Yazarlar ifşa gerek yok.

Etik onay Etik Komitesi, Shanghai dokuzuncu People's hastanesinden elde edildi ve her hastanın yazılı Onam bizim çalışma elde.
1. hasta ve cerrahi malzemeler
Notlar: BPH ile hastaların tanısı ve cerrahi tedavi uygun olarak Avrupa Birliği, Üroloji (EAU) yönergeleri dahil10olabilir. Bu cerrahi işlem deneyimi ve uzun bir öğrenme eğrisi gerektirir. Cerrahın tecrübesi bu tekniği, özellikle prostat ile 100 gr aşan bir birim için gerçekleştirmek için en önemli faktörlerden biridir. Holmiyum lazer mikro patlama etkisi enükleasyon için uygundur.
<ol><li>Cerrahi öncesi hazırlık<ol>
<li>EAU yönergeleri10uygun cerrahi tedavi gerektiren hastalar BPH ile değerlendirmek.</li>
		<li>Aşağıdaki koşullar olanlar hariç: şiddetli Üriner enfeksiyon, ağır pulmoner veya kalp hastalığı, böbrek fonksiyonu, şiddetli kanama bozukluğu, düşük kan basıncı kontrolü, Nörojenik Mesane disfonksiyonu, mesane kanseri, önceki prostat bozukluğu Cerrahi, prostat kanseri, üretral yapışıklıkları ve bizim önceki raporları11' belirtilen diğer cerrahi kontrendikasyonlar.</li>
		<li>Ameliyat öncesi değerlendirme gerçekleştirmek ve belirli perioperatif tedavi sonuçlarına göre kuralları.</li>
		<li>Hastaya lomber veya genel anestezi yönetmek ve hasta litotomi bulunduğu yer.</li>
	</ol>
</li>
	<li>Önceden cerrahi değerlendirme Notlar: Ameliyat öncesi değerlendirme için düzenli cerrahi onay dahil olmak üzere aşağıdaki çözümlemesi: idrar akışı dinamiği analizi, prostat ultrasonu analizi, Prostat spesifik antijen (PSA) düzeyi analizi ve urethroscopy analizi.<ol>
<li>PERFORM HoLEP 550 µm sonunda ateş lazer fiber ve 100 W çok yönlü darbe holmiyum lazer kullanarak 80-100 Wat güç ayarlarını ile 1,6-2 J/s ve 40-50 Hz. transüretral morcellation mekanik bir morcellator kullanarak bir 26 F nephroscope ile gerçekleştirin. 1 litre normal salin (% 0,9) sulama ﬂuid kullanın.</li>
	</ol>
</li>
</ol>2. enükleasyon yordamları
Notlar: Plazma sterilizasyon aletleri sterilize ve aletleri kullanana kadar aseptik paketlerinde koymak için kullanın. Hastalar için bel ya da genel anestezi yönetmek ve hasta ameliyat sırasında litotomi bulunduğu yer.
<ol><li>Prostat ve idrar gözlem<ol>
<li>Sürekli akış cystoscope, minimal doku hasarı sağlanması ve prostat, üretra ve mesane dikkatle gözlemleyerek yerleştirin.</li>
		<li>Medyan LOB birim ve İntravezikal doku miktarı dahil olmak üzere genel bir değerlendirmesi için bir görsel obturator kullanımı ile üreteral deliklerini bulun.</li>
		<li>Enükleasyon için en önemli yerlerinden biri olan verumontanum tanımlayın. Bir lazer fiber Lazer makinesi 80-100 W 1,6-2 j / saniye için ayarla lazer makine gücü ile bağlı el probu takın ve 40-50 Hz.</li>
	</ol>
</li>
	<li>Tünel kesi mevki saat 6'prostat hastaları ile litotomi pozisyonunda.<ol>
<li>Holmiyum lazer kullanarak, bir kısa yatay kesi verumontanum önünde saat 6'mevki ( şekil 1A' gösterildiği gibi) prostat cerrahi kapsül bulmak için yapmak.</li>
		<li>Mesane boynu prostat cerrahi kapsül verumontanum üzerinden maruz. Cerrahi kapsül katmanda bir tünel mesane boynunun arkasına doğru tepe şekil 1A ve 1Bgösterildiği gibi oluşturun.</li>
		<li>İşlem mesane boynu yakın olduğunda, mukoza ve kas verimli idrar kontrolü kolaylaştırmak için korunmanızı sağlar.</li>
	</ol>
</li>
	<li>Yan lob kaldırma Notlar: Kapsül düz beyaz mendil yüzeyinde yeterli kan damarları ile karakterizedir. Damarları kanama da (daha küçük mesafe kesim için uygun olmakla birlikte daha büyük mesafe hemostaz için uygundur) enucleated işleminde kullanılan daha biraz daha fazla mesafe ile lazer kullanarak kapalı. Prostatik apex tam cerrahi kapsül bulunmaktadır emin olmak için tereddüt etmeden iade işlemi sırasında hangi operatör açık görüş bulamadığında yordamda kaybolmadan önlemek yararlıdır.<ol>
<li>İlk olarak, 12 yönünde için 6'dan yan lob cerrahi kapsül düzeyinde getirin ve diğer yan lob benzer şekilde enucleate sol enucleate.</li>
		<li>İşlem sırasında kullanmak bulanıklık ayrılık lazer kesim ile kombine bir kapsam kılıf kullanarak.</li>
		<li>Saat 12 yönünde aşağı kesim olmadan mesane boynu pozisyonda prostat asmak.</li>
		<li>Mesane boynu doku kes ve mesane enükleasyon yordamının sonunda içine itin.</li>
		<li>Aktif kanama yok emin olmak için prostat kapsülü oluşur yeniden denetleyin. Tüm genişletilmiş bezleri kaldırmak ve şiddetli kanama Puan durdurmak ( şekil 1A' resimli-1F).</li>
	</ol>
</li>
</ol>3. Morcellation
Notlar: Uygulanan ayak basınca göre değiştirdi morcellator iki vites bulunmaktadır. İlk dişli doku ve su emmek için hafif basınç kullanır, ikinci dişli ise morcellation için kullanılır. Komplikasyonları önlemek ve yordamı verimliliğini artırmak için biz geleneksel morcellation beceri ve yordamlar geliştirdik. Yaklaşım uygulamak için bu durumda ayrıntılı bizim önceki çalışma12olarak ele alınmıştır. Mesane dışında alınan doku Şekil 2' de gösterilmiştir.
<ol><li>Morcellation yordamı<ol>
<li>Morcellator ve morcellator öğretim, bağımsız olarak kullanılan morcellator tür göre maç tüp donatmak. Prostat doku mesane bir morcellator verimli bir şekilde kullanarak kaldırın.</li>
		<li>İşlem sırasında mesane doku çok dikkatli13ile tedavi. Mesane nedenle mesane yaralanma kaçınarak tıkanmış, mesane ve morcellator içinde en üst düzeyde koruma için mesane mesane duvarı kalan mesane duvardan uzak tutmak için yeterli sulama suyu korumak.</li>
		<li>Son olarak, mesane genel durumunu gözlemlemek ve mesane sol hiçbir özel amaçlı doku olun.</li>
	</ol>
</li>
	<li>Morcellation becerileri<ol>
<li>Rapor bizim önceki12, morcellation önce çalışma, bezi doku doku değerlendirmek.</li>
		<li>Bezinin yüzeye sürtünme sağlamak ve böylece pürüzsüz bir yüzey elde etmek için lazer kullanarak çukur kazmak.</li>
		<li>Ters tekniği morcellate için büyük ve sert doku yanı sıra fibrotik, küresel bezleri düzgün yüzeyler ve sağlam dokular ile kullanın. İşlemi sırasında morcellator aşağı doğru mesane yüz açılış için tersine çevirin. Dolaşımdaki su kapatılmamış olduğundan emin olun ve sürekli mesane basınç morcellation sırasında hissediyorum.</li>
	</ol>
</li>
</ol>4. ameliyat sonrası tedavi
<ol style="margin-left: 40px;"><li>Cerrahi sonra kateter takın ve sulama suyu açık ya da sadece hafif kırmızımsı olana normal salin mesane sulamak.</li>
	<li>İdrar brüt hematüri açık hale gelinceye kadar kateter kaldırın.</li>
	<li>Hiçbir açık tutma görülmektedir ve hastanın kateter çıkarıldıktan sonra yardımı olmadan işemek, hastane14,15hasta taburcu et.</li>
</ol>5. takip gözlem
<ol><li>Hastane taburcu olduktan sonra hastanın 1 için izleme verilerini inceler, 6 ve 12 ay, uluslararası prostat semptom dahil puan (IPSs), puanlama sistemi (OABSS), yaşam kalitesi (QoL) ve Qmax-aktif mesane. Ameliyat sonrası komplikasyonlar oluşursa, daha fazla tedavi14uygulamak.</li>
</ol>

<ol>
	<li>Bushman, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Etiology,+epidemiology,+and+natural+history+of+benign+prostatic+hyperplasia.">Etiology, epidemiology, and natural history of benign prostatic hyperplasia.</a> Urol Clin North Am. 36 (4), 403-415 (2009).</li><li>Millin, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retropubic+prostatectomy;+a+new+extravesical+technique;+report+of+20+cases.">Retropubic prostatectomy; a new extravesical technique; report of 20 cases.</a> Lancet. 2 (6380), 693-696 (1945).</li><li>Kahokehr, A. 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=Which+laser+works+best+for+benign+prostatic+hyperplasia?.">Which laser works best for benign prostatic hyperplasia?.</a> Curr Urol Rep. 14 (6), 614-619 (2013).</li><li>Gilling, P. J., Cass, C. B., Malcolm, A. R., Fraundorfer, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combination+holmium+and+Nd:YAG+laser+ablation+of+the+prostate:+initial+clinical+experience.">Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience.</a> J Endourol. 9 (2), 151-153 (1995).</li><li>Fraundorfer, M. R., 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=Holmium:YAG+laser+enucleation+of+the+prostate+combined+with+mechanical+morcellation:+preliminary+results.">Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results.</a> Eur Urol. 33 (1), 69-72 (1998).</li><li>Chen, Y. B., 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+prospective,+randomized+clinical+trial+comparing+plasmakinetic+resection+of+the+prostate+with+holmium+laser+enucleation+of+the+prostate+based+on+a+2-year+followup.">A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup.</a> J Urol. 189 (1), 217-222 (2013).</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> Curr Opin Urol. 24 (1), 49-55 (2014).</li><li>Kuntz, R. M., Lehrich, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transurethral+holmium+laser+enucleation+versus+transvesical+open+enucleation+for+prostate+adenoma+greater+than+100+gm.::+a+randomized+prospective+trial+of+120+patients.">Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.:: a randomized prospective trial of 120 patients.</a> J Urol. 168 (4 Pt 1), 1465-1469 (2002).</li><li>Elzayat, E., Habib, E., Elhilali, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Holmium+laser+enucleation+of+the+prostate+in+patients+on+anticoagulant+therapy+or+with+bleeding+disorders.">Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders.</a> J Urol. 175 (4), 1428-1432 (2006).</li><li>Oelke, M., 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=EAU+guidelines+on+the+treatment+and+follow-up+of+non-neurogenic+male+lower+urinary+tract+symptoms+including+benign+prostatic+obstruction.">EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction.</a> Eur Urol. 64 (1), 118-140 (2013).</li><li>Xu, H., 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=Efficacy+and+safety+of+an+improved+technique+of+holmium+laser+enucleation+of+the+prostate+versus+open+prostatectomy+in+treating+enlarged+prostates+combined+with+multiple+bladder+stones:+one-year+of+followup.">Efficacy and safety of an improved technique of holmium laser enucleation of the prostate versus open prostatectomy in treating enlarged prostates combined with multiple bladder stones: one-year of followup.</a> Int J Clin Exp Med. 9 (12), 23612-23617 (2016).</li><li>Chen, Q., 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=An+improved+morcellation+procedure+for+holmium+laser+enucleation+of+the+prostate.">An improved morcellation procedure for holmium laser enucleation of the prostate.</a> J Endourol. 26 (12), 1625-1628 (2012).</li><li>El Tayeb, M. M., Borofsky, M. S., Paonessa, J. E., Lingeman, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wolf+Piranha+Versus+Lumenis+Versacut+Prostate+Morcellation+Devices:+A+Prospective+Randomized+Trial.">Wolf Piranha Versus Lumenis Versacut Prostate Morcellation Devices: A Prospective Randomized Trial.</a> J Urol. , (2015).</li><li>Gilling, P. J., Aho, T. F., Frampton, C. M., King, C. J., Fraundorfer, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Holmium+laser+enucleation+of+the+prostate:+results+at+6+years.">Holmium laser enucleation of the prostate: results at 6 years.</a> Eur Urol. 53 (4), 744-749 (2008).</li><li>Shah, H. N., 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=Prospective+evaluation+of+the+learning+curve+for+holmium+laser+enucleation+of+the+prostate.">Prospective evaluation of the learning curve for holmium laser enucleation of the prostate.</a> J Urol. 177 (4), 1468-1474 (2007).</li><li>Gratzke, 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=EAU+Guidelines+on+the+Assessment+of+Non-neurogenic+Male+Lower+Urinary+Tract+Symptoms+including+Benign+Prostatic+Obstruction.">EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction.</a> Eur Urol. 67 (6), 1099-1109 (2015).</li><li>Vincent, M. W., 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=HoLEP+has+come+of+age.">HoLEP has come of age.</a> World J Urol. 33 (4), 487-493 (2015).</li><li>Qian, 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=Functional+outcomes+and+complications+following+B-TURP+versus+HoLEP+for+the+treatment+of+benign+prostatic+hyperplasia:+a+review+of+the+literature+and+Meta-analysis.">Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis.</a> Aging Male. 20 (3), 184-191 (2017).</li><li>Xu, H., Chen, Y. B., Gu, M., Chen, Q., Wang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+noise+hazard+during+the+holmium+laser+enucleation+of+prostate.">Evaluation of noise hazard during the holmium laser enucleation of prostate.</a> BMC Urol. 17 (1), 71 (2017).</li><li>Gilling, P. J., 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=Long-term+results+of+a+randomized+trial+comparing+holmium+laser+enucleation+of+the+prostate+and+transurethral+resection+of+the+prostate:+results+at+7+years.">Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years.</a> BJU Int. 109 (3), 408-411 (2012).</li></ol>

Bu araştırma anahtar disiplinleri Grup İnşaat proje Pudong Sağlık Bürosu, Shanghai (PWZxq2014-11), en iyi tıbbi akademik lider ve özel inşaat, entegre geleneksel Çin tıbbı ve Batı için Program tarafından desteklenmiştir Shanghai General Hospital (ZHYY-ZXYJHZX-1-03) içinde Wedicine.

Bu protokol için bir yordam BPH cerrahi tedavisi için tanıtmak. HoLEP günlük klinik pratikte istihdam edilebilir. Belirtildiği gibi BPH cerrahi gelişimi üç simge içerir. Açık cerrahi ilkidir. Retropubic prostatektomi ve SUPRAPUBIK açık prostatektomi kapsamlı bir şekilde uzun süre klinik ortamda istihdam edilmiştir. Buna rağmen ciddi olumsuz yan etkileri, perioperatif dönemde sık sık gözlenen teknik içerir. Bu yan etkiler cerrahi ve yavaş hasta kurtarma sonra kanama, büyük yara izi içerir. Ayr?...

Hiperplazi prostat bezinin olan benign prostat hiperplazisi (BPH), yaşlı erkeklerde oluşur. Bu durum yaklaşık 40, başlar y eski ve morbidite ulaşabilirsiniz için kendi 60s erkeklerde % 50-% 60 ve % 80-% 90 onların 70s ve 80s1erkekler için. BPH ilerici tıkanıklığı, Alt Üriner Sistem semptomları, saklama ve komplikasyonlar ve tüm bunların yaşlı erkek yaşam kalitesi düşük bile böbrek yetmezliği neden olur. Tıbbi tedavi sonrası cerrahi tedavi genellikle semptomatik BPH için en etkili tedavi olarak kullanılır.
Çeşitli cerrahi 18942 ve transüretral endoskopik cerrahi (içli)'de bir yüzyıl sonra sunulan ilk açık prostatektomi dahil olmak üzere BPH belirtileri tedavisi için geliştirilmiştir. Gelişimi beri içli ameliyatla prostat büyümesi hafifletmek için altın standart kabul edilmiştir.
Holmiyum lazer su buharlaşma indükler doku su3, benzer 2120 nm dalga boyu çalışır. Doku penetrasyonu 0.4 mm ulaşır ve koagülasyon bununla da çalıştırılabilir. İşleminin ilk 19944' te BPH için kullanılmıştır. 1998'de Peter Gilling cihazın enükleasyon uygulama5gerçekleştirmek için kullanılır. Önerilen tarafından Peter Gilling ve ark. 1990'larda4, holmiyum lazer enükleasyon (HoLEP) prostat ameliyatı açık enükleasyon ve içli4de dahil olmak üzere, önceki iki tür birleştirerek BPH tedavi etmek için kullanılır. Hiperplazi işleminin gelişmesiyle birlikte, prostat periferik bölgesi geçiş bölgesi (TZ) sözde bir cerrahi kapsül formu tarafından compassed. HoLEP prostat, prostat kapsülü ayıran TZ hyperplasic parçası kaldırılmasını sağlar. Böylece, HoLEP, TZ ve kapsül arasında kurulan ayrılık genişlemiş prostat bölgesinden anatomik cerrahi olarak enucleate. Geleneksel cerrahi yöntemi ile karşılaştırıldığında, daha güvenli, daha verimli ve kapsamlı dayanıklı sonuçlar ile HoLEP olabilir. İÇLİ ile karşılaştırıldığında, holmiyum kateter saat yordam ve kısaltılmış hastanede kalış süresi, sulama zamanı ve süresi azalır. 6 , 7 , 8 teknik da güvenli bir şekilde antikoagülan tedavi veya kanama bozuklukları9ile sorunu olan hastalar üzerinde gerçekleştirilebilir. Yordamlar HoLEP için farklı olsa da, temel prosedür aşağıda belirtildiği gibi aynıdır. Biz de kendi deneyimleri ve yenilik bu yöntemin kabul ve öğrenme eğrisi kısaltmak kolaylaştırmak için tanıtmak. Holmiyum lazer litotripsi8için de kullanılabilir verilen bu yordamı özellikle büyük prostat ve mesane taşları ile kombine olanlar için uygundur. Bu yazı bu teknik ve ayrıntılı yordam tanıttı.

<table border="0" cellpadding="0" cellspacing="0" width="1069">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:260px;">holmium laser</td>
			<td style="width:205px;">Lumenis, USA</td>
			<td style="width:344px;"></td>
			<td style="width:260px;">PowerSuite 100W</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">mechanical morcellator</td>
			<td>Lumenis, USA</td>
			<td></td>
			<td>VersaCut</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">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).

Benign Prostat Hiperplazisi (BPH) yaygın olarak yaşlı erkekler arasında oluşur. Koşul alt böylece yaşam kalitesini azaltarak idrar içinde belirtilere neden olmaktadır. BPH içerir 2 büyük tedavi: ilaç tedavisi ve cerrahi. Cerrahi tedavi genellikle en etkin ve en son müdahale olur. Holmiyum lazer enükleasyon prostat (HoLEP), BPH için en verimli cerrahi yordamlardan birini transurethrally yapılır. Ameliyat sırasında belgili tanımlık en önemli ve en zor bölüm anatomik ameliyat fikrine yol tutarlıdır prostat cerrahi kapsül bulmaktır. Farklı parçalar prostat tedavisinde farklı becerileri gerekli olabilir. HoLEP verimli ve güvenli iyi Kan durdurucu sargı özelliklere sahip olma eğilimindedir ve mesane Diferansiyel ve İntegral Hesap tedavi etmek mümkün, hangi BPH komplikasyonlar olabilir. Teknik birimler ve boyutları değişen prostat için özellikle uygundur. Gerçekten de, HoLEP de bir uzun öğrenme eğrisi ve pahalı donanım gibi bazı dezavantajları sunar. Ne olursa olsun, bu yöntem-ebilmek var olmak "yeni bir standart" ve BPH cerrahi tedavisi için mükemmel yöntem.

2016 için 2015 toplanan retrospektif verileri departmanımız klinik veritabanından elde edilmiştir. BPH için tedavi edilen 100 hastaların toplam çalışma odasına kayıtlı. Perioperatif sonuçları dahil: Operasyon süresi (OT), hemoglobin azalması ameliyatı, Na+ varyasyon, hastanede kalış süresi, mesane sulama süresi ve aşağıdaki veriler sonra. Temel hasta özelliklerini de çalışmamız sırasında toplanmıştır. Buna ek olarak, hastaneye yatış süresi ...

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.

Burada bir güvenli ve etkin iletişim kuralı, holmiyum lazer enükleasyon benign prostat hiperplazisi tedavisinde Prostat, mevcut.

Benign Prostatik Hiperplazi için cerrahi tedavi: holmiyum lazer enükleasyon prostat (HoLEP).

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).

16.8K Görüntüleme.  Shanghai Jiaotong University School of Medicine. Burada bir güvenli ve etkin iletişim kuralı, holmiyum lazer enükleasyon benign prostat hiperplazisi tedavisinde Prostat, mevcut.

Video: 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.

Cerrahi Örnekler kaynaktan İnsan pankreas adacıklarının Lazer Diseksiyon için Geliştirilmiş Protokolü

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

Tıp

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.

Prostat Karsinogenezde ve İyi Huylu Prostat Büyümesi ve Değerlendirilmesi için böbrek Kapsül Xenografting ve Derialtı Pelet İmplantasyonu

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 Analizi İnsan Prostat Epitelinin Lazer yakalama mikrodiseksiyon

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.

Mürin Prostat Mikro-diseksiyon ve Cerrahi Kastrasyon

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.

İlaca dirençli Temporal Lob Epilepsi Hastalarında Foramen Ovale Elektrot Kayıtları Ağ Analizi

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.

Nasolacrimal kanalı tıkanıklığı Transcanalicular diyot lazer destekli Dacryocystorhinostomy birincil tedavisi için elde

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.

Photoselective Vaporesection bir sonu-ateş lityum Triborate kristal lazer ile prostat

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 Diyot Lazer Kullanılarak İyi Huylu Prostat Hiperplazisinin Tedavisi için Prostatın Enükleasyonu

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

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in pastoral communities. It is difficult to differentially diagnose and usually leads to irreversible neurologic deficits and spinal deformities. The initial diagnosis of BS is based on clinical findings and radiographic assessments, and the confirmed diagnosis should be established by the isolation of Brucella species from the blood and/or the standard tube agglutination test. Differential diagnosis of multifocal BS from either degenerative disc diseases or tuberculosis is especially highlighted. The surgical approach, either endoscopic or open, is demonstrated in detail, accompanied by radiographic evidence of structural compression or severe instability. Further, the crucial surgical steps, including single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation, are explained. Moreover, perioperative care and postoperative rehabilitation are also addressed. Taken together, this clinical algorithm presents a practical guide that has yielded substantially satisfactory outcomes in the past decades, which can also be introduced for large-scale application to manage human BS, especially in endemic regions.

We describe a clinical algorithm, based on decades of front-line experience of diagnosis and surgical treatment of human Brucellar spondylodiscitis in the largest medical center of the China's Xinjiang Pastoral Area.

İnsan Brucellar Spondilodistis Tanı ve Cerrahi Tedavisi

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in ...

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.

Prostat Kanserinin Odak Lazer Ablasyonu: Bir Ofis Prosedürü

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