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HOW I DO IT


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  • State of the art: Advanced techniques for prostatic urethral lift for the relief of prostate obstruction under local anesthesia

    Walsh Patrick Lance, MD Eisenhower Medical Center, Rancho Mirage, California, USA

    Benign prostatic hypertrophy (BPH) affects an estimated 60% of men over the age of 50 and 90% of men over the age of 80. The prostatic urethral lift (PUL) is a safe and effective office-based procedure that is used worldwide for the treatment of BPH in men who are dissatisfied with medications due to side effects or lack of efficacy or don?t want to have a transurethral resection of the prostate due to the side effects and invasiveness of the procedure. In 2012 Barkin et al, published the standard technique for the delivery of the Urolift implant. The objective of this article is to describe the current state of the art advanced techniques for the delivery of the UroLift implant.

    Keywords: prostatic urethral lift, UroLift, benign prostatic hyperplasia, prostate, LUTS, PUL,

    Jun 2017 (Vol. 24, Issue 3, Page 8859)
  • How I do it: Aquablation of the prostate using the AQUABEAM system

    MacRae Catriona, Gilling Peter, MD Department of Urology, Tauranga Hospital, Tauranga, New Zealand

    Benign prostatic hyperplasia (BPH) represents one of the most common conditions encountered in urological practice. For many years, transurethral resection of the prostate (TURP) has been considered the gold standard for surgical management of symptoms in prostates of 30 cc-80 cc. Although TURP provides excellent functional outcomes, there is significant morbidity associated with the procedure, particularly with regards to bleeding, electrolyte imbalance and sexual dysfunction. Emerging technologies aim to maintain the excellent functional results of TURP whilst decreasing the adverse events experienced by the patient. Aquablation is a novel therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for targeted removal of prostate tissue. We present our experiences with this new technique, the equipment required and steps involved.

    Keywords: benign prostatic hyperplasia, transurethral resection of prostate, ablation techniques, aquablation, bladder outlet obstruction,

    Dec 2016 (Vol. 23, Issue 6, Page 8590)
  • How I do it: Same day discharge for transurethral resection of prostate using Olympus PlasmaButton and PlasmaLoop

    Pham Ryan, Parke Jacob, Kernen M. Kenneth, MD Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA

    Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older men. Transurethral resection of the prostate (TURP) has widely been considered the gold standard in surgical treatment for BPH. However, this procedure remains largely an inpatient procedure. Inpatient admission ultimately adds to healthcare cost and patient morbidity. In this article, we present an alternative methodology to treat BPH using combination Olympus PlasmaButton and Olympus PlasmaLoop therapy. Preliminary results from our experience suggest improved hemostasis with adequate resection, allowing a majority of our patients to be discharged the same day of the procedure. We describe our novel technique as a safe and effective way to possibly treat BPH in an outpatient setting.

    Keywords: benign prostatic hyperplasia, transurethral resection of prostate, monopolar- transurethral resection of prostate, bipolar- transurethral resection of prostate, continuous bladder irrigation, transurethral vaporization of prostate,

    Oct 2016 (Vol. 23, Issue 5, Page 8491)
  • How I Do It: GreenLight XPS 180W photoselective vaporization of the prostate

    Elterman S. Dean, MD Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada

    The treatments for benign prostate enlargement (BPE), also known as lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH-LUTS), have evolved significantly over recent years. Where transurethral resection of the prostate (TURP) has been the gold standard surgery for enlarged prostate glands < 80 grams, newer modalities such as laser technology have proliferated with safe and efficacious results. Notably, for prostates larger than 80-100 grams, the surgical options were an open, simple prostatectomy or perhaps a staged TURP. Both of these surgeries have the potential for bleeding complications, electrolyte abnormalities, and prolonged hospital admissions. Additional demographic and healthcare forces are also at play. Our aging population of men is being increasingly successfully treated for cardiovascular disease. This means more men are on anti-coagulation therapy, many of whom must stay on these drugs to prevent stent clotting or stroke. Hospital resources, especially overnight hospital admissions do add considerable strain to our healthcare systems. Men are also increasingly becoming more savvy consumers when it comes to their health. Many male patients would prefer to take as few medications as possible. Studies of BPH medications in Europe and the United States have shown drug discontinuation rates between 58%-70% at 1 year. Men who are faced with the choice of daily medication for life versus an outpatient procedure will often opt for the latter, which is in keeping with AUA guidelines that still put surgery as a patient choice alongside medications. Being able to offer GreenLight photoselective vaporization (GL-PVP) with the GreenLight XPS 180Watt system addresses all of these concerns. Men with bothersome BPH-LUTS with essentially any sized prostate gland, can be treated as same-day surgery requiring no overnight admission to hospital, while continuing necessary anti-coagulants, with significantly diminished risks of bleeding, erectile dysfunction, TUR-syndrome. Just as there are many ways to perform a TURP, techniques for GL-PVP do vary. The objectives of this article are to breakdown some of the basic steps for the novice user of GL-PVP, as well as impart some 'pearls' for the more experienced user. Nothing can replace hands-on experience for any surgery. The GL-PVP is unique in that there are guides such as this and previous articles, an excellent simulation device (GreenLight SIM), and mentoring programs in place. The success of many surgeries has been the standardization of the procedure. Performing GL-PVP should not be haphazard. A surgical plan based on prostate anatomy and size, cystoscopic appearance, and application of routinized techniques should yield consistent and optimal surgical outcomes.

    Keywords: prostate, BPH, photoselective vaporization, GreenLight,

    Jun 2015 (Vol. 22, Issue 3, Page 7836)
  • How I Do It: Managing bone health in patients with prostate cancer

    Barkin Jack, MD Humber River Hospital, Toronto, Ontario, Canada

    Urologists have two scenarios where they have to address bone loss or increased risk of fractures in men with prostate cancer. In the first setting, a patient who has been started on androgen deprivation therapy may develop cancer-treatment-induced bone loss. In the second setting, a patient’s prostate cancer may have metastasized to the bone. This article describes six steps to manage bone health in patients diagnosed with prostate cancer in a community practice.

    Keywords: prostate cancer, managing bone health,

    Aug 2014 (Vol. 21, Issue 4, Page 7399)
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August 2017, Vol.24 No.4
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