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HOW I DO IT


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  • How I Do It: Techniques to avoid complications in transvaginal mesh surgery

    Faber Ken, Fromer Debra, MD Department of Urology, Hackensack University Medical Group, Hackensack, New Jersey, USA

    This article details recommendations on minimizing complications in pelvic floor reconstruction using mesh. It is designed to incorporate real world experience from an expert urologist in female pelvic floor reconstruction with medical literature and prevailing theories.

    Keywords: pelvic organ prolapse, transvaginal mesh, mesh complications,

    Jun 2015 (Vol. 22, Issue 3, Page 7844)
  • 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)
  • Adjunctive use of Narrow Band Imaging during transurethral resection/vaporization of bladder tumors to aid In identifying mucosal and sub-mucosal hypervascularity

    Diorio J. Gregory, Canter J. Daniel, MD Einstein Healthcare Network, Philadelphia, Pennsylvania, USA

    For patients with non-muscle invasive bladder cancer, cystoscopy and transurethral resection/vaporization of the bladder tumor plays an integral role in the treatment of a given patient's bladder cancer. Although considered the current gold standard for tumor detection, traditional or white light cystoscopy has been shown to have its limitations visualizing both small papillary tumors and/or carcinoma in-situ. Current efforts have been directed to closing this gap with data demonstrating that by identifying these previously missed lesions, tumor recurrence and progression rates are reduced, thereby improving patient outcomes. Narrow Band Imaging, which can be used during cystoscopy and transurethral resection/vaporization of bladder tumors, can aid in visualizing mucosal and sub-mucosal hypervascularity--a probable surrogate for malignant lesions--potentially visualizing the boundaries of lesions that may have been missed during white light cystoscopy alone. This technique may produce equivalent visual markers with fewer logistical hurdles than currently available methods. In this article, we detail our technique for the adjunctive use of Narrow Band Imaging during cystoscopy and transurethral resection/vaporization of bladder tumors to aid in visualizing mucosal and sub-mucosal hypervascularity. Although not yet readily adopted, Narrow Band Imaging may be a practical and easy to use adjunct to existing methods in visualizing occult bladder lesions.

    Keywords: bladder cancer, transurethral resection/vaporization of a bladder tumor, Narrow Band Imaging,

    Apr 2015 (Vol. 22, Issue 2, Page 7763)
  • The prone ureteroscopic technique for managing large stone burdens

    Sternberg M. Kevan, Jacobs L. Bruce, King J. Benjamin, Wachterman B. Jared, Shahrour Khaled, Theisen M. Katherine, Sprauer E. Sarah, Ohmann Erin, Averch D. Timothy, MD University of Vermont, Burlington, Vermont, USA

    Percutaneous nephrolithotomy (PCNL) is the standard treatment for patients with large stone burdens, but can be associated with significant complications. Flexible ureteroscopy is an alternative approach that is less invasive, but often requires multiple procedures. Typically, many factors play a role in the decision to perform PCNL or ureteroscopy. The challenge is that it is difficult to predict which stone burdens will be able to be cleared ureteroscopically. We describe our approach using initial prone ureteroscopy with the transition to standard prone PCNL if required.

    Keywords: percutaneous nephrolithotomy (PCNL), prone ureteroscopy, ureteroscopy, renal calculi, shock wave lithotripsy (SWL),

    Apr 2015 (Vol. 22, Issue 2, Page 7758)
  • Urologic and endovascular repair of a uretero-iliac artery fistula

    Hirsch M. Lior, Amirian J. Michael, Hubosky G. Scott, Das K. Akhil, Abai Babak, Lallas D. Costas, MD Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA

    Patients with a uretero-iliac artery fistula (UIAF) are at an elevated risk of life-threatening hemorrhage. Identification and treatment of the fistula may be challenging, and requires the combined expertise of a urologist and endovascular specialist. This manuscript provides a list of equipment needed and describes our technique for diagnosing and treating a UIAF.

    Keywords: uretero-iliac artery fistula (UIAF), ureteroarterial fistula (UAF),

    Feb 2015 (Vol. 22, Issue 1, Page 7661)
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