Techniques in urology最新文献

{"title":"Laparoscopic adrenalectomy.","authors":"D. Fahlenkamp, M. Beer, B. Schönberger, M. Lein, I. Türk, S. Loening","doi":"10.1002/9781119524328.ch98","DOIUrl":"https://doi.org/10.1002/9781119524328.ch98","url":null,"abstract":"Fifteen patients with benign adrenal tumors underwent laparoscopic adrenalectomy for the following indications: six pheochromocytomas, four adenomas, two Cushing's syndromes, one hematoma, one myolipoma, and one Conn's syndrome. Fourteen of 15 procedures were completed laparoscopically. The average blood loss was 300 ml; the mean operative time was 150 min. In the hands of a laparoscopically experienced surgeon, laparoscopic adrenalectomy is a safe and effective procedure involving minimal morbidity. With the accepted indications for removal of benign adrenal tumors, laparoscopic adrenalectomy is our therapy of choice.","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"2 1 1","pages":"48-53"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/9781119524328.ch98","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47311145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male Slings for Postprostatectomy Incontinence","authors":"F. Yanaral, Çağlar Dizdaroğlu, O. Sarilar, F. Ozgor","doi":"10.5336/urology.2019-66416","DOIUrl":"https://doi.org/10.5336/urology.2019-66416","url":null,"abstract":"","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70796635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In situ anterior vaginal wall sling.","authors":"H. Goldman","doi":"10.1201/B14154-26","DOIUrl":"https://doi.org/10.1201/B14154-26","url":null,"abstract":"PURPOSE\u0000The aim of this article is to review the indications, technique, and outcomes of the in situ anterior vaginal wall sling (AVWS) for treatment of female stress urinary incontinence.\u0000\u0000\u0000MATERIALS AND METHODS\u0000The operative techniques and the published literature on outcomes of the AVWS were reviewed.\u0000\u0000\u0000RESULTS\u0000Success rates in the range from 70% to 95% were noted. Some authors found that patients with a lower Valsalva leak point pressure (VLPP) had lower success rates than those with a higher VLPP.\u0000\u0000\u0000CONCLUSIONS\u0000The AVWS is a technically straightforward minimally invasive procedure for treatment of stress urinary incontinence that minimizes patient morbidity and avoids some of the potential problems associated with other sling materials.","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"7 2 1","pages":"101-4"},"PeriodicalIF":0.0,"publicationDate":"2004-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65982192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial laser coagulation of the prostate.","authors":"J. C. Williams","doi":"10.1016/S1063-5777(02)00008-7","DOIUrl":"https://doi.org/10.1016/S1063-5777(02)00008-7","url":null,"abstract":"","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"2 3 1","pages":"130-5"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56447643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In situ anterior vaginal wall sling.","authors":"Goldman Hb","doi":"10.1097/00005392-200112000-00052","DOIUrl":"https://doi.org/10.1097/00005392-200112000-00052","url":null,"abstract":"PURPOSE The aim of this article is to review the indications, technique, and outcomes of the in situ anterior vaginal wall sling (AVWS) for treatment of female stress urinary incontinence. MATERIALS AND METHODS The operative techniques and the published literature on outcomes of the AVWS were reviewed. RESULTS Success rates in the range from 70% to 95% were noted. Some authors found that patients with a lower Valsalva leak point pressure (VLPP) had lower success rates than those with a higher VLPP. CONCLUSIONS The AVWS is a technically straightforward minimally invasive procedure for treatment of stress urinary incontinence that minimizes patient morbidity and avoids some of the potential problems associated with other sling materials.","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"7 1","pages":"101"},"PeriodicalIF":0.0,"publicationDate":"2001-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61507240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transurethral microwave thermotherapy in the armamentarium of therapeutic modalities for benign prostatic hyperplasia.","authors":"D L Floratos,&nbsp;G J Alivizatos,&nbsp;F M Debruyne,&nbsp;J J de la Rosette","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transurethral microwave thermotherapy (TUMT) has gained a firm place in the spectrum of therapeutic modalities for management of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction. To achieve optimum results following TUMT, intense research focuses on appropriate patient selection, heat-tissue interactions, and modification of technical specifications. Results of TUMT are good to excellent for the majority of patients, but there is a non-negligible number of patients who respond poorly. The selection of favorable candidates for TUMT aims to improve the therapeutic results, and both clinical baseline parameters and intrinsic characteristics of the prostate (histologic composition and vasculature) may influence treatment outcome. TUMT achieves therapeutic response through coagulative necrosis of the hyperplastic tissue, but additional theories have been proposed recently, suggesting that TUMT may cause neural destruction and induce apoptosis. Individualization of the treatment is expected to offer the best results, and because the temperature achieved inside the prostate determines the actual parenchymal necrosis, thermal monitoring during treatment will permit application of microwave energy in a feedback mode. Various microwave devices differ in technical specifications (operating frequency, design of antenna, cooling system), and recently introduced software programs (high-energy protocols, heat-shock strategy, short-duration protocols) aim at better efficacy, providing a more patient-friendly procedure. TUMT has survived the \"test of time\" that other, initially promising, modalities have failed. What remains to be determined is the maximum benefit that patients and health systems can gain from such a technique.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 4","pages":"256-61"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21932693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Water-induced thermotherapy for benign prostatic hyperplasia.","authors":"I Cioanta,&nbsp;R Muschter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Water-induced thermotherapy (WIT), administered by the Thermoflex System, represents a novel minimally invasive technique for the treatment of benign prostatic hyperplasia (BPH). The Thermoflex System consists of an extracorporeal heat source and a proprietary closed-loop catheter system. Water, heated to 60 degrees C, is continuously circulated through the catheter to a treatment balloon, which conducts thermal energy to targeted prostatic tissue. The combination of heat and compression reduces the heat sink effect of the circulating blood, thus enhancing the thermal energy transfer to the compressed tissue. WIT treatment is performed using only topical urethral anesthetic, in a single 45-minute session. The 2-year follow-up data from a European multicenter study consisting of 125 patients showed an improvement in peak urine flow of 87.4% (from baseline 8.7 +/- 1.9 to 16.3 +/- 9.1 mL/s) and in the International Prostate Symptom Score (IPSS) of -54.2% (from baseline 24 +/- 5 to 11 +/- 5). Patient tolerance of WIT was rated as \"excellent\" or \"good\" in 91.8% of the procedures. WIT is efficacious, simple, and inexpensive, has few side effects, and does not need special probes to monitor prostate or rectum temperature; thus, it can be used in hospitals, outpatient clinics, and doctors' offices.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 4","pages":"294-9"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21931973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome predictors of high-energy transurethral microwave thermotherapy.","authors":"B Bursa,&nbsp;R Wammack,&nbsp;B Djavan,&nbsp;B Planz,&nbsp;M Waldert,&nbsp;T Dobronski,&nbsp;T Stoklosa,&nbsp;T Borkowski,&nbsp;T Jakubcky,&nbsp;M Marberger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Despite the good results of high-energy transurethral microwave thermotherapy (TUMT) for treatment of benign prostatic hyperplasia (BPH), it still is difficult to predict the response to treatment on an individual basis. In addition to clinical baseline parameters, histologic parameters seem to play a role in response variance after TUMT. High-energy TUMT has become widely accepted as a minimally invasive outpatient treatment in patients with lower urinary tract symptoms and BPH. Most patients benefit substantially from targeted microwave thermotherapy; however, little is known about optimal patient selection and the most relevant outcome parameters.</p><p><strong>Materials and methods: </strong>We evaluated Medline-based studies published between 1989 and 2000, including 900 patients suffering from lower urinary tract symptoms due to BPH who were undergoing TUMT. We evaluated outcome predictors for TUMT, such as histopathological parameters, prostate-specific antigen, and volume.</p><p><strong>Results: </strong>Histologic and clinical outcome parameters were identified. Patient-to-patient differences in stromal-to-epithelial ratio of prostate tissue did affect outcomes. Poor responders to TUMT seemed to have a higher vessel density and a lower epithelial/stromal ratio. Relatively more abundant epithelial cells in the prostate tissue may lead to more favorable outcomes. Use of higher energy, patients with higher grade of obstruction, younger patient age, larger prostate volume (>25 mL), and higher prostate-specific antigen levels seemed to be associated with a better response to TUMT.</p><p><strong>Conclusions: </strong>New energy protocols could help tailor treatment to the individual needs of each patient. Nomograms based on volume, age, and pressure-flow parameters could assist in making clinical recommendations and identifying treatment responders; however, the total amount of energy appeared to have a high impact on the prediction of response.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 4","pages":"262-6"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21932694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transurethral microwave thermotherapy of the prostate without intravenous sedation: results of a single United States center using both low- and high-energy protocols. TJUH TUMT Study Group.","authors":"D A Rivas,&nbsp;D Bagley,&nbsp;L G Gomella,&nbsp;I H Hirsch,&nbsp;C Hubert,&nbsp;S Lombardo,&nbsp;D E McGinnis,&nbsp;S G Mulholland,&nbsp;P J Shenot,&nbsp;S E Strup,&nbsp;S P Vasavada","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Previous studies have indicated that high-energy transurethral microwave thermotherapy (TUMT) requires intravenous (IV) sedation and/or narcotics for patient tolerance. This study was performed to determine tolerability, patient acceptance, and efficacy of TUMT using both low- and high-energy protocols in a single United States university setting.</p><p><strong>Materials and methods: </strong>Between August 11, 1997 and October 28, 1999, 210 men (mean age 64.9 +/- 9.1 years) presenting with symptomatic benign prostatic hyperplasia (BPH) received treatment with a Prostatron TUMT using either the low-energy Prostasoft 2.O or high-energy Prostasoft 2.5 software. Each patient had digital rectal examination and prostate-specific antigen level consistent with BPH, American Urological Association symptom score > or = 15, and Qmax <15 mL/s. Each patient received TUMT with only ibuprofen 400 mg by mouth (PO), lorazepam 1.0 mg PO, and ketorolac 30 mg intramuscularly (IM) prior to TUMT. A few patients who were concerned about limited pain threshold received oxycodone 5 mg/acetaminophen 325 mg PO. Of 210 patients treated, 12-month efficacy data were available for analysis in 80 patients.</p><p><strong>Results: </strong>Forty-eight men (mean age 65 +/- 9.2 years) received low-energy 2.0 software TUMT, and 32 men (mean age 65.1 +/- 9.2 years) were treated with high-energy 2.5 software. Mean prostatic volume was 44.3 +/- 23.9 mL and 60.7 +/- 26.4 mL for the 2.0 and 2.5 groups, respectively. Mean energy delivered was 108.8 +/- 50.4 kJ and 173.1 +/- 41.1 kJ for the 2.0 and 2.5 treatment groups, respectively. International Prostate Symptom Score decreased from 23 pre-TUMT to 8 post-TUMT and 21 pre-TUMT to 10 post-TUMT at 12 months in the 2.0 and 2.5 groups, respectively. Mean peak flow rate improved 31.9% from 9.1 mL/s pre-TUMT to 12.0 mL/s post-TUMT and 45.8% from 9.6 mL/s pre-TUMT to 14.0 mL/s post-TUMT at 12 months in the 2.0 and 2.5 groups, respectively. All but two patients tolerated treatment without IV sedation. One patient experienced intolerable rectal spasm, and treatment was terminated in another patient because of poorly controlled hypertension.</p><p><strong>Conclusions: </strong>Patients can be treated safely with TUMT using either low or high energy, with almost universal patient tolerance and without the need for IV sedation or narcotics, if they premedicated effectively using a PO/IM regimen. Patients experience significant relief of symptoms whether low- or high-energy TUMT is used; however, high-energy TUMT improves flow rate to a greater extent than does low-energy therapy.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 4","pages":"282-7"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21932699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is transurethral microwave thermotherapy an alternative to medical therapy for patients with benign prostatic hyperplasia?","authors":"B Djavan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Scientific evidence supports the safety and efficacy of transurethral microwave thermotherapy (TUMT) as well as medical therapy for management of patients with benign prostatic hyperplasia (BPH). TUMT is being increasingly considered as an alternative to medical management with alpha-blockers or finasteride in patients with lower urinary tract symptoms of BPH. Enduring clinical benefits have been demonstrated after a single 1-hour microwave treatment session under topical anesthesia, and associated morbidity is low. Optimal results are obtained with the delivery of high thermal doses and accurate targeting of microwave energy. Extensive evidence from randomized clinical trials supports the safety and efficacy of both microwave treatment and medical management. Randomized clinical trial data have only recently become available directly comparing these two approaches to BPH treatment. These data indicate that greater long-term improvements in symptoms, peak urinary flow rates, and quality of life are attained with microwave treatment as compared with alpha-blockade. Furthermore, the actuarial rate of treatment failure is markedly lower in patients undergoing microwave vs. alpha-blocker treatment. However, the onset of action with alpha-blocker treatment is more rapid. Limitations of alpha-blockade are side effects and lack of efficacy leading to treatment failure in some patients. Maximal effects of finasteride are modest and require a period of months to be manifested, although the side effect profile and tolerability of this agent are favorable. Neoadjuvant and adjuvant alpha-blocker therapy can accelerate symptom and flow rate improvement after microwave treatment. In contrast to medical management, microwave treatment is highly versatile, allowing patients over a broad range of baseline symptom severities and prostate sizes to be treated with a high probability of success. Compared with medical management, microwave treatment also appears to possess greater versatility, allowing patients who fall within a broad range of baseline symptom severities and prostate sizes to be treated with a high probability of success.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 4","pages":"300-6"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21931974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}