著者が明らかに何もありません。

倫理委員会の上海第九人民病院で倫理的な承認を得て、本研究では各患者の書面によるインフォームド コンセントが得られました。
1. 患者と手術材料
ノート:前立腺肥大症と診断された患者とヨーロッパ泌尿器科学会 (EAU) ガイドラインに従って手術必要があります含まれている10をすることができます。この手術には、経験と長い学習曲線が必要です。外科医の経験が 100 g を超えるボリュームと前立腺の具体的には、このテクニックを実現する最も重要な要因の 1 つです。ホルミウム レーザーのミクロ爆発効果は核出に適しています。
<ol><li>術前準備<ol>
<li>EAU のガイドライン10に従って手術を必要とする前立腺肥大症患者を評価します。</li>
		<li>以下の条件での除外: 重症尿路感染症、重度の肺や心臓の病気、腎機能、重度の出血、貧しい血圧コントロール、神経因性膀胱、膀胱癌、以前前立腺の障害手術、前立腺癌、尿道狭窄、私たちの以前のレポート11に記載されているその他の手術禁忌。</li>
		<li>術前評価を行い、結果に応じて特定の周術期治療を実施します。</li>
		<li>患者に腰椎または全身麻酔を管理、患者を砕石位に。</li>
	</ol>
</li>
	<li>術前評価 ノート:術前評価の定期的手術チェックを含む以下の分析を実行: 尿流動態解析、前立腺超音波、前立腺特異抗原 (PSA) レベルの解析、urethroscopy 解析。<ol>
<li>実行 HoLEP 550 μ m 終わり焼成レーザー繊維と 100 W 逆パルス ホルミウム レーザーを用いて 80-100 ワットの電源設定 1.6-2 J/s と 40-50 Hz。 実行経尿道的取り出した機械 morcellator を使用して 26 F 孟と。灌漑気体として食塩 (0.9%) の約 1 リットルを使用します。</li>
	</ol>
</li>
</ol>2. 摘出術の手順
ノート:楽器を殺菌し無菌パッケージを使用するまでに楽器を置くプラズマ滅菌を使用します。患者に腰椎または全身麻酔を管理し、手術中に患者を砕石位に。
<ol><li>前立腺と尿道の観察<ol>
<li>連続的なフロー膀胱鏡で検査、最低限の組織損傷を確保し、膀胱、尿道、前立腺を慎重に観察を挿入します。</li>
		<li>視覚的閉鎖の中央葉のボリュームと膀胱組織の量などを含む、一般的な評価を使った尿管オリフィスを探します。</li>
		<li>核出術の最も重要なランドマークの一つである verumontanum を識別します。ハンドピースを秒速 1.6-2 J で 80-100 W に設定レーザー マシンのパワーを持つレーザー マシンに接続されているレーザーのファイバーを挿入し、40-50 Hz。</li>
	</ol>
</li>
	<li>トンネル砕石位で患者と前立腺の 6 位置の周囲を切開。<ol>
<li>ホルミウム レーザーを使用して、ように短い水平切開、verumontanum の前に 6 の位置の周り (図 1 aに示されている) 前立腺の外科的被膜を見つけよう。</li>
		<li>膀胱頚部に、verumontanum から前立腺の外科的被膜を公開します。外科的被膜の層を図 1 aと1 Dに示すように、膀胱頸部の後方の頂点からトンネルを作成します。</li>
		<li>操作が膀胱頚部に近づくと、粘膜と筋が効率的な排尿管理を容易にするために保護されていることを確認します。</li>
	</ol>
</li>
	<li>外側葉除去 ノート:カプセルは、表面に十分な血管と滑らかな白い組織が特徴です。血管を出血も封印できる (大きい距離は止血に適した小さい距離は切削に適した) 除核プロセスで使用されるよりも少し距離レーザーを用いた。ためらうことがなく正確な外科的被膜があるように前立腺アペックスへ戻り処理中にオペレーターが明確なビューを見つけることができない場合の手順で失われて得ることを避けるために役立つであります。<ol>
<li>まず、左に、12、6 から外側の葉外科的被膜のレベルに置き、他の外側の葉を同様に摘出を摘出します。</li>
		<li>中には、使用は、レーザー切断と組み合わせてスコープ シースを使用して分離をぼかし。</li>
		<li>落とすことがなく膀胱頸部の 12 の位置に前立腺肥大をハングします。</li>
		<li>膀胱頸部から組織を切断し、膀胱摘出プロシージャの終わりにそれをプッシュします。</li>
		<li>出血を防ぐために前立腺のカプセルが発生しますを再確認します。すべて拡大腺を削除および停止重篤な出血点 (図 1 aに示されている-1F)。</li>
	</ol>
</li>
</ol>3. 取り出した
ノート:足圧によるとシフトすることができますの morcellator に 2 つのギアがあります。最初のギアは、ティッシュと水を吸収する光の圧力を使用して、2 番目のギアに対し取り出した使用されます。合併症を防ぐため、手順の効率を向上させる伝統的な取り出したスキルと手順を行った。この場合実装へのアプローチは私たちの以前の研究12で詳しく説明です。膀胱から採取した組織を図 2に示します。
<ol><li>取り出した手順<ol>
<li>Morcellator と morcellator の使用の種類を問わず、morcellator の指示に従って一致チューブを装備します。膀胱から前立腺組織を削除するには、効率的に、morcellator を使用します。</li>
		<li>中には、偉大な注意13膀胱組織を扱います。膀胱膀胱損傷を避けるために充血、膀胱を保つために、最大限の保護、膀胱内で残りの膀胱壁、膀胱壁から morcellator を維持するに十分な灌漑用水を維持します。</li>
		<li>最後に、膀胱の全身状態を観察し、膀胱内予約組織が残っていないか確認します。</li>
	</ol>
</li>
	<li>取り出したスキル<ol>
<li>報告されたわれわれの以前12取り出した前を研究、腺組織の性状を評価します。</li>
		<li>腺の表面に摩擦を提供し従って滑らかな表面を得るレーザーを使用して穴を掘る。</li>
		<li>滑らかな表面および会社組織の線維化、球状の腺と同様、大きくてしっかりした組織 morcellate に逆の手法を使用します。プロセス中に、その開口部は膀胱の下方に直面する morcellator を反転します。循環水が、閉塞ではないことを確保し、取り出した時に膀胱内圧を常に感じる。</li>
	</ol>
</li>
</ol>4. 術後治療
<ol style="margin-left: 40px;"><li>手術後、カテーテルを挿入し、灌漑水がクリアまたはのみわずかに赤味がかったまで膀胱に生理食塩水入りを灌漑します。</li>
	<li>尿が血尿なしクリアになるまでカテーテルを削除します。</li>
	<li>明白な保持が認められなかった患者がカテーテルの抜去後の援助なし排尿することができる場合は、病院14,15から退院します。</li>
</ol>5. 経過観察
<ol><li>1 の患者のフォロー アップのデータを調べて、病院退院後、6、および国際前立腺症状があります 12 ヶ月スコア (IPSS) は、過剰膀胱スコア システム (OABSS)、生活の質 (QoL) と認めた。術後合併症が発生した場合は治療14をさらに適用されます。</li>
</ol>

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この研究はキー分野グループ建設プロジェクトの健康局の上海浦東 (PWZxq2014-11)、優れた医療の学術的な指導と特別な構造の統合された伝統的な中国医学と西洋のプログラムでサポートされています。上海総合病院 (ZHYY-ZXYJHZX-1-03) で Wedicine。

このプロトコルでは前立腺肥大症の外科的治療の手順を紹介します。HoLEP は、日常臨床で用いることができます。前述のように、前立腺肥大症手術の開発には、3 つのランドマークが含まれています。最初の手術です。前立腺と恥骨オープン前立腺広く臨床設定で長い間採用されています。それにもかかわらず、深刻な副作用、周術期によく見られる技法が。これらの副作用は、出血、大き?...

高齢男性の前立腺の過形成である、温和な prostatic 増殖 (BPH) に発生します。この状態から始まる約 40 y 年と罹患率が 70 年代と 80 年代1の男性の 60 代の男性の 50%-60% と 80%-90% を達することができます。前立腺肥大症が進行性の閉塞、下部尿路症状、保持およびその合併症およびも腎不全、高齢男性の生活の質を下げるすべての発生します。医療療法後外科的治療は徴候 BPH のため最も効率的な治療としてよく使用されます。
様々 なタイプの外科は、世紀後 1894 年2および経尿道的内視鏡下手術 (TURP) で導入された最初開いて前立腺摘除術を含む前立腺肥大症の症状を治療するために開発されています。その開発以来 TURP は手術前立腺肥大を軽減するゴールド スタンダードとみなされてきた。
ホルミウム レーザーは、波長 2120 nm、水の蒸発を誘発する、組織水3のそれに類似しているで動作します。組織浸透 0.4 mm に達するし、それを凝固の運用も可能します。プロセスは BPH のため 1994年4で初めて導入されました。1998 年にピーター Gilling は摘出アプリケーション5を実行するのにデバイスを使用します。提案されているピーター ・ Gilling らによって 1990 年代4、ホルミウム レーザー核出術 (HoLEP) 前立腺の以前の 2 種類のオープンの摘出、TURP4を含め、外科手術を組み合わせることで前立腺肥大症を治療するために使用されます。過形成プロセスの開発、前立腺周辺ゾーンは移行ゾーン、いわゆる外科的被膜を形成する (TZ) によって compassed です。HoLEP は、前立腺、前立腺のカプセルを隔てる TZ の hyperplasic の部分の削除をできます。したがって、HoLEP、解剖学的手術としてことができます摘出 TZ とカプセルの間に形成された分離から拡大前立腺ゾーン。従来の手術方法と比較して、安全なより効率的な耐久性のある成果を徹底的に HoLEP があります可能性があります。TURP と比べて、ホルミウム減少期間、洗浄時間、および手順の短縮入院カテーテル時間。6,7,8技術も実行できます安全に抗凝固療法または出血疾患9患者の。HoLEP のプロシージャのさまざまな種類がありますが、主な手順は次のように記載されているものと同じです。我々 はまた受け入れ、学習曲線を短縮しやすくために私たち自身の経験とこのメソッドの革新を紹介します。手順は、ホルミウム レーザーは砕石8も使用できることを考えれば大規模な前立腺と膀胱結石と組み合わせるために特に適してです。この記事は、この手法と詳細な手順を紹介します。

<table><tbody><tr><td>holmium laser</td><td>Lumenis, USA</td><td></td><td>PowerSuite 100W</td></tr><tr><td>mechanical morcellator</td><td>Lumenis, USA</td><td></td><td>VersaCut</td></tr><tr><td>27Fr continuous flow resectoscope</td><td>Storz, Tuttlingen, Germany</td><td></td><td></td></tr></tbody></table>

surgical treatment for benign prostatic hyperplasia: holmium laser enucleation of the prostate (holep).

良性前立腺過形成 (BPH) は、高齢者の男性の間でよく発生します。条件は、生活の質を減らす下部尿路の症状を引き起こします。前立腺肥大症に 2 主要なトリートメントが含まれています: 薬や手術。手術治療は、しばしば最も効果的かつ最終的な介入です。ホルミウム レーザー前立腺 (HoLEP)、前立腺肥大症の最も効率的な手術の手順の 1 つ摘出腔に行われています。手術中、最も重要で、最も困難な部分は、解剖学的外科の考えに一致している前立腺の外科的被膜を見つけることです。さまざまなスキルは、前立腺のさまざまな部分の治療に必要ことがあります。HoLEP は効率的で安全な良い止血性がちし、膀胱結石を治療することが、可能性があります前立腺肥大症の合併症。テクニックはボリュームやサイズの異なる前立腺に特に適しています。確かに、HoLEP も長い学習曲線など高価な装置の特定の欠点を説明します。関係なく、このメソッドには、「新基準」と前立腺肥大症の手術治療ための優れた方法があります。

レトロスペクティブ データ、2015 年から 2016 年までの収集は、当科の臨床データベースから得られました。前立腺肥大症の治療を受けた 100 患者の合計は、研究に登録されました。周術期アウトカムが含まれていた: 操作時間 (OT)、手術、Na+変化、入院日数、膀胱灌漑期間およびフォロー アップ データ後ヘモグロビン減少。基本患者特性を私達の調査中に収集...

Watch this Scientific Journal Video about Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP. at JoVE.com

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

ここで安全かつ効率的なプロトコル、ホルミウム レーザー前立腺肥大症を治療するために、前立腺摘出を提案します。

前立腺肥大症の外科治療: ホルミウム レーザー核出術 (HoLEP) 前立腺の。

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

surgical-treatment-for-benign-prostatic-hyperplasia-holmium-laser

Research

JoVE Journal

Medicine

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

16.9K ビュー.  Shanghai Jiaotong University School of Medicine. ここで安全かつ効率的なプロトコル、ホルミウム レーザー前立腺肥大症を治療するために、前立腺摘出を提案します。

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

Improved Protocol For Laser Microdissection Of Human Pancreatic Islets From Surgical Specimens

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected cells can be used for a variety of investigations, such as transcriptomic or proteomic studies, DNA assessment or chromosomal analysis 2,3. An especially challenging application of LMD is transcriptome analysis, which, due to the lability of RNA 4, can be particularly prominent when cells are dissected from tissues that are rich of RNases, such as the pancreas. A microdissection protocol that enables fast identification and collection of target cells is essential in this setting in order to shorten the tissue handling time and, consequently, to ensure RNA preservation. 
Here we describe a protocol for acquiring human pancreatic beta cells from surgical specimens to be used for transcriptomic studies 5. Small pieces of pancreas of about 0.5-1 cm3 were cut from the healthy appearing margins of resected pancreas specimens, embedded in Tissue-Tek O.C.T. Compound, immediately frozen in chilled 2-Methylbutane, and stored at -80 &deg;C until sectioning. Forty serial sections of 10 &mu;m thickness were cut on a cryostat under a -20 &deg;C setting, transferred individually to glass slides, dried inside the cryostat for 1-2 min, and stored at -80 &deg;C. 
Immediately before the laser microdissection procedure, sections were fixed in ice cold, freshly prepared 70% ethanol for 30 sec, washed by 5-6 dips in ice cold DEPC-treated water, and dehydrated by two one-minute incubations in ice cold 100% ethanol followed by xylene (which is used for tissue dehydration) for 4 min; tissue sections were then air-dried afterwards for 3-5 min. Importantly, all steps, except the incubation in xylene, were performed using ice-cold reagents - a modification over a previously described protocol 6. utilization of ice cold reagents resulted in a pronounced increase of the intrinsic autofluorescence of beta cells, and facilitated their recognition. For microdissection, four sections were dehydrated each time: two were placed into a foil-wrapped 50 ml tube, to protect the tissue from moisture and bleaching; the remaining two were immediately microdissected. This procedure was performed using a PALM MicroBeam instrument (Zeiss) employing the Auto Laser Pressure Catapulting (AutoLPC) mode. The completion of beta cell/islet dissection from four cryosections required no longer than 40-60 min. Cells were collected into one AdhesiveCap and lysed with 10 &mu;l lysis buffer. Each single RNA specimen for transcriptomic analysis was obtained by combining 10 cell microdissected samples, followed by RNA extraction using the Pico Pure RNA Isolation Kit (Arcturus). This protocol improves the intrinsic autofluorescence of human beta cells, thus facilitating their rapid and accurate recognition and collection. Further improvement of this procedure could enable the dissection of phenotypically different beta cells, with possible implications for better understanding the changes associated with type 2 diabetes.

Laser microdissection is a technique that allows the recovery of selected cells from minute amounts of parenchyma. Here we describe a protocol for acquiring human pancreatic islets from surgical specimens to be used for transcriptomic studies. Our protocol improves the intrinsic autofluorescence of human beta cells, thus facilitating their collection.

手術標本からヒト膵島のレーザーマイクロダイセクションのために改良されたプロトコル

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected ...

医学

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.

前立腺発がんおよび良性前立腺過形成の評価のための腎皮膜異種移植および皮下ペレット移植

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

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.

RNA分析のためのヒト前立腺上皮のレーザーキャプチャーマイクロダイセクション

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

Murine Prostate Micro-dissection and Surgical Castration

Mouse models are used extensively to study prostate cancer and other diseases. The mouse is an excellent model with which to study the prostate and has been used as a surrogate for discoveries in human prostate development and disease. Prostate micro-dissection allows consistent study of lobe-specific prostate anatomy, histology, and cellular characteristics in the absence of contamination of other tissues. Testosterone affects prostate development and disease. Androgen deprivation therapy is a common treatment for prostate cancer patients, but many prostate tumors become castration-resistant. Surgical castration of mouse models allows for the study of castration resistance and other facets of hormonal biology on the prostate. This procedure can be coupled with testosterone reintroduction, or hormonal regeneration of the prostate, a powerful method to study stem cell lineages in the prostate. Together, prostate micro-dissection and surgical castration opens up a multitude of opportunities for robust and consistent research of prostate development and disease. This manuscript describes the protocols for prostate micro-dissection and surgical castration in the laboratory mouse.

This manuscript describes the protocols for prostate micro-dissection and surgical castration in the laboratory mouse. We also depict representative results produced by these protocols. Finally, we discuss the advantages and utilization of these protocols.

マウス前立腺マイクロ解剖と外科的去勢

Mouse models are used extensively to study prostate cancer and other diseases. The mouse is an excellent model with which to study the prostate and has ...

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.

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

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.

プライマリの治療のための Transcanalicular ダイオード レーザ リノストーミー取得鼻涙管閉塞

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

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.

最後発火リチウム三ほう酸結晶レーザーを介して前立腺の Photoselective Vaporesection

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 ...

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

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

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

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.

前立腺がんの焦点レーザーアブレーション:事務処置

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

射精管閉塞を治療するための精嚢鏡レーザー支援手術

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

著者スポットライト:内視鏡検査を介した精液チャネル再流動を用いた精管閉塞の高度治療 

This protocol introduces the clinical application of seminal vesicle endoscopy combined with holmium laser in the treatment of ejaculatory duct obstruction caused by ejaculatory duct cyst.

精嚢鏡検査支援フロー修正による射精管閉塞の治療

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

前立腺肥大症の外科治療: ホルミウムレーザー核出術 (HoLEP) 前立腺の。

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前立腺肥大症の外科治療: ホルミウム レーザー核出術 (HoLEP) 前立腺の。

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前立腺肥大症の外科治療: ホルミウムレーザー核出術 (HoLEP) 前立腺の。