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  • The Rezūm system - a minimally invasive water vapor thermal therapy for obstructive benign prostatic hyperplasia

    Cantrill H. Christopher, Zorn C. Kevin, Elterman S. Dean, Gonzalez R. Ricardo, MD Urology San Antonio, San Antonio, Texas, USA

    Benign prostatic hyperplasia (BPH) and accompanying lower urinary tract symptoms (LUTS) sits in the top ten prominent and costly disease conditions in men over 50 years of age. In the United States it is the most common diagnosis made by urologists for men 45 to 74 years of age. Twenty percent of the population will reach 65 years of age or older by 2030, and those over 85 years will represent the fastest growing segment of our population. The prevalence of symptomatic BPH increases proportionally with the aging population. It is estimated that BPH now affects 6% of the male population worldwide. Moreover, in Canada, the estimated BPH prevalence is more than 1 million men aged 50 years and older. Among the various surgical treatments, Rezūm water vapor thermal therapy has been developed as a unique, rapid and reproducible minimally invasive surgical treatment exhibiting safe and early effective relief of LUTS/BPH. The targeted prostate tissue ablation is amenable to all zones of the prostate including intravesical median lobes. We present our experiences with this technique, which can be quickly performed under local anesthesia in an office setting.

    Keywords: benign prostatic hyperplasia, prostate, LUTS, water vapor thermal therapy, Rezum system, minimally invasive surgical treatment,

    Jun 2019 (Vol. 26, Issue 3, Page 9787)
  • How I do it: Apalutamide use in non-metastatic castrate resistant prostate cancer

    Moul W. Judd, MD Division of Urology, Department of Surgery and Duke Cancer Institute, Durham, North Carolina, USA

    Urologists have been using oral nonsteroidal antiandrogens (AA) for 30 years as a component of combined androgen blockade. In February 2018, a new third generation AA, apalutamide, became available for the first time for non-metastatic (M0) castrate resistant prostate cancer (CRPC). Apalutamide was found to delay the presence of metastases (metastases free survival-MFS) by approximately 2 years versus placebo in M0 CRPC. While overall survival benefit has yet to be established, the MFS benefit is clinically meaningful and urology practices should be equipped to manage patients using this new oral agent. Since the majority of patients remain under urologic care when this disease stage develops and because the drug is straightforward to administer, urology practices are ideal to identify and treat. The objective of this brief article is to discuss the typical patient profile for use of apalutamide and to review the pros and cons of use and common side effects and management.

    Keywords: prostate cancer, apalutamide, castrate-resistant, non-metastatic disease, antiandrogen,

    Jun 2019 (Vol. 26, Issue 3, Page 9782)
  • How I Do It: Hydrogel spacer placement in men scheduled to undergo prostate radiotherapy

    Montoya Juan, Gross Eric, Karsh Lawrence, MD The Urology Center of Colorado, Denver, Colorado, USA

    Hydrogel spacer placement between the prostate and rectum in men scheduled to undergo prostate radiotherapy is an emerging technique well suited for urologists. The hydrogel spacer reduces rectal injury during radiotherapy by displacing the rectum away from the high dose region. Following radiotherapy the hydrogel spacer then liquifies, is absorbed, and then clears via renal filtration in approximately 6 months. Herein we describe the appropriate patients eligible for this procedure, and the application technique we use in our clinic.

    Keywords: prostate cancer, radiotherapy, hydrogel spacer, application, quality of life,

    Apr 2018 (Vol. 25, Issue 2, Page 9288)
  • 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)
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June 2019, Vol.26 No.3
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