed, back on the calendar.
never need a hysterectomy
At ten years of follow up, in the largest trial that has measured it.
PMID 27393268and the uterus stays
The fibroid is treated through the one artery that feeds it.
PMID 25541260stay, and faster back to normal
A shorter procedure and a shorter hospital stay, in every study that measured it.
PMID 25541260The night you stop counting how many times you got up.
as likely to affect ejaculation
Against the operation. Erections are comparable either way.
PMID 35349161in hospital
Symptoms usually settle over about two weeks rather than overnight.
The ache you had learned to live with, gone quiet.
after a ligation that failed
Which is the situation a good number of men arrive in.
PMID 41137990A parent who spends the time he has left living, rather than recovering.
in every 100 had a severe side effect
Against 50.6 on drug treatment, in advanced disease.
PMID 29498924in every 100 responded
In a single tumour of 8 cm or less. And 92.8 of those carried through to surgery or a transplant.
PMID 33739462decides before he treats
Radiology, oncology and surgery in one room. He is one voice in it.
PMID 32399360The pain that finally gets taken seriously, and looked at properly.
had substantial pain relief
Across 21 studies and 1 308 women, and it generally increased over time.
PMID 27397619and no general anaesthetic
It is done through the vein, from a single puncture.
PMID 27397619A fibroid is not fed by the whole body. It is fed by one road, and so is an enlarged prostate, and so is the vein that aches when you stand. Close that road and the thing at the end of it shrinks, while everything with another way in carries on as normal.
The instrument is a tube narrower than the tip of a pen. It is steered through the vessels under live imaging, from a puncture that does not need a stitch. There is no incision anywhere on you.
The word for it is embolization.
Recruited between January 2015 and June 2017, median age 64. One complication across the series, a cholecystitis treated with antibiotics.
“Performing radioembolization in a non-referral, private center in Lebanon resulted in good patient outcomes with few complications.”Cureus 2020 · PMID 32399360
His hospital’s newsroom, 26 January 2015: “our Interventional Radiologist Dr. Kabalane Yammine has performed the first three cases in Lebanon to treat liver tumors that are inoperable.”
That page is gone from the live site. This links to the archived copy, which carries the same sentence in six snapshots between 2019 and 2024.
Clemenceau Medical Center newsroom · archivedOn liver radioembolization, on a uterine arteriovenous malformation, and on peripheral vascular intervention. The earliest is from 2002, written with an interventional radiologist at Allegheny General in Pittsburgh, where he trained.
PMID 32399360 · 37101894 · 29595682 · 29988675 · 12101383Diagnostic radiology at Harlem Hospital Center and at Allegheny General Hospital, Pittsburgh. Registered with the Lebanese Order of Physicians, Beirut, under ي/225.
Photographed off the monitor mid procedure, November 2020. The vessel tree is what he is steering through, and the device at the branch is the road being closed.
An interviewer put it to him directly, in a medical magazine, in June 2023. He answered in Arabic.
هذا الخيار لعلاج تضخم البروستات ليس بديلاً عن الجراحة او العلاجات الأخرى المعتمدة
This option for treating an enlarged prostate is not a replacement for surgery or the other established treatments.
Arab Hospital Magazine · 19 June 2023A tumour board decides before he treats. The author list on the 2020 paper spans radiology, oncology and surgery, which is what that means in practice.
Cureus 2020 · the author list
Clemenceau Medical Center
A physician profile, filmed and published by the hospital.
Watch it ↗
Clemenceau Medical Center
Treating liver tumours without opening the body.
Watch it ↗
What it spares you
No incision, and the uterus stays. Far less likely to need a transfusion, odds ratio 0.07. A shorter procedure, a shorter stay and a faster return to normal, in every study that measured it.
Cochrane · PMID 25541260What it costs you
Between 15 and 32 in every 100 need further surgery within two years, against about 7 after hysterectomy or myomectomy. At ten years 35 in every 100 had had a hysterectomy anyway, and 78 in every 100 were satisfied or very satisfied, against 87.
EMMY, ten year follow up · PMID 27393268What it spares you
No general anaesthetic. Nothing passed through the urethra. A day case. Ejaculatory problems are about half as likely, risk ratio 0.51, and erections are comparable either way.
PMID 35349161What it costs you
You are about three times more likely to need treating again, risk ratio 3.20. At five years the operation relieved more: symptom score down 11.6 points against 7.8, flow up 9.3 against 3.6. Only 18 of 48 men reached that visit, so the long term evidence is thinner than the confidence it is usually quoted with, on both sides.
PMID 35349161 · 38531756It is the first choice rather than the second if you cannot safely have a general anaesthetic, if you are on blood thinners, if the gland is very large, or if you are catheterised and want it out.
What it spares you
Fewer complications overall, odds ratio 0.65. No general anaesthetic, no incision, home the same day. Hydrocele is close to eliminated, odds ratio 0.19.
PMID 41137990What it costs you
It comes back more often, odds ratio 1.37. Surgical ligation is better at making it stay fixed. On sperm count the evidence is genuinely inconclusive and the authors say so themselves.
PMID 41137990It also works after a ligation that failed.
What it spares you
Against drug treatment in advanced disease, severe side effects were far less common: 27.7 in every 100 against 50.6. Pooling all three trials, severe treatment related events ran at 28.9 against 43.3.
NEMESIS · PMID 32358087What it costs you
It did not extend life. Two trials measured survival against sorafenib and both were negative, 8.0 months against 9.9, and 8.8 against 10.0. In colorectal secondaries it improved control in the liver and left overall survival unchanged at 14.0 months against 14.4.
SARAH · SIRveNIB · EPOCH · PMID 29107679Where the results are strongest is narrower than most pages imply: a single tumour of 8 cm or less. There, response ran at 88.3 in every 100 and three year survival at 86.6. Treating a liver tumour with heat is a different offer again, and it is the one that can be curative.
What it spares you
Across 21 studies and 1 308 women, about 75 in every 100 had substantial early pain relief, which generally increased over time. Repeat procedures were uncommon and coils moved in under 2 in every 100.
PMID 27397619What it costs you
The same review says the quality of that evidence is low, and that the link between leaking pelvic veins and chronic pelvic pain has not been established.
PMID 27397619The evidence here is not as strong as he would like. Most women in these studies got substantially better. The first thing he will do is take the pain seriously enough to scan for a cause.
The evidence points that way and it is not close enough to argue about. Live births were more likely after myomectomy, and quality of life at two years was better. If that is your situation he will say so in the room and tell you who to see.
Pregnancy after embolization happens and is usually normal. Across 24 studies, 40.5 in every 100 women who wanted a pregnancy had at least one, and about a third of pregnancies were lost. That is not nothing, and it is not the first option if a baby is the point.
At five years the operation beat this on every measure that was tested. What this spares you is the anaesthetic, the urethra and, very often, the ejaculation. What it costs you is that you are three times more likely to be back. Which of those two trades is right is a conversation, not a web page.
Recurrence is higher after embolization, odds ratio 1.37, and that is the honest reason to choose the operation. And if you are here because of a semen analysis rather than an ache, the effect on sperm count is not proven either way. The authors of the largest review say so themselves.
Two randomised trials measured survival against drug treatment and both were negative. In colorectal secondaries it improved control in the liver and left overall survival unchanged. What it changed was how many of those months were spent seriously unwell, and for a family deciding how a parent spends a year that is not a small thing. But it is not the same as longer, and it is not said here as though it were.
The largest review found that about three in four women had substantial relief. The same review says the quality of that evidence is low, and that the causal link between leaking pelvic veins and chronic pelvic pain has not been established. Both of those sentences are true and you should have both before you decide anything.
Possibly, and it is not the first choice if a pregnancy is the point. Across 24 studies, 40.5 in every 100 women who wanted a pregnancy had at least one. If you want to be pregnant, ask about a myomectomy first.
Between 15 and 32 in every 100 women need something more within two years. At ten years, about two thirds had never needed a hysterectomy.
Shorter than after surgery, and the exact answer depends on the fibroids. It is confirmed at the first visit rather than guessed at here.
It is about half as likely to than the operation is, risk ratio 0.51. Erections are comparable either way. That single side effect is why most men ask about this in the first place.
No. Local anaesthetic with light sedation, and one day in hospital.
Symptoms usually settle over about two weeks rather than overnight.
No. Embolization works after a failed surgical ligation, and that is a common reason to be referred.
Honestly, that is not proven. The largest review found the effect inconclusive and its authors say so. If the ache is the problem, the case is much clearer.
No. No incision, no general anaesthetic, home the same day.
Not on the evidence. Two trials measured survival against drug treatment and both were negative. What it changed was how many of the months were spent seriously unwell.
A tumour board of radiologists, oncologists and surgeons, before anything is booked.
He published the results of his own programme in 2020: 23 patients, treated at his own centre in Beirut, with his name first on the paper.
Because pelvic veins are not what a standard scan is looking for. The first thing done here is to look for a cause properly.
About three in four women in the studies had substantial relief, and it generally increased over time. The same review says the quality of that evidence is low. Both of those are true.
No.
The message starts itself and stops mid sentence. An empty box is where a question dies.
Kabalane Yammine, MD · also written Kabalan, and قبلان يمّين · Lebanese Order of Physicians, Beirut · ي/225
This page describes treatments and the evidence behind them. It is not medical advice and it cannot tell you which treatment is right for you. That is decided with a doctor who has seen your scans.