Die Autoren bedanken sich für die Unterstützung durch das National Key Research and Development Program of China (Grant 2017YFC840102).

Alle hier beschriebenen Methoden wurden von der Ethikkommission des Pekinger Krankenhauses genehmigt. Die Indikationen für eine Operation richten sich nach den Leitlinien der European Association of Urology für nicht-neurogene männliche LUTS. Kontraindikationen sind der Verdacht auf Prostatakrebs oder eine Detrusorfunktionsstörung.
1. Instrumente für den Betrieb
<ol><li>Stellen Sie die Verfügbarkeit von Diodenlasern (980 nm) mit einer Leistung einschließlich Dauerbetrieb (80-100 W) sicher.</li>
	<li>Verwenden Sie eine Laserfaser und eine 0,9%ige Kochsalzlösung für die intraoperative Blasenspülung.</li>
	<li>Verwenden Sie ein 26-F-Laserresektoskop, um eine gute Visualisierung zu erzielen und die Effizienz zu steigern.</li>
</ol>2. Vorbereitung für den Betrieb
<ol><li>Führen Sie am Tag der Operation eine Hautvorbereitung durch.</li>
	<li>Geben Sie allen Patienten präoperativ ein intravenöses Antibiotikum10. HINWEIS: Cefuroxim-Natrium (1,5 g in 100 ml 0,9% Natriumchlorid) wird 30 Minuten vor der Operation verabreicht.</li>
	<li>Lassen Sie den Patienten vor der Anästhesie auf dem Operationstisch liegen. HINWEIS: Eine Vollnarkose ist wirksam und für diese Operation geeignet. Die Anästhesisten sollten die Art der Anästhesie in Abhängigkeit vom Allgemeinzustand des Patienten bestimmen.</li>
	<li>Drapieren Sie den Patienten steril in der dorsalen Lithotomieposition.</li>
</ol>3. Schritte des Verfahrens
<ol><li>Beobachtung<ol><li>Direkte Beobachtung der Harnröhre, des Verumontanums, des Blasenhalses, der Harnleiteröffnungen, der Blasenschleimhaut und der trabekulären Hyperplasie mit dem Resektoskop (15-30°).</li>
	</ol></li>
	<li>Entwerfen Sie den Bereich der Enukleation (Amorpfeil).<ol><li>Zirkulär einschneiden (Tiefe bis zur Drüse, Breite ca. 3-4 mm) die Blasenhalsschleimhaut mit einem Laser (Abbildung 1).</li>
		<li>Zirkulär einschneiden (Tiefe bis zur Drüse, Breite ca. 3-4 mm) der Prostata-Harnröhrenschleimhaut am proximalen Ende des Verumontanums mit einem Laser (Abbildung 2). HINWEIS: Bestätigen Sie die anatomische Markierung vor dem Einschnitt, um Verletzungen der Blasenhalsschleimhaut und der Schließmuskelharnröhre zu vermeiden. Verwenden Sie während der Operation eine Laserleistung von 80-100 W, außer für die Blutstillung.</li>
		<li>Verbinden Sie die konzentrischen Kreise des Blasenhalses und der Spitze der Prostata in der hinteren Harnröhre in einer 12-Uhr-Position.</li>
		<li>Schneiden Sie den linken und rechten Lappen mit dem Laser ein (Abbildung 3). HINWEIS: Sobald die 12-Uhr-Position der hinteren Harnröhre vorgeschnitten ist, behalten Sie die distale Schleimhaut bei. Die konzentrischen Kreise, die sich am Hals der Blase und an der Spitze der Prostata bilden, werden als Amorpfeile bezeichnet.</li>
	</ol></li>
	<li>Erstellen eines Kanals<ol><li>Suchen Sie die chirurgische Kapsel an der 5- und 7-Uhr-Position des Scheitelpunkts der Prostata.</li>
		<li>Suchen Sie die chirurgische Kapsel an den Positionen der chirurgischen Kapsel um 5 und 7 Uhr.</li>
		<li>Verbinden Sie die Positionen der chirurgischen Kapsel bei 5 und 7 Uhr mit einem Laser (Abbildung 4).</li>
		<li>In der 6-Uhr-Position der Prostataspitze wird der Medianlappen von der chirurgischen Kapsel von der Prostataspitze bis zum Blasenhals mit einem Laser getrennt (Abbildung 5). HINWEIS: Wenn das Volumen der Prostata >80 ml beträgt, werden der Median- und der Laterallappen an der 5- und 7-Uhr-Position der Spitze der Prostata vollständig getrennt.</li>
	</ol></li>
	<li>Enukleation des linken und rechten Lappens<ol><li>Gegen den Uhrzeigersinn den rechten Lappen bei 6 und 12 Uhr von der Spitze der Prostata bis zum Blasenhals mit einem Resektoskop enukleieren (Abbildung 6).</li>
		<li>Im Uhrzeigersinn enukleieren Sie den linken Lappen bei 6 und 12 Uhr von der Spitze der Prostata bis zum Blasenhals (Abbildung 7).</li>
		<li>Schieben Sie nach der Enukleation alle Drüsen in die Blase. HINWEIS: Wenn das Volumen der Prostata >80 ml beträgt, enukleieren Sie den Median- und den Laterallappen in der richtigen Reihenfolge; Drücken Sie dann in die Blase.</li>
	</ol></li>
	<li>Hämostase<ol><li>Verwenden Sie eine niedrigere Laserleistung (50 W), um Blutungen an der Operationsstelle zu stoppen. Halten Sie einen angemessenen Abstand (z. B. 1-3 mm) ein.</li>
	</ol></li>
	<li>Morcellieren Sie das Prostatagewebe.<ol><li>Morcellieren Sie das enukleierte Prostatagewebe mit einem Morcellator in kleine Stücke (so klein wie möglich) und entfernen Sie anschließend das Gewebe aus der Blase (Abbildung 8).</li>
	</ol></li>
	<li>Katheterisierung<ol><li>Entfernen Sie den Morcellator aus der Harnröhre.</li>
		<li>Legen Sie vorsichtig einen 22 F Foley-Katheter durch die Harnröhrenöffnung in die Blasenhöhle mit 30 ml Wasser im Ballon, nachdem Sie die Harnröhre ausreichend mit Lidocain-Gel geschmiert haben.</li>
	</ol></li>
	<li>Nachsorge10<ol><li>Lassen Sie den Patienten nach der Operation ca. 3 h auf der Pflegestation auf dem Bett liegen, bis er vollständig aus der Narkose erwacht ist. Stellen Sie sicher, dass in dieser Zeit Patientenmonitore und medizinischer Sauerstoff zur Verfügung stehen.</li>
		<li>Sobald der Patient vollständig aufgewacht ist, bringen Sie ihn zurück auf die Station. Lassen Sie den Patienten anfangen, etwas Wasser zu trinken und etwas zu essen. Notieren Sie die Urinausscheidung und achten Sie auf die Farbe des Urins.</li>
	</ol></li>
</ol>

<ol>
	<li>Maliszewski, T. M., Sikorski, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=574+Diode+laser+980+nm+for+the+treatment+of+BPH:+Long-term+comparison+of+the+enucleation+vs.+vaporization.">574 Diode laser 980 nm for the treatment of BPH: Long-term comparison of the enucleation vs. vaporization.</a> European Eurology. 14 (2), 137-151 (2015).</li><li>Lerner, L. B., Rajender, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (Suppl 1), 53-59 (2015).</li><li>Das, A. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+retrospective+comparison+of+diode+to+holmium+for+laser+enucleation+of+the+prostate.">A retrospective comparison of diode to holmium for laser enucleation of the prostate.</a> Canadian Journal of Urology. 26 (4), 9836-9842 (2019).</li><li>Hruby, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Eraser+Laser+Enucleation+of+the+Prostate:+Technique+and+Results.">Eraser Laser Enucleation of the Prostate: Technique and Results.</a> European Urology. 63 (2), 341-346 (2013).</li><li>Lerner, L. B., Archana, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (5 Suppl 1), 53 (2015).</li><li>Leonardi, R., Caltabiano, R., Lanzafame, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histological+evaluation+of+prostatic+tissue+following+transurethral+laser+resection+(TULaR)+using+the+980+nm+diode+laser.">Histological evaluation of prostatic tissue following transurethral laser resection (TULaR) using the 980 nm diode laser.</a> Archivio Italiano di Urologia e Andrologia. 82 (82), 1-4 (2010).</li><li>Kahokehr, A., Gilling, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Enucleation+techniques+for+benign+prostate+obstruction:+Which+one+and+why?.">Enucleation techniques for benign prostate obstruction: Which one and why?.</a> Current Opinion in Urology. 24 (1), 49-55 (2013).</li><li>Chung, D. E., Te, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+techniques+for+laser+prostatectomy:+an+update.">New techniques for laser prostatectomy: an update.</a> Therapeutic Advances in Urology. 1 (2), 85-97 (2014).</li><li>Wu, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparative+study+of+diode+laser+and+plasmakinetic+in+transurethral+enucleation+of+the+prostate+for+treating+large+volume+benign+prostatic+hyperplasia:+a+randomized+clinical+trial+with+12-month+follow-up.">A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up.</a> Lasers in Medical Science. 31 (4), 599-604 (2016).</li><li>Wang, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Photoselective+Vaporesection+of+the+Prostate+via+an+End-firing+Lithium+Triborate+Crystal+Laser.">Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser.</a> Journal of Visualized Experiments. (135), e57336 (2018).</li><li>Shigemura, K., Tanaka, K., Yamamichi, F., Chiba, K., Fujisawa, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Predictive+Factors+for+Postoperative+Incontinence+of+Holmium+Laser+Enucleation+of+the+Prostate+by+the+Surgeons'+Experience+During+Learning+Curve.">Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons' Experience During Learning Curve.</a> International Neurourology Journal. 20 (1), 59-68 (2016).</li><li>Stroman, L., Ellis, D., Toomey, R., Mazaris, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+18-month+Audit+of+TURP+Complications+using+the+Clavien-Dindo+Classification+System.">An 18-month Audit of TURP Complications using the Clavien-Dindo Classification System.</a> Journal of Urology. 1 (3), 3 (2013).</li><li>Li, B., Xu, A., Zou, Y., Liu, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Randomized+Trial+Comparing+Diode+Laser+Enucleation+of+the+Prostate+with+Plasmakinetic+Enucleation+and+Resection+of+the+Prostate+for+the+Treatment+of+Benign+Prostatic+Hyperplasia.">A Randomized Trial Comparing Diode Laser Enucleation of the Prostate with Plasmakinetic Enucleation and Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia.</a> Journal of Endourology. 27 (10), 1254-1260 (2013).</li><li>Lerner, L. B., Rajender, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (5 Suppl 1), 53 (2015).</li><li>Wu, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparative+study+of+diode+laser+and+plasmakinetic+in+transurethral+enucleation+of+the+prostate+for+treating+large+volume+benign+prostatic+hyperplasia:+a+randomized+clinical+trial+with+12-month+follow-up.">A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up.</a> Lasers in Medical Science. 31 (4), 599-604 (2016).</li><li>Xu, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized+trial+comparing+diode+laser+enucleation+of+the+prostate+with+plasmakinetic+enucleation+and+resection+of+the+prostate+for+the+treatment+of+benign+prostatic+hyperplasia.">A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia.</a> Journal of Endourology. 27 (10), 1254-1260 (2013).</li><li>Yang, S. S., Hsieh, C. H., Lee, Y. S., Chang, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diode+laser+(980+nm)+enucleation+of+the+prostate:+a+promising+alternative+to+transurethral+resection+of+the+prostate.">Diode laser (980 nm) enucleation of the prostate: a promising alternative to transurethral resection of the prostate.</a> Lasers in Medical Science. 28 (2), 353-360 (2013).</li><li>Liu, L., Cheng, F., Li, H., Yu, W., Rao, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Clinical+Effect+Between+Transurethral+1+470+nm+Diode+Laser+Enucleation+of+the+Prostate+and+Transurethral+Bipolar+Plasmakinetic+Resection+of+Prostate.">Comparison of Clinical Effect Between Transurethral 1 470 nm Diode Laser Enucleation of the Prostate and Transurethral Bipolar Plasmakinetic Resection of Prostate.</a> Medical Journal of Wuhan University. 39 (5), 809-812 (2018).</li><li>Nair, S. M., Pimentel, M. A., Gilling, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Review+of+Laser+Treatment+for+Symptomatic+BPH+(Benign+Prostatic+Hyperplasia).">A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia).</a> Current Urology Reports. 17 (6), 1-8 (2016).</li><li>Cho, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictor+of+de+novo+urinary+incontinence+following+holmium+laser+enucleation+of+the+prostate.">Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate.</a> Neurourology, Urodynamics. 30 (7), 1343-1349 (2011).</li><li>Herrmann, T. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcome+after+endoscopic+enucleation+of+the+prostate:+From+monopolar+enucleation+to+HoLEP+and+from+HoLEP+to+EEP.">Long-term outcome after endoscopic enucleation of the prostate: From monopolar enucleation to HoLEP and from HoLEP to EEP.</a> Der Urologe. Ausg. A. 55 (11), 1446 (2016).</li></ol>

Die Autoren haben nichts offenzulegen.

Derzeit wird der 980-mm-Diodenlaser für die Behandlung von BPH5 eingesetzt. In wenigen Berichten wurden verwandte klinische Studien beschrieben. Im Vergleich zur Wirkung von TURP bei der Behandlung von BPH haben viele Studien gezeigt, dass DiLEP weniger Blutverlust verursacht, eine bessere Funktion beim Wasserlassen erreicht und kürzere Katheterverweilzeiten aufweist 9,13,14,15.<sup class="xr...

Im Vergleich zur traditionellen transurethralen Resektion der Prostata (TURP) haben Laseroperationen aufgrund ihrer besseren Patientenverträglichkeit, des geringeren intraoperativen Blutverlusts, der Wirksamkeit und der kürzeren postoperativen Genesung allmählich an Popularität gewonnen 4,5.
In den letzten Jahren waren die am schnellsten wachsenden Techniken der Einsatz von Lasern verschiedener Wellenlängen. Gegenwärtig können viele Arten von Lasern mit unterschiedlichen Eigenschaften verwendet werden, um die Prostata-Enukleation abzuschließen. Seit der Zulassung des Diodenlasers durch die US-amerikanische FDA zur Behandlung der Prostatahyperplasie im Jahr 2007 hat sein Einsatz bei der Behandlung von BPH aufgrund seiner hervorragenden Schneidfähigkeit und des Blutstillungseffekts schrittweise zugenommen6. Die Wellenlänge des Lasers bestimmt den Grad der Absorption durch Wasser und Hämoglobin. Ein Diodenlaser mit einer Wellenlänge von 980 nm sorgt für die höchste kombinierte Absorptionsrate von Wasser und Hämoglobin. Die Penetrationsfähigkeit des Gewebes beträgt 0,5 mm und kann in tieferem Gewebe Gerinnungseffekte hervorrufen, was ihm eine sehr gute Gewebeablations- und Blutstillungsfähigkeit verleiht 7,8.
Viele Forschungszentren haben begonnen, DiLEP zur Behandlung der gutartigen Prostatahyperplasie einzusetzen. In der Praxis hat die traditionelle DiLEP eine längere Lernkurve und bietet keine offensichtlichen Vorteile in Bezug auf den Harnschließmuskelschutz9. Aus den oben genannten Gründen wurde die traditionelle DiLEP in unserem Zentrum modifiziert, um den Wert der Diodenlaserbehandlung bei Patienten mit BPH zu verbessern.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>HU Diode Laser</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>HU-150</td>
			<td>Wavelength: 980nm 
			Maximum Power: 150W 
			Operation Mode: Continuous and pulsed</td>
		</tr>
		<tr>
			<td>Optical Fiber</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>YYGX600</td>
			<td>Fiber core diameter: 
			600 &#956;m 
			Fiber length: 2m</td>
		</tr>
		<tr>
			<td>Morcellator System</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>PXQ-01</td>
			<td>Rotate Speed: 100-3000rpm 
			MAX. Vacuum Pressure: -80KPa 
			Rated Output Torque: 12mNm 
			Blade Size: &#934;5.0*390mm; &#934;3.5*390mm 
			Blade Work Mode: Corotation alternates reversal</td>
		</tr>
	</tbody>
</table>

enucleation of the prostate for the treatment of benign prostatic hyperplasia using a 980 nm diode laser

In der alternden männlichen Bevölkerung ist das Auftreten von Symptomen der unteren Harnwege (LUTS), die durch eine gutartige Prostatahyperplasie (BPH) verursacht werden, ein häufiges Problem. Hier stellen wir eine neue Technik namens 980-nm-Diodenlaser-Enukleation (DiLEP) zur Behandlung von BPH1 vor. Diodenlaser können sowohl Wasser als auch Hämoglobin gleichzeitig absorbieren, so dass sie gut zum Schneiden und zur Blutstillunggeeignet sind 2. Der Diodenlaser wurde 2007 von der FDA zugelassen und wird aufgrund seiner effektiven Schneid- und Blutstillungswirkung bei der Behandlung von BPH eingesetzt3. DiLEP bietet mehrere Vorteile gegenüber anderen Techniken wie TURP, HoLEP und PVP. Während des Eingriffs definieren wir die Grenze einer Prostata mit hohem Volumen und teilen sie mit einem Diodenlaser in drei Lappen, indem wir zwei Ringe und eine Rille (wie ein Amorpfeil) brennen. Im Vergleich zu anderen Verfahren weist mDiLEP weniger intraoperative Komplikationen auf, eine kürzere Lernkurve und führt zu mehr Geweberesektionen.

Insgesamt wurden 40 Patienten mit BPH, die sich einer DiLEP unterzogen hatten, in eine unserer Studien eingeschlossen. Als statistische Methode wurde ein unabhängiger Stichproben-t-Test verwendet. Alle Patienten schlossen die Operation erfolgreich ab. Bei fast allen Patienten wurde der Katheter innerhalb von 5 Tagen nach der Operation entfernt (Tabelle 1). Alle Patienten kehrten im 1., 3. und 12. Monat postoperativ zur Nachuntersuchung in...

Watch this Scientific Journal Video about Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser at JoVE.com

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

Hier stellen wir ein Protokoll für die modifizierte 980-nm-Diodenlaser-Enukleation zur Behandlung großvolumiger gutartiger Prostatahyperplasie vor.

Enukleation der Prostata zur Behandlung der gutartigen Prostatahyperplasie mit einem 980 nm Diodenlaser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

enucleation-prostate-for-treatment-benign-prostatic-hyperplasia-using

Research

JoVE Journal

Medicine

2.0K Aufrufe.  Beijing Hospital. Hier stellen wir ein Protokoll für die modifizierte 980-nm-Diodenlaser-Enukleation zur Behandlung großvolumiger gutartiger Prostatahyperplasie vor.

Serie: Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

Renal Capsule Xenografting and Subcutaneous Pellet Implantation for the Evaluation of Prostate Carcinogenesis and Benign Prostatic Hyperplasia

New therapies for two common prostate diseases, prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend critically on experiments evaluating their hormonal regulation. Sex steroid hormones (notably androgens and estrogens) are important in PrCa and BPH; we probe their respective roles in inducing prostate growth and carcinogenesis in mice with experiments using compressed hormone pellets. Hormone and/or drug pellets are easily manufactured with a pellet press, and surgically implanted into the subcutaneous tissue of the male mouse host. We also describe a protocol for the evaluation of hormonal carcinogenesis by combining subcutaneous hormone pellet implantation with xenografting of prostate cell recombinants under the renal capsule of immunocompromised mice. Moreover, subcutaneous hormone pellet implantation, in combination with renal capsule xenografting of BPH tissue, is useful to better understand hormonal regulation of benign prostate growth, and to test new therapies targeting sex steroid hormone pathways.

We describe the manufacture of compressed hormone pellets, as well as subcutaneous surgical implantation into mice. This strategy can be combined with the growth of cell and tissue xenografts under the renal capsule of athymic nude mice to evaluate hormonal carcinogenesis and regulation of benign prostate growth.

Nierenkapsel Xenografting und subkutane Implantation Pellet für die Beurteilung von Prostata-Karzinogenese und benigne Prostatahyperplasie

New therapies for two common prostate diseases,  prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend  critically on experiments ...

Forschung

Medizin

Laser-capture Microdissection of Human Prostatic Epithelium for RNA Analysis

The prostate gland contains a heterogeneous milieu of stromal, epithelial, neuroendocrine and immune cell types. Healthy prostate is comprised of fibromuscular stroma surrounding discrete epithelial-lined secretory lumens and a very small population of immune and neuroendocrine cells. In contrast, areas of prostate cancer have increased dysplastic luminal epithelium with greatly reduced or absent stromal population. Given the profound difference between stromal and epithelial cell types, it is imperative to separate the cell types for any type of downstream molecular analysis. Despite this knowledge, the bulk of gene expression studies compare benign prostate to cancer without micro-dissection, leading to stromal bias in the benign samples. Laser-capture micro-dissection (LCM) is an effective method to physically separate different cell types from a specimen section. The goal of this protocol is to show that RNA can be successfully isolated from LCM-collected human prostatic epithelium and used for downstream gene expression studies such as RT-qPCR and RNAseq.

The goal of this protocol is to use laser-capture micro-dissection as an effective method to isolate pure populations of cell types from heterogeneous prostate tissues for downstream RNA analysis.

Laser-Mikrodissektion für Menschen Prostataepithel für die RNA-Analyse

The prostate gland contains a heterogeneous milieu of stromal, epithelial, neuroendocrine and immune cell types.  Healthy prostate is comprised of ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

Netzwerkanalyse von Foramen Ovale Elektrode Recordings in Resistente Temporallappen Epilepsie-Patienten

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Transcanalicular Diode Laser-assistierte Dacryocystorhinostomy für die Behandlung von primären erworben Nasengang Obstruktion

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Here we present a safe and efficient protocol, holmium laser enucleation of the prostate, to treat benign prostatic hyperplasia.

Chirurgische Behandlung der benignen Prostatahyperplasie: Holmium Laser Enukleation der Prostata (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the ...

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging male population. Although it is not a life-threatening disease, BPH causes problems that seriously impact the quality of life. Here, we introduce a new technique called photoselective vaporesection of the prostate (PVRP) in treating BPH, which can be seen as a variation of photoselective vaporization of the prostate (PVP). This procedure presents several advantages compared to the PVP technique including less laser energy loss, less intraoperative complications as well as more tissue resection rate.

Here we present a protocol to perform Photoselective Vaporesection of the Prostate (PVRP) for benign prostatic hyperplasia (BPH) treatment.

Photoselektiven Vaporesection der Prostata mittels einer Ende-Firing Lithium Triborate Kristall Laser

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging ...

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium.
A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20&#8210;2 5W in continuous mode. Each cyst is punctured&#160;until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed.
This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.

The aim of this report is to describe the photoablation of endometrial cysts in the mare using an endoscopic laser device, and to discuss the interest and limitations of this new approach to deal with low fertility issues.

Endoskopiegeführte Photoablation von Endometriumzysten mit einem 980-nm-Laser mit einer Kontaktfaser in Stuten

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

Fokale Laserablation von Prostatakrebs: Ein Büroverfahren

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

Adjunktive Diodenlasertherapie und probiotische Lactobacillustherapie bei Parodontitis und periimplantärer Erkrankung

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode ...

Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions

Minimally invasive pancreatic resections are gaining popularity despite being technically demanding. However, in contrast to laparoscopic pancreatoduodenectomy (LPD), laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has not yet obtained wide acceptance. This could be attributed to the technical challenges involved in preserving the blood supply of the duodenum and bile duct.
This study describes and demonstrates all the steps of LDPPHR. A 48-year-old woman was diagnosed with a 3.0 cm x 2.5 cm pancreatic head cystic mass, which was detected unexpectedly. The surgery was performed using the 3D laparoscopy via an inferior infracolic approach. The operation lasted approximately 310 min with 100 mL of blood loss. Postoperatively, the patient experienced no complications and was discharged 5 days later. Pathology revealed intraductal papillary mucinous neoplasms.
LDPPHR via an inferior infracolic approach is feasible and safe when performed by experienced surgeons in selected patients with thin mesenteric fat layers. The described technique for LDPPHR via inferior infracolic approach should be well standardized and performed at high-volume centers with experienced surgeons in both open and laparoscopic pancreatology.

This article provides a whole technical process of laparoscopic duodenum-preserving pancreatic head resection via an inferior infracolic approach. This is a surgical approach for benign tumors without intraoperative fluorescence image guidance.