Techniques in urology最新文献

{"title":"Management of entrapped ureteral stone baskets.","authors":"R C O'Connor,&nbsp;G S Gerber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Entrapped stone baskets can occur and can lead to significant ureteral injury and long-term morbidity. We describe two patients in whom semirigid ureteroscopy was used to facilitate safe removal of impacted baskets from the ureter.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 3","pages":"231-3"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21800045","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":"A new approach to orthotopic bladder replacement using the transplanted bowel segment.","authors":"N Yamanaka,&nbsp;K Kimura,&nbsp;M Fujisawa,&nbsp;K Ueno,&nbsp;H Shimogaki,&nbsp;S Kamidono","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>When constructing an orthotopic neobladder, a short colonic mesentery may make the operation difficult. We have developed a new technique to autotransplant a free segment of intestine into the pelvis to augment the bladder.</p><p><strong>Methods and materials: </strong>In this animal feasibility study, we used eight female dogs to perform orthotopic bladder replacement using a transplanted bowel segment. A segment of bowel was transected and revascularized between the ileal artery of the reservoir and the internal iliac artery in the end-to-end fashion.</p><p><strong>Results: </strong>Follow-up studies revealed that the bladder autoaugmentation using the transplanted bowel segment was functional and free of leakage.</p><p><strong>Conclusions: </strong>Our work in dogs demonstrates that the use of an autotransplanted segment of intestine appears to be feasible for augmenting the bladder in those cases where mechanical difficulty arises in anastomosing the urinary reservoir to the urethra. This procedure merits clinical evaluation in cases that present difficulty for completing orthotopic neobladder.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 3","pages":"234-5"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21800046","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":"A nomogram to compensate for intraoperative prostate edema during transperineal brachytherapy.","authors":"L Potters,&nbsp;X H Wang,&nbsp;Y Yamada","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Prostate edema during and following prostate brachytherapy may have a negative impact on implant dosimetry. The purpose of this study was to assess the magnitude of prostate edema during the operative procedure and to develop a nomogram of isotope activity required for compensation of such intraoperative prostate volume changes.</p><p><strong>Materials and methods: </strong>Twenty-five consecutive patients with early-stage, localized adenocarcinoma of the prostate underwent ultrasound-guided transperineal interstitial permanent prostate brachytherapy with either iodine 125 or palladium 103. Transrectal ultrasound volume studies of the prostate were performed before and during the implant procedure. Computed tomography-based postimplant dosimetry was performed 3-4 weeks after surgery.</p><p><strong>Results: </strong>A median intraoperative prostate volume increase after insertion of applicator needles of 10.4% (range 1.2-32.5%) was identified. A correlation of -0.55 (95% confidence interval -0.78 to -0.19) between the minimum dose covering 90% of the prostate volume (%D90) and the amount of edema was identified. An algorithm and nomogram was developed to calculate the extra isotope activity necessary to compensate for intraoperative edema.</p><p><strong>Conclusions: </strong>Prostate edema occurs at the time of transperineal needle placement. A negative correlation was found between the amount of edema and dose coverage of the prostate (%D90). Therefore, to cover the prostate volume adequately, additional isotope activity is required when preoperative treatment planning is performed. This nomogram can be used to compensate for such volume changes.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"99-103"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646143","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":"Brachytherapy in patients with small prostate glands.","authors":"D A Loblaw,&nbsp;K Wallner,&nbsp;S Dibiase,&nbsp;K Russell,&nbsp;J Blasko,&nbsp;W Ellis","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>To better define the role of small prostate volume in selecting patients for brachytherapy.</p><p><strong>Materials and methods: </strong>Thirty patients with a transrectal ultrasound (TRUS)-based prostate volumes less than 20 cc were treated at the University of Washington by permanent isotope implantation for prostatic carcinoma. Preimplant TRUS studies were taken at 0.5-cm intervals from the base of the gland to the apex. Planning margins of 1 to 5 mm were added to the prostatic margins, and sources were routinely planned to be placed as much as 5 mm outside of the prostatic margin. The prescription dose was 144 and 115 Gy for full-dose iodine 125 and palladium 103 monotherapy, respectively. For patients receiving supplemental external-beam irradiation, the implant doses were 120 and 90 Gy for 125I and 103Pd, respectively. The morning following the implant, axial computed tomographic (CT) images of the prostate were obtained at 0.5-cm intervals with patients in the supine position. Follow-up ranged from 11 to 28 months (median 21 months).</p><p><strong>Results: </strong>The median coverage of the postimplant prostate volume by the prescription dose was 92%. To calculate the incidence of source migration, the number of sources placed at the time of implant was compared with the number identified on postimplant CT scan. The median number of sources implanted was 84 (range 65-103) compared to an average of 82 identified postoperatively, which is consistent with a source migration rate of two. A median of 31 sources appeared to be outside of the prostatic margins, as identified on postimplant CT scan (range 14-53). Of the 23 patients contacted at the time of this report, one had developed acute postimplant urinary retention that resolved within 2 weeks of implantation. At last follow-up, patient pre- and postimplant AUA scores were not substantially different, with the median AUA score increasing from 7 (range 2-21) to 8 (range 1-27).</p><p><strong>Conclusions: </strong>Patients with small prostate volumes appear to have acceptable morbidity and target coverage with prostate brachytherapy. Based on the data reported here, we do not believe that a small prostate volume in itself is a contraindication to brachytherapy.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"64-9"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646231","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":"Cystourethroscopic findings before and after prostate brachytherapy.","authors":"G Gray,&nbsp;K Wallner,&nbsp;J Roof,&nbsp;J Corman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the role of cystourethroscopy in predicting the risk of postimplant urinary retention.</p><p><strong>Materials and methods: </strong>Fifteen unselected prostate brachytherapy patients implanted with 125I or 103Pd under spinal or general anesthesia were studied. Following induction of anesthesia, the patient was placed in the lithotomy position and cystourethroscopy performed using a 17 sheath and a 30 degrees lens. Irrigation pressure was 100-cm water. A photograph was taken from the level of the verumontanum. At completion of the implant procedure, a second cystourethroscopy was performed and another photograph taken. The degree of obstruction was rated using a 3-point scale. Each patient was contacted at the time of this report to update postimplant morbidity information with follow-up from 1 to 10 months.</p><p><strong>Results: </strong>The patients' preimplant cystourethroscopic findings ranged from minimal to complete occlusion. There was no clear relationship between the American Urologic Association (AUA) score or preimplant prostate volume and the degree of obstruction. Nearly all patients had some increased physical obstruction following completion of the procedure, but only 8 of 14 patients had an increase in obstruction grade. Six patients were completely obstructed at the completion of the implant procedure, only one of whom developed urinary retention.</p><p><strong>Conclusions: </strong>Marked variability in cystourethroscopy findings do not appear to have a strong influence on the likelihood of postimplant urinary retention and are not a reliable predictor of retention.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"109-11"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646145","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":"Use of radioimmunoscintigraphy with indium-111-labeled CYT-356 (ProstaScint) scan for evaluation of patients for salvage brachytherapy.","authors":"D X Fang,&nbsp;R G Stock,&nbsp;N N Stone,&nbsp;B R Krynyckyi,&nbsp;C K Kim,&nbsp;J Machac","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Indium 111 capromab pendetide radioimmunoscintigraphy (ProstaScint) has been used to detect occult recurrent carcinoma after radical prostatectomy.</p><p><strong>Materials and methods: </strong>We evaluated the role of ProstaScint in 24 men with rising prostate-specific antigen (PSA) level following definitive radiation therapy to differentiate between local and distant recurrence in this patient population.</p><p><strong>Results: </strong>ProstaScint scan detected prostatic uptake only in 16 patients, extraprostatic uptake in 5, both prostatic and extraprostatic uptake in 1, and no uptake in 2. Ten of 21 patients with prostatic uptake had positive biopsies, 5 had negative biopsies, and 6 were not biopsied. Two of the three patients with negative scans had positive biopsies, and the third patient was not biopsied. Three patients had evidence of osseous metastasis on radionuclide bone scan, two corresponding to the sites detected on ProstaScint. All three patients had abnormal uptake beyond the prostatic fossa with (n =2) or without (n = 1) prostatic uptake. There were no positive bone scans in patients without extraprostatic uptake on ProstaScint.</p><p><strong>Conclusions: </strong>ProstaScint scan is useful in detecting occult recurrence outside the prostate in patients with rising PSA following radiation therapy. Compared to data from radical prostatectomy, ProstaScint scans in these patients reveal a higher prevalence of abnormal uptake in the prostate and less frequent extraprostatic uptake.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"146-50"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646043","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 there a role for antibiotic prophylaxis in transperineal interstitial permanent prostate brachytherapy?","authors":"A P Dicker,&nbsp;A T Figura,&nbsp;F M Waterman,&nbsp;R K Valicenti,&nbsp;S E Strup,&nbsp;L G Gomella","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>There are few data to guide the physician on the use of prophylactic antibiotic(s) for prostate brachytherapy. The purpose of this study was to evaluate the symptomatic urinary tract infection (UTI) rate after performing transperineal interstitial permanent prostate brachytherapy (TIPPB) in conjunction with cystoscopy.</p><p><strong>Materials and methods: </strong>One-hundred twenty-five patients underwent TIPPB and cystoscopy. All patients received intravenous perioperative antibiotic prophylaxis. No postimplant antibiotic medication was prescribed. All patients were evaluated at 1-month follow- up for symptomatic UTI. No screening (U/A, C+S) was performed for asymptomatic patients. Any UTI within 1 month of TIPPB was considered a complication and scored as an infection.</p><p><strong>Results: </strong>Of 125 patients who underwent TIPPB and cystoscopy, one patient (1%) developed a symptomatic UTI. In our study, a one-time perioperative intravenous dose of cefazolin (Ancef) without additional postoperative antibiotics resulted in an overall symptomatic UTI rate of 1%. Hence, additional postoperative antibiotics may not be warranted, thus providing a cost saving (500 mg of ciprofloxacin orally, two times a day for 5 days at a cost of $44.95) and reducing the potential risk of antibiotic resistance.</p><p><strong>Conclusions: </strong>When cystoscopy is used in conjunction with TIPPB, perioperative antibiotic prophylaxis is recommended. However, due to the low infection rate expected from TIPPB, postimplant antibiotic use is not recommended. As a result of the low infection rate anticipated from TIPPB and cystoscopy, a large multiinstitutional trial is needed to determine the necessity of antibiotic prophylaxis for TIPPB and cystoscopy.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"104-8"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646144","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":"Use of image coregistration in salvage prostate brachytherapy.","authors":"W S Bice,&nbsp;J E Freeman,&nbsp;L F Russell,&nbsp;G D Case,&nbsp;D F Dubois,&nbsp;J J Prete,&nbsp;B R Prestidge","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>We describe a method of performing salvage prostate brachytherapy on patients whose initial implant was suboptimal. This technique uses an image correlation algorithm only previously used to fuse postimplant magnetic resonance and computed tomographic (CT) images. Here, the initial postimplant CT and the second preimplant volume study are coregistered to plan delivery of the salvage implant.</p><p><strong>Materials and methods: </strong>Two early-stage patients had salvage implants performed with this technique, in which only a limited number of sources were visible on the ultrasound images. The dosimetric results of the first implant were displayed on the preplan generated for the second procedure. The planned total dose then was visualized prior to salvage implant.</p><p><strong>Results: </strong>The implants were performed without complication. Rectum and urethra doses remained acceptable. In each case, the improvement in coverage of the gland was dramatic (V80 coverage improved from 65.2% and 47.3% to 93.1% and 92.2%, respectively), precluding the need for further intervention.</p><p><strong>Conclusions: </strong>Coregistration of the postimplant CT scan to an ultrasound volume study can be quantifiably and reliably performed. The resulting image set can be used to guide needle placement during a second salvage implant to achieve much improved dosimetric coverage of the gland.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"151-6"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646044","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":"Prior transurethral resection does not increase morbidity following real-time ultrasound-guided prostate seed implantation.","authors":"N N Stone,&nbsp;E R Ratnow,&nbsp;R G Stock","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with localized prostate cancer who had a prior open prostatectomy or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) may be at risk for greater morbidity when treated with brachytherapy. This analysis examines the morbidity following brachytherapy using the real-time method to determine if patients with a history of TURP are at increase risk for developing complications.</p><p><strong>Materials and methods: </strong>An ultrasound-guided transperineal interactive prostate seed was implanted in 419 patients with T1-T2 prostate cancer. All patients were implanted using a peripheral weighting of sources (75%) with the interior sources placed at least 5 mm from the urethra. The patients were divided into two groups: group 1 consisted of 376 patients (89.7%) without a prior TURP, and group 2 consisted of 43 patients (10.3%) who had a TURP prior to their implant. The mean age, prostate-specific antigen level, Gleason score, clinical stage, prostate volume, isotope implanted, and number of patients treated with neoadjuvant hormone therapy were comparable for both groups.</p><p><strong>Results: </strong>Median follow-up for group 1 was 12 months and for group 2 was 18 months. No patients suffered from radiation-related proctitis or cystitis in either group of patients. Two patients in group 2 implanted with iodine 125 and who had a history of two prior TURPs developed mild superficial urethral necrosis (SUN). The actuarial freedom from developing superficial urethral necrosis at 4 years was 84% in patients with a history of prior TURP. There were no episodes of SUN in group 1 and no cases of incontinence reported in either group of patients. The actuarial rate of potency was 78% at 2 years.</p><p><strong>Conclusion: </strong>Whereas other techniques of seed implantation report incontinence in patients who had a prior open prostatectomy or TURP, the real-time method combined with peripheral loading avoids this complication.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"123-7"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646040","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":"Can the cost of permanent prostate implants be reduced? An argument for peripheral loading with higher strength seeds.","authors":"P D Maguire,&nbsp;F M Waterman,&nbsp;A P Dicker","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the economic impact of higher vs. lower strength permanent radioactive seeds used for prostate brachytherapy in the treatment of localized adenocarcinoma of the prostate.</p><p><strong>Materials and methods: </strong>Treatment plans for 50 patients who received an iodine 125 implant as monotherapy for favorable risk prostate cancer were reviewed and specific activity (mCi/cc) was determined for prostate volumes that ranged from 12 to 87 cc. Current prices for individual model 6711 125I seeds were obtained from the manufacturer (Nycomed/Amersham). Total seed costs for three theoretical prostate implant volumes of 25, 40, and 55 cc were calculated using seed strengths of 0.25, 0.34, 0.50, and 0.75 mCi/seed.</p><p><strong>Results: </strong>Specific activities for prostate volumes of 25, 40, and 55 cc were 1.25, 1.15, and 1.00 mCi/cc, respectively. Total seed cost was inversely related to seed strength. For a 25-cc prostate the cost ranged from $1,890 (0.75 mCi/seed) to $5,625 (0.25 mCi/seed), for a 40-cc prostate $2,745 to $8,280, and for a 55-cc prostate $3,285 to $9,900. For a medium-sized gland (40 cc), the treatment plan using a seed strength of 0.75 mCi/seed resulted in a total seed cost of $2,745 vs. $6,075 for a plan using an activity of 0.34 mCi/seed. This savings of approximately 55% in total seed cost between seed strengths of 0.75 and 0.34 mCi/seed held true for small (25 cc) and large (55 cc) prostate volumes as well.</p><p><strong>Conclusions: </strong>Given the current prices for 125I individual seeds, prostate implants using a peripheral loading technique with higher activity seeds may result in a significantly lower material cost than techniques using lower activity seeds. However, issues regarding morbidity as well as sensitivity to source placement error need to be addressed further before any final conclusions can be made.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"6 2","pages":"85-8"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21646140","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}