You were offered an operation.
I am an interventional radiologist. I treat fibroids, an enlarged prostate, varicocele, liver tumours and pelvic pain from inside the blood vessel that feeds them, with a needle instead of a cut.
A question costs you a message. Nothing is decided today.
Most people who write to me are dealing with one of five things.
Open the one that is yours. I have put what it spares you next to what it costs you, because you will find the second part eventually and I would rather you found it here.
FibroidsHeavy bleeding, and someone has told you the answer is a hysterectomy.
What I do
A fibroid is fed by its own artery. I pass a fine tube up to that artery and block it, and the fibroid loses its blood supply and shrinks. Your uterus stays where it is. There is no cut, and no general anaesthetic.
What it spares you. At ten years of follow up, in the largest trial that measured it, two women in three never went on to need a hysterectomy. The hospital stay is shorter and you are back to normal faster.
Source: PMID 27393268 and PMID 25541260.
What it costs you
Between 15 and 32 women in 100 need a further procedure within two years, against about 7 in 100 after surgery. Minor complications are more common, not fewer.
And if you want to be pregnant, this is probably not your operation. The evidence points toward myomectomy for fertility, and I will tell you that in the room and send you to the right surgeon.
Source: PMID 25541260.
Ask me about fibroidsAn enlarged prostateUp several times a night, and you have been offered a TURP.
What I do
I block the small arteries feeding the prostate, from inside, through a needle in the wrist or the groin. The prostate shrinks over the following weeks. Nothing is cut and nothing is passed through the urethra.
What it spares you. I will say the thing most men are too polite to ask about. After a TURP, semen commonly goes backwards into the bladder instead of forwards. After this, that is roughly half as likely.
Source: PMID 35349161.
What it costs you
You are about three times more likely to need treating again than after a TURP, and at five years a TURP has done the better job on the symptoms themselves.
So this is the right operation for a man who wants to keep what a TURP takes, and the wrong one for a man who wants the most complete result and does not mind the trade.
Source: PMID 35349161 and PMID 38531756.
Ask me about the prostateVaricoceleAn ache that is not there in the morning and is there by the evening.
What I do
The vein that is not draining properly gets closed off from the inside, through a needle. No incision in the groin, no general anaesthetic, and you go home the same day.
What it spares you. After open surgery a fluid swelling called a hydrocele is a common complication. After this route it is close to eliminated.
Source: PMID 41137990.
What it costs you
It comes back somewhat more often than after surgery.
And if you are here about fertility, I have to be straight with you. Whether this improves a sperm count is not proven. The best analysis of it does not reach significance and its own authors call it inconclusive. Anyone who promises you a number is ahead of the evidence.
Source: PMID 41137990.
Ask me about varicoceleLiver tumoursA scan found something, and someone said the word radioembolization.
What I do
This is radioembolization, also called SIRT or Y-90. I deliver radioactive beads straight down the artery that feeds the tumour, so the dose lands on the tumour and largely spares the rest of the liver. I also use heat, radiofrequency and microwave, to destroy small tumours directly.
I published my own results. Twenty three of my own patients, at Clemenceau, in a journal anyone can open for free and read.
Cureus, 2020. PMID 32399360. Median age 64.
What it costs you, and what it does not buy
It does not make you live longer. Two large trials compared it against standard chemotherapy and neither found a survival advantage. In my own published series the median survival was twelve months. Anyone telling your family this turns months into years is not telling you the truth.
What it does change is how those months are spent. Severe side effects were markedly less common than with chemotherapy, 29 patients in 100 against 43 in 100.
Sources: PMID 29107679, PMID 32358087 and PMID 32399360.
Ask me about the liverPelvic pain that nobody has explainedYears of being told the scans are normal.
What I do
Sometimes this pain comes from veins in the pelvis that do not drain properly, and it gets worse through the day and when you stand. It is looked for with a scan aimed at the veins, and if it is there, those veins can be closed from the inside.
What it spares you. Mostly, being disbelieved. This is a real and findable cause, and looking for it properly is the first thing anyone should have done.
What it costs you
I will not pretend the evidence here is as strong as it is for the others. The trials are small and the field does not agree with itself yet.
What I can tell you honestly is whether your veins look like the cause of your pain, and if they do not, I will say that too rather than treat you anyway.
Ask me about pelvic painThe same idea, every time.
Almost everything I do works the same way. Something in your body has one road feeding it. I drive up that road and close it, and I leave every other road open.
01One artery feeds the growth. The other branches feed healthy tissue, and they are the reason this works at all.
02A tube the width of a pen tip goes in at your wrist or your groin. I watch it on a screen the whole way and steer it into that one branch.
03I close that branch. The growth loses its supply and shrinks over the following weeks, while everything else carries on.
What you can check without taking my word for it.
Not one line here is something I wrote about myself.
2020 Selective internal radiation therapy for tumours in the liver My own twenty three patients at Clemenceau, written up with my name first, in a journal any doctor anywhere can open for free and check against what I have told you. Clemenceau
2015 First in Lebanon to treat inoperable liver tumours this way My hospital's own announcement, 26 January 2015, crediting me with the first three cases in the country. I did not write that sentence. Their page has since come down, so this is the archived copy. Archived MTV
Santé Fifteen minutes of live questions about fibroids, on national television Lebanese television asked me on to take viewers' own calls, unscripted, on their daily medical programme. Clemenceau
film My hospital filmed me explaining how I work On their premises, on their own channel, in their own words. I did not write the script and I do not control the page.
Beirut, by way of Washington.
I studied medicine at the American University of Beirut. I went to Georgetown University in Washington, DC, to train in interventional radiology. I worked in the United States for a while, and then I came home.
Today I practise at Clemenceau Medical Center and at Saint George Hospital University Medical Center, both in Beirut, in the Department of Diagnostic and Interventional Radiology.
In 2023 a medical magazine asked me, on the record, what a newer treatment for an enlarged prostate could and could not do. I answered the second half first.
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 for the other treatments that are already established.
Arab Hospital Magazine, 19 June 2023
That is the answer I give in the room, too. If a specialist has already told you something that still holds, I will tell you that, and where to go instead.
Tell me what is happening, in your own words.
I will tell you whether this is even a problem to solve my way, and where to go if it is not. If you are abroad, or you are asking on behalf of a parent, send me the scan report in the same message and I will read it before we speak.
A question costs you a message. Nothing is decided today.
Lebanese Order of Physicians, Beirut · ي/225
Clemenceau Medical Center
Department of Diagnostic and Interventional Radiology, Beirut
Saint George Hospital University Medical Center
Achrafieh, Beirut
Send the imaging and the question on the same number and I will come back to you, not to your patient.
Arabic, English and French