We developed a new resection device-the Rotoresect -with the aim of reducing morbidity during transurethral resection of the prostate (TURP). During rotoresection, a rotating ablator electrode enables simultaneous tissue coagulation by high-frequency current and mechanical tissue ablation. The tissue ablation rate and the extent of bleeding were quantified ex vivo using a blood-perfused porcine kidney (N = 30) and then compared with loop resection and electrovaporization (grooved roller/Rollerball). Additionally, transurethral rotoresection of the prostate and open partial resection of the liver were carried out in five dogs. With the blood-perfused porcine kidney, we demonstrated that the tissue ablation rate increases with increasing of the coagulation current and rotation speed of the ablator electrode. The Rotoresect achieved a tissue ablation rate comparable to that of the resection loop (5.5-6.0 g/min), which was more than twice the rate achieved by electrovaporization (1.7-2.0 g/min). The extent of bleeding during standard loop resection was many times higher (16.5-18.0 g/min) than that induced by rotoresection and electrovaporization (< 2.3 g/min). In our in vivo canine trials, we performed transurethral prostate resection and open segmental liver resection with minimal bleeding. The Rotoresect is a promising instrument for ablation of parenchymal organs during transurethral, laparoscopic, and open surgical procedures.
Patient selection is vital for the successful outcome of penile revascularization surgery. We adhere to strict selection criteria, such as patient age maximum of 50 years, less than 2 risk factors, no recent diabetes and termination of nicotine abuse. Penile revascularization surgery is highly indicated in this group of patients, especially since it is the only causal therapy for erectile failure.
At the doorstep of the twenty-first century the role of extracorporeal shock-wave lithotripsy (ESWL) as the treatment of choice for more than 80% of all stones in children is established. ESWL is safe and effective, with very few differences in success rates being observed among different lithotriptors. The present problem with ESWL appears to be the residual stone fragment, which has a proven clinical significance. A thorough metabolic evaluation and metaphylaxis is indicated in all children, and this will enable physicians to deal with the residual fragments in a more cause-specific manner and prevent regrowth. Another subject that needs prospective randomized studies to be unveiled is the assumption that a specific or universal metaphylaxis, possibly with alkaline citrates, will enhance stone clearance, lower the incidence of residual stone fragments, and optimize the ESWL results. Finally, both percutaneous nephrolithotomy and ureteroscopic stone removal have been established in children as safe and effective treatment options. This gives the clinician the opportunity to choose from a wide range of treatment alternatives, including open surgery, and only this approach will ensure 100% stone removal in individual patients along with the prevention of recurrence and, thus, the elimination of long-term morbidities in this vulnerable patient population.
Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction who underwent interstitial laser coagulation (ILC) of the prostate. We evaluated the safety and efficacy of ILC with respect to relief of symptoms and bladder outlet obstruction. In addition to the critical evaluation of our clinical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, including prostate size, number of sticks per prostate volume and type of application. A total of 59 patients were treated with the Nd-YAG laser (mediLas fibertom) between April 1993 and December 1996. At the time of reevaluation, 47 patients had completed a follow-up of up to 24 months. A perineal approach was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% were high-risk patients in accordance with the ASA score (ASA III). The efficacy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in accordance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volume reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A significant improvement in all voiding parameters (flow rate, residual volume), including the symptom score, was observed. Pdet decreased from an average of 90 cm H2O preoperatively to 42 cm H2O postoperatively after 24 weeks and the mean reduction in prostate volume was 14 cm3. Interestingly, it was noted that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed and the improvement in objective and subjective parameters. In view of the low morbidity outcome, especially in high-risk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia.
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