Name: surgical treatment for benign prostatic hyperplasia: holmium laser enucleation of the prostate (holep).
Uploaded: 2018-03-06T12:30:00
Description: Watch this Scientific Journal Video about Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP. at JoVE.com

The authors have nothing to disclose.

Ethical approval was obtained from the Ethics Committee of Shanghai Ninth People&#39;s Hospital and the written informed consent of each patient were obtained in our study.
1. Patients and Surgical Materials
Notes: Patients diagnosed with BPH and need surgical treatment in accordance with the European Association of Urology (EAU) guidelines can be included10. This surgical procedure requires experience and a long learning curve...

<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. 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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>

In this protocol, we introduce a procedure for the surgical treatment of BPH. HoLEP can be employed in daily clinical practice. As mentioned, the development of BPH surgery includes three landmarks. The first is the open surgery. Retropubic prostatectomy and suprapubic open prostatectomy have extensively been employed in the clinical setting for a long time. Despite this, the technique involves severe adverse side effects, which are often observed during the perioperative period. These side effects include hemorrhage, la...

Benign prostatic hyperplasia (BPH), which is hyperplasia of the prostate gland, occurs in elderly males. This condition starts at approximately 40 y old, and morbidity can reach 50%-60% for men in their 60s and 80%-90% for men in their 70s and 80s1. BPH causes progressive obstruction, lower urinary tract symptoms, retention and its complications, and even renal failure, all of which lower the quality of life of the elderly male. After medical therapy, surgical treatment is often used as the most efficient treatment for symptomatic BPH.
Various types of surgery have been developed to treat the symptoms of BPH, including the first open prostatectomy introduced in 18942 and transurethral endoscopic surgery (TURP) a century later. Since its development, TURP has been regarded as the gold standard to surgically alleviate prostate enlargement.
The holmium laser operates at a wavelength of 2120 nm, which is similar to that of the tissue water3, which induces vaporization of water. Tissue penetration reaches 0.4 mm, and coagulation can also be operated with it. The process was first introduced for BPH in 19944. In 1998, Peter Gilling used the device to perform enucleation application5. As proposed by Peter Gilling et al. in the 1990s4, holmium laser enucleation of the prostate (HoLEP) is used to treat BPH by combining the two earlier types of surgery, including the open enucleation and the TURP4. With the development of the hyperplasia process, the prostatic peripheral zone is compassed by the transitional zone (TZ) to form a so-called surgical capsule. HoLEP allows the removal of the hyperplasic part of the prostate, the TZ, which separates the prostate capsule. Thus, HoLEP, as the anatomical surgery, can enucleate the enlarged prostate zone from the formed separation between TZ and capsule. Compared with the traditional surgical method, HoLEP may be safer, more efficient, and thorough with durable outcomes. Compared with TURP, holmium reduced the duration, irrigation time, and catheter time of the procedure and shortened hospital stay.6,7,8 The technique can also be performed safely on patients who are on anticoagulant therapy or with bleeding disorders9. Though there are different kinds of procedures for HoLEP, the main procedure is the same as mentioned in the following. We also introduce our own experiences and the innovation for this method in order to make it easier to accept and shorten the learning curve. The procedure is particularly suitable for large prostates and those combined with bladder stones, given that the holmium laser can also be used for lithotripsy8. This article introduces this technique and the detailed procedure.

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	<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 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.

Retrospective data, collected from 2015 to 2016, were obtained from the clinical database of our department. A total of 100 patients treated for BPH were enrolled in the study. Perioperative outcomes were included: operation time (OT), hemoglobin decrease after surgery, Na+ variation, hospital stay duration, bladder irrigation duration and following-up data. Basic patient characteristics were also collected during our study. In addition, the catheterization time and hospitaliza...

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.

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

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 ...

The overall goal of this surgical intervention is to treat hyperplastic prostate and to relieve urethral obstruction caused by benign prostatic hyperplasia or BPH. This method helps us to answer the key questions about how to enucleate the prostate and how to do the surgical treatment for BPH. The main advantages on this method are that it is minimally invasive and it allows quick recovery after the surgery.Holmium Laser Enucleation of the prostate should be proposed as a new gold standard instead of the old one, transurethal resection of the prostate, because it is a low application load and quick recovery. We treated more than 2000 patients in the past 10 years and got very good results. Before beginning the procedure assess the BP of each patient in accordance with the European Association of Urology guidelines.After administering the appropriate anesthesia, place the patient in the lithotomy position and gently insert a continuous plastiscope into the patients urethral tract without damaging the mucosal tissue. Carefully observe the prostate, urethra, and bladder. Using a visual obturator, locate the uretal orifices including the medium lobe volume and the amount of intra-vesicle tissue.After locating the verumontanum, insert hand pieces equipped with a laser fiber connected to a laser instrument and set the laser power to 80 to 100 watts, at 1.6 to two joules per second, and 40 to 50 hertz. Tunnel the incision around the six o'clock position of the prostate and use a 100 watt versiapulsium laser to make a short horizontal incision around the six o'clock position in front of the verumontanum to locate the surgical capsule of the prostate. Finding the surgical capsule is critical to the success of this procedure as this is the plane in which we will do the whole aplasia.Expose the prostate surgical capsule from the verumontanum to the bladder neck. Then, create a tunnel from the apex toward the back of the bladder neck, taking care that the mucosa and the muscle are protected to facilitate efficient urinary control. To remove the lateral lobe, use a scope sheath combined with laser cutting and blur separation to enucleate the left lateral lobe from the six o'clock to the 12 o'clock position at the level of the surgical capsule.Then, enucleate the right lateral lobe as just demonstrated. Hang the enlarged prostate in the 12 o'clock position of the bladder neck without cutting down. Remove the enlarged prostate tissue from the bladder neck and push the excised tissue into the bladder.Recheck the prostate capsule to ensure no active bleeding occurs. Then, remove all of the enlarged glands and stop any severe bleeding points. After making holes in the surface of the prostate gland, equip the morcellator and the match tube according to the manufacturers instructions and insert the morcellator and a 26-french nephroscope into the patients urethral tract.Carefully and efficiently invert the morcellator so that the opening faces downward in the bladder to remove large and firm tissues, as well as fibrotic spherical glands with smooth surfaces and firm tissues. Keep the bladder sufficiently engorged with saline to avoid bladder injury throughout the procedure, taking care not to injure the bladder wall during the morcellation process. When all of the tissue has been removed, observe the general condition of the bladder.If no reserved tissue is left, insert a new catheter and irrigate normal saline into the bladder until the solution is clear or only slightly reddish. Remove the catheter when the urine becomes clear without gross hematuria. After hospital discharge, examine the follow up data of the patient for one, six, and 12 months, including the International Prostate Symptom Score, Overactive Bladder Scoring System, and quality of life and QMAC scores.Prostatic tissue removed by morcellation can be analyzed pathologically, post-surgery, as appropriate. In this representative study, pre and postoperative outcomes were assessed for 100 patients treated for benign prostatic hyperplasia, as just demonstrated. In 47 patients, the International Prostate Symptom Score was significantly decreased between four to 24 weeks after the prostate enucleation and morcellation procedures.Once mastered, this technique can be finished in only one hour and depending on the size of the prostate, if it is properly performed. While attempting the procedure, it is very important to finish the preoperative exam before beginning the surgery. After watching this video, you should have a very good understanding of how to perform HoLEP, the laser enucleation of the prostate which causes the bi-BPH.

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

Research

JoVE Journal

Medicine

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.

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.

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.

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 ...

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.

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.

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.

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.

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

Surgical Treatment of an Endolymphatic Sac Tumor

Endolymphatic sac tumors (ELST) are low-grade papillary adenocarcinoma originating from the endolymphatic sac. Usually slow-growing, with local aggressiveness and a low risk of distant metastases, ELST can be sporadic but also frequently associated with von Hippel Lindau disease. The current treatment of ELST is primarily surgical resection. A 55-year-old woman accessed our otologic tertiary level referral center for a sudden worsening of hearing loss in her left ear and vertigo. A magnetic resonance (MRI) and computer tomography scan study subsequently showed a mass in the petrous bone; hence, the presence of an ELST was hypothesized. After embolization of the mass, the patient underwent surgical removal of the lesion. The resection of the mass was done through a translabirinthine approach, with an uneventful procedure. No residual disease remained after surgery. After 24 months of radiologic follow up with MRI, there are no signs of recurrence disease. This paper reports the management of this sporadic ELST, as well as the follow up results, providing clinicians this protocol for the handling of such a challenging otologic skull base surgery and rare disease.

Here, we discuss clinical and radiological features of endolymphatic sac tumors and report the methodology and results of a surgical removal in a case in care at our otologic referral center.

Endolymphatic sac tumors (ELST) are low-grade papillary adenocarcinoma originating from the endolymphatic sac. Usually slow-growing, with local ...

Seminal Vesiculoscope Laser-Assisted Surgery to Treat Ejaculatory Duct Blockage

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.

Author Spotlight: Advanced Treatment of Seminal Duct Blockage Employing Endoscopy-Mediated Semen Channel Refluviation 

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.

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

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

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

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