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HOW I DO IT
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How I do it: Surgically inserted transversus abdominis plane (TAP) catheters for flank incisions
Khurana Jaasmit, Ip Vivian, Todd Gerald, Sondekoppam V. Rakesh, MD Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
Pain control following major abdominal surgery remains a significant barrier to patient comfort. Although thoracic epidurals have been used to provide analgesia for these surgeries, the transversus abdominis plane (TAP) block is gaining popularity. The TAP catheter insertion method has transformed over the past two decades from a blinded technique to one conducted primarily under ultrasound guidance by anesthesiologists. Recently, however, interest has increased on the potential for direct surgical insertion of catheters into the TAP plane following flank incisions due to anatomical considerations. Proposed advantages include a reduction in operating time, requirement of minimal expertise and increased accuracy of catheter placement. In this report, we describe the rationale and the technique of surgical insertion of TAP catheters following open nephrectomies as performed by urologists at our institution.
Keywords: transversus abdominis plane block, nerve block, open nephrectomy,
Dec 2018 (Vol. 25, Issue 6 , Page 9623)PDF (655.9KB)Free -
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) -
How I do it: Balloon tamponade of prostatic fossa following Aquablation
Aljuri Nikolai, Gilling Peter, Roehrborn Claus, MD PROCEPT BioRobotics Corporation, Redwood Shores, California, USA
Since its first report in the 1870s, control of bleeding after transurethral resection of the prostate (TURP) has remained a concern. Foley's initial report of a urinary catheter involved placement of the balloon into the prostatic fossa following TURP. Removal of prostate tissue with a high-velocity saline stream (Aquablation) is a recently reported alternative to TURP. As Aquablation is heat-free, alternatives to non-thermal hemostasis were sought to optimize the procedure. We report use of a balloon catheter in the prostatic fossa after Aquablation as a post-resection hemostatic method.
Keywords: benign prostatic hyperplasia, aquablation, bladder outlet obstruction, minimally invasive robotic surgery, balloon catheter, TURP,
Aug 2017 (Vol. 24, Issue 4 , Page 8937) -
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) -
Treating male retention patients with temporary prostatic stent in a large urology group practice
Roach M. Richard, MD Advanced Urology Institute, Oxford, Florida, USA
Men with either chronic or temporary urinary retention symptoms are common patients treated in a urology practice. Both indwelling and intermittent catheterization are widely used to treat this condition. These approaches are associated with significant complications including infection and reduced quality-of-life. Infection is a target for quality improvement and cost reduction strategies in most care settings today. We use a temporary prostatic stent (TPS) to address these issues in our practice. In this report, we describe our approach to patient selection, sizing, placement and follow up of 214 TPS placed in 56 men with chronic or temporary urinary retention in an office setting. With the first stent placement, average indwelling time was 27 days. Thirty-two patients had multiple stents placed. Replacement was performed routinely and was generally required because underlying comorbidities precluded surgery. In these patients, an average of six stents were placed (range 2-18) with average dwell times of 31 days. Symptomatic urinary tract infections (SUTI) occurred in only 6 of 214 TPS placements (2.8%), resulting in an incident rate of 0.93 SUTI per 1,000 TPS days. TPS is a safe and efficacious means of alleviating symptoms of urinary retention. TPS does not share the same infection risk profile or quality-of-life drawbacks associated with urinary catheters; this makes TPS use relevant as a urinary catheter alternative or when a urinary catheter is not recommended.
Keywords: benign prostatic hyperplasia, LUTS, urinary retention, lower urinary tract symptoms, temporary prostatic stent,
Apr 2017 (Vol. 24, Issue 2 , Page 8776)
Humber River Health