HOW I DO IT

• Ureteroileal anastomotic strictures after a Bricker ileal conduit: 50 case assessment of the impact of conversion from a slit incision to a shield shaped ileotomy

  Cheng Marina , Looney W. Stephen , Brown A. James, MD Division of Urology, Medical College of Georgia, Augusta, Georgia, USA

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  PURPOSE: Ureteroileal anastomotic stricture is a late complication of Bricker ileal conduits. We report our utilization of a 'shield shaped' rather than a standard slit ileotomy. MATERIALS AND METHODS: We retrospectively reviewed a single surgeon's experience performing Bricker ileal conduits, initially using a slit incision, then a shield shaped ileotomy. Patient demographics, type of ileotomy, indication, history of prior radiation or chemotherapy, development of postoperative ureteroileal anastomotic stricture, date of stricture diagnosis, imaging modality, stricture treatment, outcome, and length of follow up were recorded. RESULTS: A total of 50 ileal conduit patients were identified between 2001-2009. A traditional slit incision ileotomy was performed in 25 patients (Group 1) and a shield shaped ileotomy was performed in the following 25 (Group 2). After excluding 1 patient in each group that died within 90 days postoperatively, a total of 95 renal units were anastomosed, (Group 1: 24 patients, 48 renal units, 2001-2005; and Group 2: 24 patients, 47 renal units, 2006-2009). A total of 8 (8.3%) ureteroileal anastomotic strictures were identified: 6 (12.5%) in Group 1, including 1 with bilateral strictures, and 2 (4.3%) in Group 2. Stricture diagnosis occurred at 1, 4, 4, 5, 14 and 42 months in Group 1, and at 6 and 10 months in Group 2. Mean follow up was 24.2 (2-85) months and 12.3 (2-26) months for each cohort, respectively. No increase in postoperative anastomotic leakage was identified. CONCLUSIONS: Modifying the standard ileotomy slit to a shield shaped incision does not eliminate postoperative anastomotic strictures. This technique provides greater visualization of the suture line, making it technically easier to perform.

  Keywords: posterior urethral valves, adulthood, late diagnosis, outcome,

  Apr 2011 (Vol. 18, Issue 2 , Page 5644)
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• High intensity focused ultrasound (HIFU)

  Barkin Jack, MD Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada

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  INTRODUCTION: Curative treatments for localized prostate cancer, from least invasive to most invasive, include brachytherapy, cryosurgery, three-dimensional conformal radiation therapy, external beam radiation therapy, and radical prostatectomy. A patient with localized, low risk or intermediate risk prostate cancer who is diagnosed at an early age and receives one of these treatments has only an approximately 50% chance of maintaining an undetectable prostate-specific antigen (PSA) level, good spontaneous erections, and total continence by 5 years after treatment. OBJECTIVE: This article discusses transrectal high intensity focused ultrasound (HIFU) treatment of localized prostate cancer using the Sonablate 500 (Focus Surgery, Indianapolis, IN, USA) device, which the author has adopted in favor of the Ablatherm (EDAP, TMS S. A., Lyons, France) device, the other HIFU device approved for use in Canada. METHOD: Characteristics of the ideal prostate cancer include stage T1-T2b, less than 40 cc in size, and with an anterior-posterior dimension of up to 35 mm high. The anterior zone of the prostate is treated before the posterior zone. The procedure involves 2 to 3 second bursts of ultrasound energy, followed by 3 second cooling cycles. In each treatment lesion, the physician achieves a temperature of 100 C at the focal point. The device allows for real-time visualization of tissue response following the delivery of ultrasound energy. CONCLUSION: HIFU is a minimally invasive, outpatient treatment for localized prostate cancer that provides similar short term and medium term cure rates and considerably less morbidity and side effects than other treatments. Although the effectiveness of HIFU has not yet been demonstrated in large, long term studies, this treatment option should be discussed with patients who have just been diagnosed with low risk or intermediate risk prostate cancer and desire aggressive, noninvasive, curative therapy, with potentially a lower incidence of side effects compared to conventional therapy.

  Keywords: prostate cancer, HIFU,

  Apr 2011 (Vol. 18, Issue 2 , Page 5634)
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• Olympus PlasmaButton transurethral vaporization technique for benign prostatic hyperplasia

  McClelland Michael, MD Urology Austin, Austin, Texas, USA

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  OBJECTIVE: This article will describe an efficient and effective method of using Olympus PlasmaButton (Olympus, Southborough, MA, USA) for transurethral vaporizations of the prostate (TUVP). METHODS: This method was developed over the last 18 months. Patients undergoing this Olympus PlasmaButton TUVP had the inner aspect of the prostate vaporized until it was believed to be significantly open and unobstructed. RESULTS: Patients were found to do very well with what appears to be durable results. Postoperative short and long term bleeding has not been a significant issue using this method. CONCLUSION: The Olympus PlasmaButton procedure is a new minimally invasive therapy for benign prostatic hyperplasia (BPH). As with all new technologies there are methods that a surgeon learns with increased experience that help make the procedure more effective, efficient, and safer. This article shows one surgeon's technique that has been developed over time and has become a successful way to manage patients undergoing the minimally invasive transurethral vaporization of the prostate. There are probably other vaporization techniques that surgeons have learned with use of the PlasmaButton that may be equally effective.

  Keywords: benign prostatic hyperplasia, photovaporization, transurethral vaporization of the prostate, technique,

  Apr 2011 (Vol. 18, Issue 2 , Page 5630)
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