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HOW I DO IT


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  • How I Do It: Holmium laser cystolitholapaxy and enucleation of the prostate for benign prostatic hyperplasia

    Gao M. Bruce, Saadat Seyedamirvala, Choi J. H. Edward, Jiang James, Das K. Akhil Department of Urology, University of California, Irvine, Orange, California, USA

    Holmium enucleation of the prostate (HoLEP) is a gold-standard, size-independent surgical treatment for benign prostatic hyperplasia (BPH) distinguished for its efficacy in tissue removal, shorter catheterization durations, lower transfusion rates, and decreased hospital stays when compared to transurethral resection of the prostate (TURP). The objective of this article is to demonstrate the step-by-step procedure of holmium laser cystolitholapaxy and enucleation of the prostate for BPH, emphasizing a top-down modified two-lobe technique with early apical release which enhances visualization and irrigation flow during the enucleation process.

    Keywords: prostate, BPH, HoLEP, cystolitholapaxy, holmium,

    Jun 2024 (Vol. 31, Issue 3 , Page 11904)
  • 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)
  • Urethral bulking with native tissue during artificial urinary sphincter surgery          

    Rabinowitz J. Matthew, Liu L. James, Levy A. Jason, DuComb William, Burnett L. Arthur The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA  

    The artificial urinary sphincter (AUS) is the “gold standard” surgical treatment for severe stress urinary incontinence.  However, a subset of patients with frail urethras may require technical adjuncts to ensure optimal cuff function.  Our objective is to provide a detailed tutorial of our institution’s method for performing urethral bulking with native tissue in patients with frail urethras during AUS surgery. We have found that urethral bulking with native tissue provides a cost-efficient and durable technique for improved AUS cuff coaptation.  Our experience demonstrates adequate short and intermediate term efficacy with limited complications.  These techniques equip surgeons with an alternative surgical approach for appropriate patients receiving AUS surgery who have been previously exposed to pelvic radiation and/or significant surgical morbidity resulting in frail urethral tissue.

    Keywords: prostate cancer, artificial urinary sphincter, urinary stress incontinence, urethral disease,

    Apr 2023 (Vol. 30, Issue 2 , Page 11516)
  • 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: Transperineal prostate biopsy using local anesthetic in an outpatient setting

    Ordones Vasconcelos Flávio, Vermeulen Lodewikus, Bressington Morgan, Menon Abilash, Burns Timothy, Muller Loretta, Fraundorfer Mark, Gilling J. Peter Urology Department, Tauranga Public Hospital, Tauranga, Bay of Plenty, New Zealand // Division of Urology, São Paulo State University, UNESP, Botucatu, São Paulo, Brazil // Honorary Senior Lecturer, University of Auckland, Auckland, New Zealand

    Transperineal prostate biopsy (TPPB) is proven to be an effective diagnostic tool for prostate cancer detection. It allows satisfactory sampling of apical and anterior areas which is not well achieved with the transrectal route, without the associated risks of urinary tract infection or sepsis. The main objective of this paper is to describe the technique utilized in our institution to perform transperineal prostate biopsy under local anesthetic in the outpatient clinic setting.

    Keywords: prostate cancer, transperineal, prostate biopsy, local anesthetic,

    Feb 2023 (Vol. 30, Issue 1 , Page 11453)
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