Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia

Although transurethral resection of the prostate (TURP) is considered to be the reference standard for minimally invasive surgical treatment (MIST) of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), it is associated with a noteworthy rate of complication. Transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), and laser prostatectomy (including holmium laser enucleation of the prostate [HoLEP] and potassium titanyl phosphate [KTP] laser) represent the best studied and most accepted MISTs. TUNA and TUMT are simple and safe techniques that can be performed under local anaesthesia in a significant number of patients. Both MISTs significantly improve functional outcomes with respect to baseline values, but they do not reach the same level of efficacy and long-lasting success as TURP. They are, however, superior to TURP in terms of associated morbidity and anaesthetic requirements. HoLEP and KTP have demonstrated similar efficacy and anaesthetic requirements to TURP. Additionally, both lasers are prostate-size independent and seem to have better safety profiles, including shorter catheterisation and hospitalisation time. Yet HoLEP is associated with a steeper learning curve, a higher initial purchase cost, and difficulty in tissue removal. KTP is characterised by longer operative time, lack of tissue for histologic evaluation, and cost including single-use fibres, especially in cases of larger adenomas. High-quality long-term data on the durability of KTP are still missing. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved

Percutaneous nephrolithotomy and its legacy

Objective: We review the indications of Percutaneous Nephrolithotomy (PNL), its safety and efficacy when applied to various patient groups as well as the different points of technique, giving emphasis on new tips and ongoing debates. Methods: A literature search was performed using MEDLINE database on PNL between 1980 and 2004. Results: Percutaneous nephrolithotomy (PNL) has been successfully and safely used to treat patients with renal stones for more than a quarter of a century. Still, the use of PNL in treating renal stones in different patient groups, such as children, obese patients, patients with renal congenital anomalies, patients who had previous open renal surgery and patients who have undergone renal transplantation are always of high interest. Simultaneous bilateral percutaneous nephrolithotomy seems to have a certain role in treating bilateral renal stones, especially when proficiency is achieved for unilateral PNL. Various aspects of the procedure such as patient positioning, renal access, the ideal dilating method, the type of nephrostomy tube used, as well as the actual need for drainage, have been debated. Conclusion: PNL is currently the procedure of choice for removal of large renal calculi. The need for well designed prospective randomized trials comparing PNL with alternative treatment modalities arises through the literature review. (C) 2004 Elsevier B.V. All rights reserved

Analysis of outcome after thermotherapy using different classifications of bladder outlet obstruction

The urodynamic profiles of 97 patients with benign prostatic hyperplasia undergoing low-energy transurethral microwave thermotherapy (TUMT) for lower urinary tract symptoms were analysed using the Abrams/Griffiths nomogram, the urethral resistance algorithm, the linPURR, Schafer nomogram, and the CHESS classification. A significant clinical response was seen for the whole group, as shown by changes in symptom score, free flow rate, and residual urine. The best symptomatic response was identified in patients in whom obstruction was present, whatever the classification used. Only the two-dimensional CHESS classification was found to predict a group of patients with a better response in both symptoms and objective variables. Obviously, a better response from TUMT can only be predicted by a classification system that identifies the independent variables of footpoint and slope of the PURR. The CHESS classification was the only one of those studied that satisfactorily identified these two parameters and could be used as a system of case selection for this minimally invasive treatment. (C) 1998 Wiley-Liss, Inc

Current status of transrectal ultrasound techniques in prostate cancer.

Purpose of review: Present the current status of transrectal ultrasound imaging in prostate cancer (PCa) and discuss the latest techniques now under preclinical evaluation. Recent findings: Three-dimensional ultrasound and quantification techniques are superior to two-dimensional ultrasound in visualizing PCa and can be beneficial in staging prior to operation. Doppler-guided biopsies are more likely to yield positive results, especially when high Gleason scores are present. Furthermore, Vardenafil usage strengthens Doppler enhancement and can help in increasing the diagnostic accuracy of Doppler. Multiple studies show elastography to be a promising new addition to the ultrasound investigations for detection of PCa. Especially the recently introduced Shear Wave Elastography shows decreased user dependency and increased PCa detection rates. MRI can also aid in the diagnostics of PCa. However, MRI-guided biopsies are more complicated compared to ultrasound guidance. MRI/ultrasound fusion combines best of both techniques and, although just recently emerged, the studies available show promising PCa detection rates. Summary: Technical improvements in classical ultrasound modalities (2D/3D-greyscale, Doppler) and new modalities (elastography/MRI/ultrasound fusion) raised the accuracy of PCa detection. Especially latest elastography and MRI/ultrasound fusion are showing promising results in PCa visualization

Contrast-enhanced ultrasound for prostate cancer imaging

\u3cp\u3eProstate cancer is the number one non-skin malignancy of males in Western countries. Analysis of the care cycle for prostate cancer patients indicates the lack of an accurate screening test, and the lack of a widely available and reliable imaging method for local tumors. This article presents a new approach to imaging localized prostate cancer: contrast-enhanced ultrasonography (CEUS). The method is based on the visualization of microvessel density by microbubble contrastagents. In this pilot project, contrast-enhanced ultrasound (CEUS) imaging was correlated with histology. The results indicate that changes in theperfusion characteristics revealed by CEUS correlate with malignant tissue.\u3c/p\u3

Transrectal contrast enhanced ultrasound for diagnosis of prostate cancer

The diagnosis of prostate cancer is based on histology. Prostate biopsies are obtained based on the triad of prostate specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound. Because prostate biopsies still have a large percentage of negative outcomes, patient selection and biopsy direction need improvement. This paper describes the recent improvements in prostate cancer imaging, especially contrast-enhanced transrectal ultrasound

Evaluation of renal masses with contrast-enhanced ultrasound

The clinical need for characterising small renal masses (SRMs) is increasing due to their rising incidental detection. This increase is especially seen in younger and older generations and concerns mainly SRMs. Diagnostics is mainly made by contrast-enhanced CT or MRI. However, these imaging methods fail to accurately distinguishing benign from malignant SRMs. Other disadvantages of CT or MRI are high costs, the use of ionizing radiation, nephrotoxicity induced by iodine contrast agents or nephrogenic systemic fibrosis (NSF) induced by gadolinium contrast agents. Contrast-enhanced ultrasound (CEUS) is based on ultrasonography and microbubbles to real-time visualize the renal blood flow without the use of nephrotoxic agents or ionizing radiation. This comprehensive review evaluates the capabilities of CEUS in the diagnostics of benign (angiomyolipomas, cysts, oncocytomas, pseudotumors) and malignant masses (renal cell carcinomas), and focuses on possible future treatment