Interventional Radiologists in Nephrology and Urology

Interventional radiologists increasingly are involved in the treatment of urologic and nephrologic conditions and diseases.

They perform such procedures as renal cryoablation, renal artery angioplasty and stenting in patients with renal artery stenosis, and stent grafting in hemodialysis patients.

At the recent annual meeting of the Society of Interventional Radiology (SIR), interventional radiologists reported data showing that they can perform fiducial marker placement safely in patients undergoing radiotherapy for prostate cancer and prostatic artery embolization in patients with lower urinary tract infections secondary to benign prostatic hyperplasia.

Interventional radiology (IR) has grown from a radiology subspecialty into a primary specialty. This is the result of a joint effort of SIR and the American Board of Radiology, which grant a dual IR/diagnostic radiology certificate (now being modeled after other dual certificates). The Accreditation Council for Graduate Medical Education is now reviewing the certificate order to begin the accreditation process of interventional radiology residencies.

The SIR meeting this year featured an “In the Trenches” series focusing on various trends affecting IR. The speakers included Michael C. Soulen, MD, Professor of Radiology at the University of Pennsylvania School of Medicine in Philadelphia; interventional radiologist Brooke Spencer, MD, of RIA Endovascular in Greenwood Village, Colo.; Matthew Johnson, MD, Director of Interventional Oncology at the Indiana University School of Medicine in Indianapolis; and George A. Fueredi, MD, SIR's Executive Council on Health Policy and Economics. All four spoke with Renal & Urology News about the state of IR.

From surgery to radiology

“I was around when IR was being born,” Dr. Soulen said. “IR primary specialty status presents a great opportunity to start the process to develop separate residency programs. Many of us in IR started as surgeons, then added a fellowship in radiology to specialize in interventional radiology—a great foundation for the work we do in the trenches, whether it's in the operating room or an outpatient clinic. The minimally invasive treatments and therapies are bringing a [better] quality of life to cancer patients with advanced disease. So whether it's the oncologist, urologist, or nephrologist, the Tumor Board becomes complete with the interventional radiologist.”

The Philadelphia area has 50 hospitals providing IR services and 20 years of IR fellowships, Dr. Soulen pointed out. “We have every type of IR model that exists: academic, outpatient, free-standing and hospital-based IR practice, large radiology-IR groups, independents, and multi-specialty group practice.”

Dr. Soulen said he believes interventional radiologists should avoid becoming too specialized. “While I focus on cancer-related therapies of the lung, kidney, bone metastasis, and urinary malignancies, that expertise came from a broad base of doing IR in the trenches. For example, if I'm called to consult on a renal mass prior to surgery or a urologic malignancy, we establish a close relationship with our urology and oncology colleagues. At Tumor Board, we all contribute to every aspect of the care plan.”

In Dr. Soulen's view, interventional radiologists of the future will need to entrench themselves in all types of medicine.

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