Content

Welcome to the CJU website » LOG IN

HOW I DO IT


First Prev Page 1 of 2 Next Last
  • How I Do It: Optilume BPH catheter system

    Elterman S. Dean, Gao Bruce, Zorn C. Kevin, Bhojani Naeem, Te Alexis, Chughtai Bilal, Kaplan A. Steven Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada

    Benign prostatic hyperplasia (BPH) is a common and progressive disease affecting aging men which has a significant impact on quality of life. The Optilume BPH Catheter System (Optilume BPH) is a prostatic dilation system that combines balloon dilation with a localized transfer of paclitaxel to maintain long term patency. Optilume BPH can be deployed using standard rigid cystoscopy without general anesthesia in an office setting. Prospective data indicate that Optilume BPH has favorable functional and sexual patient outcomes. Readers will familiarize themselves with Optilume BPH, significant historical studies and the technique for deploying Optilume BPH.

    Keywords: prostate, BPH, MIST, Optilume,

    Jun 2023 (Vol. 30, Issue 3 , Page 11568)
  • How I Do It: The prostatic urethral lift for obstructive median lobes

    Ashley S. Matt, Phillips Jason, Eure Gregg Summit Health, Bend, Oregon, USA

    Millions of men in North America suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are managed on medical therapy. Most patients, however, report poor adherence, and yet relatively few pursue more definitive surgical solutions. The Prostatic Urethral Lift (PUL) was designed to address many of the patient-identified barriers to surgery, namely iatrogenic sexual dysfunction, incontinence, lengthy recovery and postoperative catheterization. Randomized studies and large real world multicenter and database studies have demonstrated safety and effectiveness of PUL when addressing lateral lobe disease. In recent years further technique and device development has led to the FDA approval for PUL addressing obstructive median lobes as well. At 12 months, PUL median lobe patients in a controlled trial and a large retrospective study experienced average IPSS improvement of 13.5 and 11.6 points, QoL improvement of 3.0 and 2.1 points, and Qmax improvement of 6.4 and 7.1 mL/sec, respectively. In the controlled setting, both ejaculatory and erectile function were preserved and postoperative catheterization rates, while higher than lateral lobe PUL rates, were similarly short lived with a mean duration of 1.2 days. We describe the current technique for performing PUL to address the obstructive median lobe and detail a new device, which can make it easier to alleviate obstruction due to trilobar anatomy.

    Keywords: prostatic urethral lift, UroLift, benign prostatic hyperplasia, prostate, LUTS, BPH, PUL, middle lobe, median lobe,

    Apr 2023 (Vol. 30, Issue 2 , Page 11509)
  • How I do it: Aquablation in very large prostates (> 150 mL)

    Helfand T. Brian, Kasraeian Ali, Sterious Steve, Glaser P. Alexander, Talaty Pooja, Alcantara Miguel, Alcantara Mola Kaitlyn, Higgins Andrew, Ghiraldi Eric, Elterman S. Dean Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA

    Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.

    Keywords: robotics, LUTS, BPH, aquablation, prostate surgery, urology,

    Apr 2022 (Vol. 29, Issue 2 , Page 11111)
  • How I Do It: Temporarily Implanted Nitinol Device (iTind)

    Elterman Dean, Gao Bruce, Zorn C. Kevin, Bhojani Naeem, Chughtai Bilal, MD Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Benign prostatic hyperplasia is a common and progressive disease affecting aging men which has a significant impact on quality of life. The second-generation Temporarily Implanted Nitinol Device (iTind) is an FDA approved temporary prostatic urethral device which can be deployed using standard flexible cystoscopy without sedation or general anesthesia. The device is left in-situ for 5 to 7 days and is then entirely removed in the office, using an open-ended silicone catheter. Prospective, randomized data indicate that iTind has favorable functional and sexual patient outcomes. Readers will familiarize themselves with iTind, significant historical studies and the technique for deploying iTind using a flexible cystoscope in the office setting.

    Keywords: prostate, BPH, TMIST, iTind,

    Aug 2021 (Vol. 28, Issue 4 , Page 10788)
  • How I Do It: GreenLight XPS 180W photoselective vaporization of the prostate

    Elterman S. Dean, MD Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada

    The treatments for benign prostate enlargement (BPE), also known as lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH-LUTS), have evolved significantly over recent years. Where transurethral resection of the prostate (TURP) has been the gold standard surgery for enlarged prostate glands < 80 grams, newer modalities such as laser technology have proliferated with safe and efficacious results. Notably, for prostates larger than 80-100 grams, the surgical options were an open, simple prostatectomy or perhaps a staged TURP. Both of these surgeries have the potential for bleeding complications, electrolyte abnormalities, and prolonged hospital admissions. Additional demographic and healthcare forces are also at play. Our aging population of men is being increasingly successfully treated for cardiovascular disease. This means more men are on anti-coagulation therapy, many of whom must stay on these drugs to prevent stent clotting or stroke. Hospital resources, especially overnight hospital admissions do add considerable strain to our healthcare systems. Men are also increasingly becoming more savvy consumers when it comes to their health. Many male patients would prefer to take as few medications as possible. Studies of BPH medications in Europe and the United States have shown drug discontinuation rates between 58%-70% at 1 year. Men who are faced with the choice of daily medication for life versus an outpatient procedure will often opt for the latter, which is in keeping with AUA guidelines that still put surgery as a patient choice alongside medications. Being able to offer GreenLight photoselective vaporization (GL-PVP) with the GreenLight XPS 180Watt system addresses all of these concerns. Men with bothersome BPH-LUTS with essentially any sized prostate gland, can be treated as same-day surgery requiring no overnight admission to hospital, while continuing necessary anti-coagulants, with significantly diminished risks of bleeding, erectile dysfunction, TUR-syndrome. Just as there are many ways to perform a TURP, techniques for GL-PVP do vary. The objectives of this article are to breakdown some of the basic steps for the novice user of GL-PVP, as well as impart some 'pearls' for the more experienced user. Nothing can replace hands-on experience for any surgery. The GL-PVP is unique in that there are guides such as this and previous articles, an excellent simulation device (GreenLight SIM), and mentoring programs in place. The success of many surgeries has been the standardization of the procedure. Performing GL-PVP should not be haphazard. A surgical plan based on prostate anatomy and size, cystoscopic appearance, and application of routinized techniques should yield consistent and optimal surgical outcomes.

    Keywords: prostate, BPH, photoselective vaporization, GreenLight,

    Jun 2015 (Vol. 22, Issue 3 , Page 7836)
First Prev Page 1 of 2 Next Last