Yazarlar, Çin Ulusal Anahtar Araştırma ve Geliştirme Programı'nın (Hibe 2017YFC840102) desteğini kabul etmek ister.

Burada anlatılan tüm yöntemler Pekin Hastanesi etik kurulu tarafından onaylanmıştır. Ameliyat endikasyonları, nörojenik olmayan erkek AÜSLERI için Avrupa Üroloji Derneği kılavuzlarına göredir. Kontrendikasyonlar şüpheli prostat kanseri veya detrusor disfonksiyonunu içerir.
1. Operasyon için aletler
<ol><li>Sürekli mod (980-80 W) dahil olmak üzere bir güce sahip diyot lazer (100 nm) ekipmanının kullanılabilirliğini sağlayın.</li>
	<li>İntraoperatif mesane irrigasyonu için bir lazer fiber ve% 0.9 tuzlu su çözeltisi kullanın.</li>
	<li>İyi görselleştirme elde etmek ve verimliliği artırmak için 26 F lazer rezektoskop kullanın.</li>
</ol>2. Operasyon için hazırlık
<ol><li>Operasyon günü cilt hazırlığı yapın.</li>
	<li>Tüm hastalara ameliyat öncesi intravenöz antibiyotik sağlayın10. NOT: Sefuroksim sodyum (100 mL %0.9 sodyum klorürde 1.5 g) operasyondan 30 dakika önce verilir.</li>
	<li>Anesteziden önce hastanın ameliyat masasına yatırılmasını sağlayın. NOT: Bu operasyon için genel anestezi etkili ve uygundur. Anestezistler, hastanın genel durumuna bağlı olarak anestezi şeklini belirlemelidir.</li>
	<li>Hastayı dorsal litotomi pozisyonunda steril bir şekilde örtün.</li>
</ol>3. Prosedür adımları
<ol><li>Gözlem<ol><li>Rezektoskop (15-30°) ile üretra, verumontanum, mesane boynu, üreter delikleri, mesane mukozası ve trabeküler hiperplaziyi doğrudan gözlemleyin.</li>
	</ol></li>
	<li>Enükleasyon aralığını tasarlayın (Cupid'in oku).<ol><li>Mesane boynu mukozasını lazerle dairesel olarak keser (beze kadar derinlik, genişlik yaklaşık 3-4 mm) (Şekil 1).</li>
		<li>Verumontanumun proksimal ucundaki prostat üretra mukozasını lazerle dairesel olarak kesi (beze kadar derinlik, genişlik yaklaşık 3-4 mm) (Şekil 2). NOT: Mesane boynu mukozasının ve sfinkter üretralarının yaralanmasını önlemek için insizyondan önce anatomik işareti onaylayın. Ameliyat sırasında hemostaz dışında 80-100 W lazer gücü kullanın.</li>
		<li>Mesane boynunun eşmerkezli dairelerini ve prostatın tepesini posterior üretrada saat 12 konumunda bağlayın.</li>
		<li>Sol lob ve sağ lob lazerle kesin (Şekil 3). NOT: Posterior üretranın saat 12 pozisyonu önceden kesildikten sonra, distal mukozayı koruyun. Mesanenin boynunda ve prostatın tepe noktasında oluşan eşmerkezli halkalara Cupid okları denir.</li>
	</ol></li>
	<li>Kanal oluşturma<ol><li>Cerrahi kapsülü prostat tepesinin saat 5 ve 7 pozisyonlarında bulun.</li>
		<li>Cerrahi kapsülü saat 5 ve 7 pozisyonlarında cerrahi kapsül bulun.</li>
		<li>Saat 5 ve 7 pozisyonlarındaki cerrahi kapsül konumlarını bir lazerle bağlayın (Şekil 4).</li>
		<li>Prostat tepe noktasının saat 6 pozisyonunda prostat tepe noktasından mesane boynuna kadar olan cerrahi kapsülden medyan lobu lazer ile ayırın (Şekil 5). NOT: Prostatın hacmi >80 mL ise, medyan ve lateral loblar prostat tepesinin saat 5 ve 7 pozisyonlarında tamamen ayrılacaktır.</li>
	</ol></li>
	<li>Sol ve sağ lobların enükleasyonu<ol><li>Saat yönünün tersine sağ lobu saat 6 ve 12 pozisyonlarında prostatın tepesinden mesane boynuna kadar rezektoskop ile enüklee edin (Şekil 6).</li>
		<li>Saat yönünde, sol lobu saat 6 ve 12 pozisyonlarında prostatın tepesinden mesane boynuna kadar enüklee edin (Şekil 7).</li>
		<li>Enükleasyondan sonra tüm bezleri mesaneye itin. NOT: Prostatın hacmi >80 mL ise, medyan ve lateral lobları uygun sırayla enüklee edin; Ardından, mesaneye itin.</li>
	</ol></li>
	<li>Hemostaz<ol><li>Ameliyat bölgesi etrafındaki kanamayı durdurmak için daha düşük bir lazer gücü (50 W) kullanın. Uygun bir mesafeyi koruyun (yani 1-3 mm).</li>
	</ol></li>
	<li>Prostat dokusunu morselasyona tabi tutun.<ol><li>Enükleasyonlu prostat dokusunu bir morselatör ile küçük parçalara (mümkün olduğunca küçük) morselasyon yapın ve ardından dokuyu mesaneden çıkarın (Şekil 8).</li>
	</ol></li>
	<li>Kateterizasyon<ol><li>Morselatörü üretradan çıkarın.</li>
		<li>Üretrayı lidokain jeli ile yeterince yağladıktan sonra, üretra deliğinden 30 mL su ile mesane boşluğuna 22 F Foley kateterini nazikçe yerleştirin.</li>
	</ol></li>
	<li>Ameliyat sonrası bakım10<ol><li>Hastayı anesteziden tamamen uyanana kadar ameliyat sonrası bakım ünitesinde yaklaşık 3 saat yatakta yatırın. Bu süre zarfında hasta monitörlerinin ve tıbbi oksijenin mevcut olduğundan emin olun.</li>
		<li>Hasta tamamen uyandıktan sonra hastayı servise geri koyun. Hastanın biraz su içmeye ve biraz yemek yemeye başlamasına izin verin. Herhangi bir idrar çıkışını kaydedin ve idrarın rengine dikkat edin.</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>

Yazarların ifşa edecek hiçbir şeyi yok.

Şu anda, 980 mm diyot lazer BPH5 tedavisi için kullanılmaya başlanmıştır. Az sayıda rapor ilgili klinik çalışmaları tanımlamıştır. BPH tedavisinde TURP'un etkisi ile karşılaştırıldığında, birçok çalışma DiLEP'in daha az kan kaybına neden olduğunu, daha iyi idrara çıkma fonksiyonu sağladığını ve daha kısa kateter tutma sürelerine sahip olduğunu göstermiştir 9,13,14,15.</...

Prostatın geleneksel transüretral rezeksiyonu (TURP) ile karşılaştırıldığında, lazer ameliyatları daha iyi hasta toleransı, daha düşük intraoperatif kan kaybı, etkinliği ve daha kısa postoperatif iyileşme süresi nedeniyle giderek daha popüler hale gelmiştir 4,5.
Son yıllarda, en hızlı büyüyen teknikler, çeşitli dalga boylarında lazerlerin kullanımını içermektedir. Şu anda, prostat enükleasyonunu tamamlamak için farklı özelliklere sahip birçok lazer türü kullanılabilir. Diyot lazerin 2007 yılında prostat hiperplazisi için ABD FDA tarafından onaylanmasından bu yana, olağanüstü kesme kabiliyeti ve hemostaz etkisi nedeniyle BPH tedavisinde kullanımı giderek artmıştır6. Lazer dalga boyu, su ve hemoglobin tarafından emilim derecesini belirler. 980 nm dalga boyuna sahip bir diyot lazer, su ve hemoglobinin en yüksek birleşik emilim oranını sağlar. Doku penetrasyon kabiliyeti 0,5 mm'dir ve daha derin dokuda pıhtılaşma etkileri üretebilir, bu da çok iyi bir doku ablasyonu ve hemostaz kabiliyetine sahip olmasını sağlar 7,8.
Birçok araştırma merkezi, iyi huylu prostat hiperplazisinin tedavisi için DiLEP'i kullanmaya başlamıştır. Pratikte, geleneksel DiLEP daha uzun bir öğrenme eğrisine sahiptir ve üriner sfinkter koruması ile ilgili belirgin bir avantaj sunmamaktadır9. Yukarıdaki nedenlere dayanarak, BPH'li hastalarda diyot lazer tedavisinin değerini artırmak için merkezimizde geleneksel DiLEP modifiye edilmiştir.

<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

Yaşlanan erkek popülasyonunda, iyi huylu prostat hiperplazisinin (BPH) neden olduğu alt üriner sistem semptomlarının (AÜSS) ortaya çıkması yaygın bir sorundur. Burada, BPH1'i tedavi etmek için 980 nm diyot lazer enükleasyon (DiLEP) adı verilen yeni bir teknik sunuyoruz. Diyot lazerler aynı anda hem suyu hem de hemoglobini emebilir, bu nedenle kesme ve hemostaz2 için iyidirler. Diyot lazer 2007 yılında FDA tarafından onaylanmıştır ve etkili kesme ve hemostaz etkisi nedeniyle BPH tedavisinde kullanılmıştır3. DiLEP, TURP, HoLEP ve PVP gibi diğer tekniklere göre çeşitli avantajlar sunar. İşlem sırasında, yüksek hacimli bir prostatın sınırını belirliyoruz ve iki halka ve bir oluk (Cupid'in oku gibi) yakarak diyot lazerle üç loba ayırıyoruz. Diğer prosedürlerle karşılaştırıldığında, mDiLEP daha az intraoperatif komplikasyona, daha kısa bir öğrenme eğrisine sahiptir ve daha fazla doku rezeksiyonu sağlar.

Çalışmalarımızdan birine DiLEP uygulanan toplam 40 BPH hastası dahil edildi. İstatistiksel yöntem olarak bağımsız örneklem t-testi kullanılmıştır. Tüm hastalar operasyonu başarıyla tamamladı. Hastaların neredeyse tamamında ameliyat sonrası 5 gün içinde kateter çıkarıldı (Tablo 1). Tüm hastalar ameliyat sonrası 1., 3. ve 12. aylarda kontrol muayeneleri için hastaneye döndü. Uluslararası Prostat Semptom Sko...

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

Burada, büyük hacimli benign prostat hiperplazisini tedavi etmek için modifiye 980 nm diyot lazer enükleasyonu için bir protokol sunuyoruz.

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. ...

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

Research

JoVE Journal

Medicine

2.0K Görüntüleme.  Beijing Hospital. Burada, büyük hacimli benign prostat hiperplazisini tedavi etmek için modifiye 980 nm diyot lazer enükleasyonu için bir protokol sunuyoruz.

Video: 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.

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 ...

Tıp

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 ...

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), ...

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.

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 ...

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 ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

Lazer Doppler Flowmetry Kullanarak Sıçanserebral Kan Akımı Otoregülasyon Değerlendirilmesi

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

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.

Mares'te Temas Lifli 980 nm Lazer Kullanarak Endometriyal Kistlerin Endoskopi Güdümlü Fotoablasyonu

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.

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 ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

Gastrik Gastrointestinal Stromal Tümörlerin Tedavisinde Laparoskopi-Endoskopi Kooperatifi Cerrahisi

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...