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Sample records for holmium laser enucleation

  1. Holmium laser enucleation of the prostate hyperplasia: technical aspects

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    P. V. Glybochko

    2015-01-01

    Full Text Available Holmium laser enucleation of the prostate (HoLEP was first described by doctor P.J. Gilling et al. from New Zealand in 1996. The operation involves anatomical dissection of the prostatic tissue off the surgical capsule using a high-powered holmium laser followed by intravesical morsellation. The objective of this article is to explain the techniques for HoLEP.

  2. Evolution and success of holmium laser enucleation of the prostate

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    Krambeck, Amy E.

    2010-01-01

    Aims: The purpose of this article is to review the development of instruments, current technique, and expected outcomes for holmium laser enucleation of the prostate (HoLEP). Materials and Methods: A review of published, peer-reviewed articles focusing on HoLEP was performed using the MEDLINE database. Results: Historically, the gold-standard management for symptomatic obstructing benign prostatic hyperplasia (BPH) has been transurethral resection of the prostate (TURP). With the development of new laser technology minimally invasive surgical procedures have been introduced in an attempt to decrease the morbidity experienced with standard TURP. Laser treatment of BPH has evolved from coagulation to complete adenoma enucleation. The holmium laser was initially utilized for prostate ablation and soon evolved into holmium laser tissue resection, but was limited by difficulties with extracting the prostate tissue from the bladder. With the development of a compatible tissue morcellator whole prostate lobes could be enucleated similar to an open prostate enucleation and the HoLEP procedure was developed. Currently HoLEP is the only procedure to demonstrate superior outcomes to TURP on urodynamic studies and long-term studies demonstrate its durability up to 7 years post procedure. Changes in enucleation technique have also increased the efficiency of the HoLEP procedure, such that any sized prostate can be treated. Conclusions: HoLEP is a safe and effective surgical treatment for symptomatic BPH, dependent on a high powered laser and morcellation system. The procedure continues to gain acceptance due to excellent short and long-term results, its wide application, and further simplification of technique. PMID:21116363

  3. Enucleated Weight/Enucleation Time, Is It Appropriate for Estimating Enucleation Skills for Holmium Laser Enucleation of the Prostate? A Consideration of Energy Consumption.

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    Kim, Khae Hawn; Kim, Kwang Taek; Oh, Jin Kyu; Chung, Kyung Jin; Yoon, Sang Jin; Jung, Han; Kim, Tae Beom

    2018-01-01

    To date, the parameters for evaluating enucleation efficiency have only considered enucleation time, although operators simultaneously consume both time and energy during holmium laser enucleation of the prostate. This study was undertaken to find a better way of assessing enucleation skills, considering both enucleation time and consumed energy. One hundred (n=100) consecutive patients who underwent holmium laser enucleation of the prostate from April 2012 to April 2014 by a single surgeon were enrolled. Ten groups of 10 consecutive cases were used to analyze the parameters of enucleation efficiency. The mean enucleation time, consumed energy, and enucleated weight were 41.3±19.2 minutes, 66.2±36.0 kJ, and 26.6±21.8 g, respectively. Concerning learning curves, like enucleation time-efficacy (=enucleated weight/enucleation time), enucleation energy-efficacy (=enucleated weight/consumed energy) also had an increasing tendency. Enucleation ratio efficacy (=enucleated weight/transitional zone volume/enucleation time) plateaued after 30 cases. However, enucleation time-energy-efficacy (=enucleated weight/enucleation time/consumed energy) continued to increase after 30 cases and plateaued at 61 to 70 cases. Furthermore, one-way analysis of variance showed that group means for enucleation time-energy-efficacy (F=3.560, p=0.001) were significantly different, but that those of enucleation ratio efficacy (F=1.931, p=0.057) were not. When both time and energy were considered, enucleation skills continued to improve even after 30 cases and plateaued at 61 to 70 cases. Therefore, we propose that enucleation time-energy-efficacy should be used as a more appropriate parameter than enucleation ratio efficacy for evaluating enucleation skills.

  4. Laser Prostatectomy: Holmium Laser Enucleation and Photoselective Laser Vaporization of the Prostate

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    Bostanci, Yakup; Kazzazi, Amir; Djavan, Bob

    2013-01-01

    Historically, transurethral resection of the prostate has been the gold standard for the treatment of benign prostatic hyperplasia (BPH). Laser technology has been used to treat BPH for > 15 years. Over the past decade, it has gained wide acceptance by experienced urologists. This review provides an evidence-based update on laser surgery for BPH with a focus on photoselective laser vaporization and holmium laser enucleation of the prostate surgeries and assesses the safety, efficacy, and durability of these techniques. PMID:23671400

  5. Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting.

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    Marien, Tracy; Kadihasanoglu, Mustafa; Tangpaitoon, Teerayut; York, Nadya; Blackburne, Andrew T; Abdul-Muhsin, Haidar; Borofsky, Michael S; Krambeck, Amy E; Humphreys, Mitchell R; Lingeman, James E; Miller, Nicole L

    2017-06-01

    Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting. We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate. Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

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    Chang Wook Jeong

    2012-06-01

    Full Text Available PURPOSE: To appraise the evaluation methods for learning curve and to analyze the non-mentor-aided learning curve and early complications following the holmium laser enucleation of the prostate. MATERIALS AND METHODS:One-hundred and forty (n=140 consecutive patients who underwent HoLEP from July 2008 to July 2010 by a single surgeon (SJO were enrolled. Perioperative clinical variables, including enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume, enucleation efficacy (enucleated weight/enucleation time, enucleation ratio efficacy (enucleation ratio/enucleation time, and early complication rate were analyzed. RESULTS: Mean prostate volume was 62.7 mL (range 21-162 and preoperative International Prostate Symptom Score (IPSS was 19.0 (4-35. Mean enucleation time and morcellation time were 49.9±23.8 (S.D. min and 11.0±9.7 min, respectively. Median duration of postoperative indwelling catheter was 1 (1-7 day and median hospital stay was 1 (1-6 day. There were a total of 31 surgery-related complications in 27 patients (19.3%, and all were manageable. There was an increasing trend of enucleation efficacy in the first 50 cases. However, enucleation efficacy was linearly correlated with the prostate size (correlation coefficients, R=0.701, p<0.001. But, enucleation ratio efficacy could eliminate the confounding effect of the prostate size (R=-0.101, p=0.233. The plateau of enucleation ratio efficacy was reached around the twenty-fifth case. CONCLUSIONS: Our results demonstrated that the operative learning curve plateau is reached after about 25 cases. We propose that a more appropriate parameter for estimating the operative learning curve is enucleation ratio efficacy, rather than enucleation efficacy.

  7. Holmium laser enucleation versus transurethral resection of the prostate.

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    Eltabey, Magdy A; Sherif, Hammouda; Hussein, Alaa A

    2010-12-01

    This was a prospective, randomized clinical trial to compare the safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation versus standard transurethral resection of the prostate (TURP) for the surgical treatment of patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH). The patients had prostates that were greater than 30 g and less than 100 g and were followed for 1 year. From April 2008 to December 2009, 80 consecutive patients with lower urinary tract obstruction (LUTS) due to BPH were randomized to either surgical treatment with HoLEP (group 1, n = 40) or standard TURP (group 2, n = 40). Preoperative assessments included American Urological Association (AUA) symptom score, serum prostate-specific antigen (PSA), post-voiding residual (PVR) urine volume, transrectal ultrasound (TRUS), and urodynamic studies. Perioperative parameters included total operating time, resected tissue weight, hemoglobin loss, presence or absence of blood transfusion, time of catheter removal, and duration of hospital stay. Postoperative evaluations were conducted at 1, 6, and 12 months. Patients in the HoLEP group had shorter catheterization times and hospital stays than patients in the TURP group. There was no significant difference in operating times between the two groups. Mean hemoglobin loss was lower in the HoLEP group (1.8 ± 1.3 g/dL versus 2.9 ± 1.5 g/dL). There was a significantly greater improvement from baseline AUA symptom scores and PVR urine volumes in the HoLEP group versus the TURP group, at all postoperative assessments. Postoperatively, 25% of patients in group 1 (HoLEP) and 20% of patients in group 2 (TURP) had irritative voiding symptoms. Urethral stricture occurred in three cases (one case in the HoLEP group and two cases in the TURP group). HoLEP proved to be a safe and highly effective technique for surgical treatment of bladder outlet obstruction due to

  8. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy--which procedure is faster?

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    Ahyai, Sascha A; Chun, Felix K H; Lehrich, Karin; Dahlem, Roland; Zacharias, Mario S; Fisch, Margit M; Kuntz, Rainer M

    2012-05-01

    The longer operative time of holmium laser enucleation of the prostate compared to transurethral resection of the prostate or simple open prostatectomy reported in the literature might have been biased by the unavailability of a soft tissue morcellator, limited surgical experience with holmium laser prostate enucleation or the fact that significantly more tissue was removed by enucleation than by resection. We objectively compared the resection speed of contemporary holmium laser enucleation vs transurethral resection of the prostate and of holmium laser enucleation vs simple open prostatectomy. The study cohort consisted of 100 cases of transurethral prostate resection and 60 of simple open prostatectomy from our previous randomized, controlled trials. These cases were subjected to matched pair analysis with greater than 1,000 from our prospective contemporary database on holmium laser prostate enucleation. Exact matches were made for the same amount of resected tissue. In all contemporary holmium laser enucleation cases a mechanical soft tissue morcellator was used. We calculated and compared the specific resection speed in gm per minute and operative time for the same amount of resected tissue. In groups 1 and 2 we matched 99 exact laser enucleation-transurethral resection pairs and 53 exact laser enucleation-simple open prostatectomy pairs, respectively. Resection speed and operative time for laser enucleation were statistically significantly faster than for resection (0.61 vs 0.51 gm per minute and 62 vs 73 minutes, p enucleation of the prostate is faster than transurethral resection of the prostate and similar to simple open prostatectomy. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Case of vascular air embolism during holmium laser enucleation of the prostate.

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    Kato, Takuma; Sugimoto, Mikio; Matsuoka, Yuki; Sakura, Yuma; Hayashida, Yushi; Hirama, Hiromi; Tsunemori, Hiroyuki; Ueda, Nobufumi; Uemura, Naoya; Miyawaki, Yuki; Shirakami, Gotaro; Kakehi, Yoshiyuki

    2015-02-01

    Vascular air embolism is a rare complication during transurethral surgery. A case of air embolism during holmium laser enucleation of the prostate in a 76-year-old man is presented. During the step of morcellation, the patient's blood pressure suddenly oscillated up and down, and end-tidal CO2 and arterial saturation decreased. Transesophageal and transthoracic echocardiography showed air collection in the right atrium. It was also discovered that incorrect assembly of the tube from the morcellator caused rapid entrainment of air into the vein. Computed tomography and abdominal X-ray showed niveau formation in the femoral vein and air collection in the pelvic retroperitoneal space. The patient recovered with careful observation and was discharged 7 days after the operation with no sequelae. This report is presented to remind urologists of this unusual complication that can occur during holmium laser enucleation of the prostate procedures. © 2014 The Japanese Urological Association.

  10. Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate?

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    Elmansy, Hazem M; Kotb, Ahmed; Elhilali, Mostafa M

    2011-11-01

    In this study we defined high risk patients at high risk of stress urinary incontinence after holmium laser enucleation of the prostate. We performed a retrospective analysis during a 10-year period of 949 consecutive patients treated with holmium laser enucleation of the prostate by a single surgeon. Patients were divided into group 1--those without postoperative stress urinary incontinence (902) and group 2--those with stress urinary incontinence (47). All preoperative, intraoperative and postoperative clinical variables were compared between the 2 groups. Patient age, preoperative and postoperative prostate specific antigen, preoperative medications, preoperative acute retention and duration of postoperative catheter time were not associated with postoperative stress urinary incontinence. The presence of diabetes mellitus was significantly associated with a higher incidence of stress urinary incontinence (p Kegel exercises in the immediate postoperative period. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Holmium laser enucleation of the prostate: a review of the clinical trial evidence

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    2014-01-01

    Transurethral resection of the prostate (TURP) has remained the procedure of choice for the surgical treatment of bladder outflow obstruction for almost five decades, but holmium laser enucleation of the prostate (HoLEP) is now emerging as a challenger as the gold standard procedure. This review summarizes the evidence base for HoLEP, with particular reference to randomized, controlled (level 1) evidence. PMID:24688602

  12. [Comparison of holmium and thulium laser in transurethral enucleation of the prostate].

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    Shao, Qiang; Zhang, Feng-Bo; Shang, Dong-Hao; Tian, Ye

    2009-04-01

    To investigate and compare the effect and safety of Holmium laser and Thulium laser in transurethral enucleation of the prostate in BPH patients. Ninety-eight BPH patients were divided into 2 groups and underwent transurethral enucleation of the prostate with holmium laser (Ho group) and thulium laser (Th group) respectively. Comparisons were made between the 2 groups in operation time, bleeding volume, electrolyte, IPSS score, PVR and Qmax. No statistically significant differences were noted between the 2 groups in age and preoperative prostate volume, IPSS, PVR and Qmax (P > 0.05). The mean operation time was shorter in the Th group ([84.6 +/- 10.2] min) than in the Ho group ([70.5 +/- 7.5] min) (P = 0.032); blood loss was less in the former ([126.5 +/- 14.6] ml) than in the latter ([176.5 +/- 14.1] ml) (P = 0.071), with no blood transfusion necessitated; and the mean times of catheter indwelling were 2.4 d and 2.5 d respectively. There were no significant differences in the levels of hemoglobin and electrolyte before and after operation between the two groups, and no TURP syndrome was observed. IPSS, PVR and Qmax before operation were significantly different from those obtained 3 months after it (P 0.05). Both holmium and thulium laser transurethral enucleation of the prostate can alleviate LUTS in BPH patients with similar short-time effectiveness. Thulium is superior to holmium laser in hemostasis, but inferior to it in anatomical distinctness.

  13. Technical Aspects of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

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    Kim, Myong; Lee, Hahn-Ey

    2013-01-01

    Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature. PMID:24044089

  14. Holmium Laser Enucleation of the Prostate and Iatrogenic Arteriovenous Fistula Treated by Superselective Arterial Embolization

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    Anastasios D. Asimakopoulos

    2016-01-01

    Full Text Available Iatrogenic pelvic pseudoaneurysm with concomitant arteriovenous fistula has been described as a rare and challenging complication, which may occur during transurethral resection of the prostate. We provide the first report of this complication after holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia. The attempt to control the bleeding by conversion to open surgery and placement of haemostatic stitches into the prostatic fossa failed. Angiography with superselective arterial embolization proved to be a modern, quick, safe, and efficient treatment of this uncommon complication.

  15. Holmium laser assisted ′anatomical′ enucleation of adenoma of benign hyperplasia of prostate

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    Shivadeo S Bapat

    2006-01-01

    Full Text Available Aims: To present our technique of Holmium Laser assisted "ANATOMICAL" enucleation of the benign prostatic adenoma (HoLEP in 219 patients. Procedure is based on the principle of digital enucleation of the adenoma from its surgical capsule, but performed entirely by perurethral endoscopic technique assisted by Holmium Laser. Materials and Methods: From March 2001 to November 2004, 219 patients under went HoLEP. After the initial cuts from bladder neck to verumontanum at 5 and 7 o′clock position, capsule is identified. The beak of the resectoscope sheath was inserted in the plane between the capsule and the adenoma and the adenoma was physically pushed away towards the urethra from the capsule. Laser was used to coagulate the bleeders, to cut the mucosal attachments and tough stromal tissue. Procedure was repeated for median and two lateral lobes. There was minimal bleeding and fluid absorption. Complications were few. Results: In 206 cases successful enucleation of the adenoma was carried out. First 13 cases formed part of the learning curve and were completed by standard transurethral resection of prostate (TURP. IPSS score dropped from average of 23 to 8 and peak flow improved from 20. No patient had postoperative urinary incontinence or stricture. Conclusions: HoLEP is an effective alternative to TURP. Ultimate end results replicate the end results of open enucleation of BPH without its morbidity and have all the advantages of endoscopic surgery. It offers distinct advantages over standard TURP as the incidence of blood transfusion and fluid absorption are greatly minimized.

  16. [Transurethral enucleation of the prostate with the holmium: YAG laser system: how much power is necessary?].

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    Rassweiler, J; Roder, M; Schulze, M; Muschter, R

    2008-04-01

    To evaluate the efficacy and safety of an intermediate power (50 W) holmium:YAG laser system for transurethral enucleation of the prostate (TULP) with the use of a new mechanical morcellator. Our results are compared with the results of high-powered holmium laser enucleation (HoLEP) presented in the literature. From December 2003 to January 2008, 129 patients with benign prostatic hyperplasia were treated by TULP. In 45 cases (group A; 2.0, 12 Hz) we used a bipolar resectoscope (VISTA/ACMI) for morcellation, whereas after that morcellation was accomplished with a modified endoscopic shaver (Wolf). Thirty-nine patients were treated using 25 W (group B; 2.0 J, 12 Hz), and 45 patients were treated using 40 W (group C; 2.2 J 18 Hz), who were compared with 45 matched-pair patients who received transurethral resection of the prostate (TURP; group D). Finally, the literature on HoLEP was reviewed. Bipolar morcellation significantly prolonged the operating time (135 vs. 131 vs. 96 min). The morcellation speed averaged 2.8 (range 1.3-5.2) g/min with no complications. The resection speed (retrieval rate) of 40-W TULP was comparable to that for TURP (0.71 vs. 0.76 g/min). The transfusion rate was lower than for TURP (8% vs. 12%), with a smaller Hb difference (3.1 vs. 3.8 mg/dl). Catheter times (3.4 vs. 4.1 days) were similar; however, hospital stay was significantly shorter after TULP (5.2 vs. 6.8 days). The complication rate was significantly lower (6.6% vs. 13.3%). The efficacy of HoLEP significantly improved with introduction of the morcellator: Resection speed increased from 0.34-0.61 g/min to 0.48-0.82 g/min. HoLEP was better than 40-W TULP regarding transfusion rate (0-4% vs. 8%) and catheter time (1.1-1.5 vs. 3.4 days). Complications and functional results were similar. CONCLUSION[UBERSCHRIFT]: The intermediate-power 50-W holmium laser together with the new morcellator enable safe transurethral enucleation of the prostate. As with HoLEP, the procedure has a significant

  17. Evolution and success of holmium laser enucleation of the prostate

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    Amy E Krambeck

    2010-01-01

    Conclusions : HoLEP is a safe and effective surgical treatment for symptomatic BPH, dependent on a high powered laser and morcellation system. The procedure continues to gain acceptance due to excellent short and long-term results, its wide application, and further simplification of technique.

  18. Holmium Laser Enucleation of the Prostate (HoLEP in Ambulatory Surger

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    Marc Fourmarier

    2015-05-01

    Full Text Available The focus of this work is the need to give an update on the holmium laser enucleation of the prostate (HoLEP technique in ambulatory surgery. Indeed, over the last two decades, there has been a significant change in surgical treatment of benign prostatic hyperplasia. Laser surgery has been growing in popularity as an alternative to standard transurethral prostatectomy. Our goal was to analyse the opportunity to perform HoLEP in one-day surgery. Furthermore, there is a willingness of the French Ministry of Health to develop this kind of management. A pilot study was performed in 50 selected patients to evaluate HoLEP feasibility in ambulatory surgery from June 2013 to April 2014. The results were good with minimal morbidity and a high satisfaction rate, but excellent organisation is necessary, leaving no room for improvisation.

  19. Does Surgeon Experience Affect Operative Time, Adverse Events and Continence Outcomes in Holmium Laser Enucleation of the Prostate? A Review of More Than 1,000 Cases.

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    Shigemura, Katsumi; Yamamichi, Fukashi; Kitagawa, Koichi; Yamashita, Masuo; Oka, Yasuhiko; Tanaka, Hirokazu; Fujisawa, Masato

    2017-09-01

    Holmium laser enucleation of the prostate has become an increasingly common surgical therapy for benign prostatic hyperplasia. However, the relationship between surgeon experience and surgical outcomes has not yet been fully investigated. In this study we investigated how surgeon experience with holmium laser enucleation of the prostate affected operative time, adverse events and outcomes related to urination. We gathered a total of 1,113 cases of holmium laser enucleation of the prostate from 5 hospitals in Hyogo Prefecture, Japan. Included were data on surgeon experience with the procedure, operative time, enucleation time, morcellation time, patient age, perioperative and postoperative surgery related complications, and outcomes related to urination. A total of 39 surgeons were included in analysis. Statistical data showed that increasing surgical experience significantly contributed only to surgical time, enucleation time and urinary incontinence after holmium laser enucleation (p = 0.0146, 0.0216 and 0.0405, respectively). No significant changes were seen postoperatively in surgery related factors such as morcellation time, resected prostate volume, infectious or noninfectious surgery related complications, or urination related outcomes (p >0.05) Experience with at least 20 cases in particular affected surgical time (p = 0.0050), enucleation time (p = 0.0068) and urinary incontinence after holmium laser enucleation (p = 0.0021). Surgeon experience contributed to shortened operative time and enucleation time, and to decreased postoperative urinary incontinence but not to surgery related complications or urination related outcomes as shown by maximum urine flow and post-void residual urine volume. We also found that experienced surgeons with 31 to 50 cases might be associated with complications after holmium laser enucleation in larger prostate cases. Based on these data further prospective studies are scheduled to establish a program for training in holmium

  20. Influence of prostate size on the outcome of holmium laser enucleation of the prostate.

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    Shah, Hemendra N; Sodha, Hiren S; Kharodawala, Shabbir J; Khandkar, Amit A; Hegde, Sunil S; Bansal, Manish B

    2008-06-01

    To analyse the effect of prostate size on the outcome of holmium laser enucleation of prostate (HoLEP, an established procedure for treating symptomatic benign prostatic hypertrophy, BPH), in the initial 354 patients at 1 year of follow-up. We retrospectively reviewed the records of 354 patients who had HoLEP at our institution from April 2003 to March 2007. In 235 patients the prostate weighed 100 g (group 3). Demographic data and perioperative variables were recorded and compared among the three groups. The mean prostate size was 38.1, 76.4 and 133.5 g for groups 1, 2 and 3, respectively (P prostate was 18.47, 40.8 and 82.76 g, respectively (P prostate size, and is associated with low morbidity. The efficiency of HoLEP increases with increasing prostate size.

  1. Prostate tissue retrieval after holmium laser enucleation of the prostate; assessment of non-morcellation approaches.

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    Elshal, Ahmed M; Eldemerdash, Yasser; Mekkawy, Ramy; Taha, Diaa-Eldin; Laymon, Mahmoud; El-Nahas, Ahmed R; El-Assmy, Ahmed

    2016-06-01

    To review non-morcellation approaches for tissue retrieval after holmium laser enucleation of the prostate (HoLEP) and whether these approaches demolish the advantages of the HoLEP procedure. We reviewed our prospectively maintained laser prostate database for HoLEP procedures where non-morcellation approaches were used for retrieval of the enucleated adenoma. Non-morcellation approaches were adopted in cases of morcellator malfunction or whenever concomitant pathology indicated laparotomy. Patients were stratified into the laparotomy group (Group I) or the transurethral resection (TUR) group (Group II). Safety and efficacy of each approach were assessed and compared. Between August 2012 and July 2015, of 392 HoLEP procedures non-morcellation approaches were used for tissue retrieval in 37 (9.4%). In 19 procedures a laparotomy approach was adopted (17 mini-laparotomies and two conventional laparotomies for concomitant diverticulectomy). TUR of the enucleated adenoma was adopted in 18 patients. Baseline demographic data and indications for surgery were comparable between the groups. However, significantly larger prostates were treated in Group I. There were no significant differences between the groups for tissue retrieval time, histopathological findings of retrieved tissue, and peri-procedure biochemical changes. However, significantly more tissue was retrieved (median tissue weight 115 vs 38 g) and at a faster rate (4.6 vs 1.09 g/min) in Group I. The median hospital stay was similar in both groups, but the median time to catheter removal was longer in Group I (5 vs 2 days). Minimal and similar peri-procedure complications were reported in both groups and in both groups there was a significant and comparable improvement in all urinary outcome measures. In the absence or malfunction of a tissue morcellator, or whenever concomitant pathology indicates laparotomy, non-morcellation tissue retrieval approaches are feasible options for endourologists practicing

  2. Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial.

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    Elmansy, Hazem; Baazeem, Abdulaziz; Kotb, Ahmed; Badawy, Hesham; Riad, Essam; Emran, Ashraf; Elhilali, Mostafa

    2012-07-01

    To our knowledge we report the first single center, prospective, randomized study comparing holmium laser enucleation and high performance GreenLight™ prostate photoselective vaporization as surgical treatment of prostatic adenomas greater than 60 ml. A total of 80 patients with a large prostatic adenoma were randomly assigned to surgical treatment with holmium laser enucleation or photoselective vaporization. International Prostate Symptom Score, International Index of Erectile Function-15, maximum flow rate, post-void residual urine, serum prostate specific antigen and transrectal ultrasound volume were recorded. Patient baseline characteristics were similar for holmium laser enucleation and photoselective vaporization. Operative time and catheter removal time were almost equal in the 2 groups (p = 0.7 and 0.2, respectively). Eight vaporization cases were converted to transurethral prostate resection or holmium laser enucleation intraoperatively due to bleeding. A significantly higher maximum flow rate and lower post-void residual urine were noted in holmium laser cases during the entire followup (at 1 year each p = 0.02). However, no significant difference in International Prostate Symptom Score, quality of life or International Index of Erectile Function-15 was detected. Prostate volume and serum PSA decreased 78% and 88% in the holmium laser group, and 52% and 60% in the vaporization group, respectively. Holmium laser enucleation and photoselective vaporization are effective for lower urinary tract symptoms due to a large prostatic adenoma. Early subjective functional results (maximum flow rate and post-void residual urine) of holmium laser enucleation appear to be superior to those of photoselective vaporization. In our hands cases intended to be treated with photoselective vaporization were at 22% risk of conversion to another modality. This could reflect our determination to vaporize to the capsule in all vaporization cases. Copyright © 2012 American

  3. Holmium Laser enucleation of the prostate (HoLEP versus Transurethral Resection of the Prostate (TURP

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    Luís Eduardo Durães Barboza

    Full Text Available OBJECTIVE:to evaluate the effectiveness and applicability of Holmium laser enucleation of the prostate (HoLEP - in the treatment of benign prostatic hyperplasia (BPH - in comparison to transurethral resection of the prostate (TURP.METHODS:patients with symptomatic prostatic hyperplasia and candidates for surgical treatment were selected. Both procedures were explained and they had choosen HoLEP or TURP. At the hospital were collected: age, date of birth, international prostate symptom score, urinary peak flow rate, prostate volume, post-voiding residual urine, globular volume and serum PSA. At the procedure operating time, morcellating time (HoLEP, bladder mucosal injury and intercurrences were collected. At the first postoperative day, globular volume and sodium. Besides that were observed the catheter indwelling time and hospital stay and after 90 days, urinary peak flow rate and international prostate symptom score. Statistical analisys have been done partially by Sinpe(r and also by a professional team.RESULTS:twenty patients in HoLEP group and 21 at TURP were operated. Baseline urinary peak flow rate was 8 ml/s in both groups and preoperative international prostate symptom score was 22 in HoLEP and 20 in TURP, very similar. Operative time was 85 minutes in HoLEP and 60 in TURP, pCONCLUSION:HoLEP is a feasible technique and is as effective as TURP on symptomatic prostatic hyperplasia surgical treatment.

  4. Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size?

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    Kuntz, Rainer M; Lehrich, Karin; Ahyai, Sascha

    2004-03-01

    In conventional transurethral resection of the prostate (TURP), perioperative morbidity resulting from causes such as blood loss and TUR syndrome increases with prostate size. Therefore, TURP is restricted to small and medium-sized glands. The present study aimed to find out whether perioperative parameters of holmium laser enucleation of the prostate (HoLEP) other than operation time and weight of resected tissue were dependent on prostate size. A total of 384 patients were treated with HoLEP (holmium:YAG laser, 2.0 J, 40 or 50 Hz, 80 or 100 W, 550-nm bare fiber) for acute removal of obstructing benign hyperplastic tissue. Among them, 111 patients (28.9%) had prostates of /=80 g (range 80-260) (group 3). The perioperative outcomes of the three groups were compared. A total of 346 patients completed the 1-month postoperative assessment. The mean prostate sizes were 31.8 g, 56 g, and 98.7 g for groups 1, 2, and 3 (P<0.0001 group 1 v group 2 v group 3). The mean resected tissue weight was 19.5 g v 34.4 g (P= 0.009) v 70.1 g (range 50-220) (P< 0.0001). The mean operation time was 64.3 v 84.2 (P= 0.009) v 118.4 minutes (P< 0.0001). The mean hemoglobin loss was 0.9 v 1.2 (NS) v 1.9 g/dL (P< 0.001). The overall correlation between hemoglobin loss and prostate size in all patients was very weak (r = 0.229) and just exceeded the level of significance (r = 0.2). In all three groups, the median postoperative catheter time was 1 day, and the median postoperative hospital stay was 2 days. The HoLEP resulted in an immediate and significant improvement of American Urological Association Symptom Scores, peak urinary flow rates, and postvoiding residual urine volumes (P< 0.0001) 1 month after the operation, without significant differences between the groups. The rate of complications was similar in all three groups. None of the patients needed blood transfusions. There were no perioperative deaths. In HoLEP, perioperative morbidity and postoperative micturition improvement do not

  5. Bone dissemination of prostate cancer after holmium laser enucleation of the prostate: a case report and a review of the literature.

    Science.gov (United States)

    Koguchi, Dai; Nishi, Morihiro; Satoh, Takefumi; Shitara, Toshiya; Matsumoto, Kazumasa; Fujita, Tetsuo; Yoshida, Kazunari; Iwamura, Masatsugu

    2014-02-01

    We report a case of dissemination of prostate cancer after holmium laser enucleation of the prostate in an 80-year-old patient. The patient presented at hospital because of nocturia. Transrectal ultrasound-guided biopsy was carried out because of high serum prostate-specific antigen (3.55 ng/mL), but it showed no malignancies. Benign prostate hyperplasia was diagnosed, and he was started on an α1-blocker. Although the urinary symptom improved with silodosin, acute urinary retention occurred 3 years after therapy began. Holmium laser enucleation of the prostate for relief of bladder outlet obstruction enabled discharge of urine. Pathological examination of the resected tissue found adenocarcinoma with a high Gleason score, 4 + 5. Serum alkaline phosphatase increased rapidly after holmium laser enucleation, and bone scintigraphy confirmed multiple bone metastases. Prostate cancer, T1bN0M1b, was diagnosed. © 2013 The Japanese Urological Association.

  6. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial.

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    Sun, Nao; Fu, Yaowen; Tian, Tengzheng; Gao, Jialin; Wang, Yuantao; Wang, Song; An, Wei

    2014-07-01

    To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), for treatment of benign prostatic hyperplasia (BPH). A total of 164 cases of BPH were selected from patients who were hospitalized between January 2010 and December 2011. Patients had received either HoLEP or TURP treatment. Clinical data were collected from the perioperative period, 1 month after surgery, and 12 months after surgery. There was no significant difference between the two groups in the maximum urinary flow rate (Q max), postvoid residual volume (PVR), international prostate symptom score (IPSS), or quality-of-life score (QOL score) at 1 month after surgery (p = 0.56, p = 0.346, p = 0.536 and p = 0.145, respectively). However, after 12 months, patients from the HoLEP group demonstrated better scores in Qmax, PVR, IPSS, and QOL than those from the TURP group (p = 0.037, p = 0.003, p < 0.001 and p = 0.019, respectively). The two groups had comparable operation time (p = 0.105), catheterization time (p = 0.173), and length of hospital stay (p = 0.395), but were statistically different in the weight of resected prostate tissue (p < 0.001), bladder irrigation time (p < 0.001), hemoglobin levels (p = 0.011), and blood sodium levels (p = 0.002) after surgery. Compared to TURP, HoLEP was safer and had better long-term efficacy as assessed by multiple quantitative measures. Therefore, HoLEP may present a better option in the treatment of BPH.

  7. Holmium laser enucleation versus transurethral resection of the prostate: a comparison of clinical results.

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    Basić, Dragoslav; Stanković, Jablan; Potić, Milan; Ignjatović, Ivan; Stojković, Ivica

    2013-01-01

    Holmium laser enucleation of the prostate (HoLEP) represents a great potential alternative technique to standard transurethral resection of the prostate (TURP). We present 12-month follow up results of a randomized clinical trial, comparing HoLEP with TURP. A total of 40 patients with BPH and prostate volume < 50 g, have been randomized for HoLEP (n = 20) or TURP (n = 20). Urinary tract ultrasound with postvoid residual urine (PVR), International Prostate Symptom Score (IPSS) and Single Question Quality of Life (QoL) Score were evaluated preoperatively and during the follow-up period at 1, 3, 6, and 12 mo postoperatively. Intra- and perioperative data as well as early and late complications were assessed. Operative time was longer in the HoLEP group (p < 0.001); catheterisation time (p < 0.05) and hospital stay (p < 0.05) shorter. Hemoglobin levels drop (p < 0.001) was higher in the TURp group. Early and late postoperative complications were more frequent in the TURp group (p < 0.001). Follow-up data favored the HoLEP group, both regarding IPSS at 6-month (p < 0.05) and 12-month (p < 0.01), and single question QoL score, at 6-month (p < 0.01) and 12-month (p < 0.05). PVR was lower in the HoLEP group at 6-month (p < 0.01). HoLEP demonstrates superiority to TURp in regards to perioperative parameters and follow-up data and has a great potential to become the new gold standard in the surgical treatment of BPH.

  8. Holmium Laser enucleation of the prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP).

    Science.gov (United States)

    Barboza, Luís Eduardo Durães; Malafaia, Osvaldo; Slongo, Luiz Edison; Meyer, Fernando; Nassif, Paulo Afonso Nunes; Tabushi, Fernando Issamu; Wendler, Eduardo; Beraldi, Rafael Alexandre

    2015-06-01

    to evaluate the effectiveness and applicability of Holmium laser enucleation of the prostate (HoLEP) - in the treatment of benign prostatic hyperplasia (BPH) - in comparison to transurethral resection of the prostate (TURP). patients with symptomatic prostatic hyperplasia and candidates for surgical treatment were selected. Both procedures were explained and they had choosen HoLEP or TURP. At the hospital were collected: age, date of birth, international prostate symptom score, urinary peak flow rate, prostate volume, post-voiding residual urine, globular volume and serum PSA. At the procedure operating time, morcellating time (HoLEP), bladder mucosal injury and intercurrences were collected. At the first postoperative day, globular volume and sodium. Besides that were observed the catheter indwelling time and hospital stay and after 90 days, urinary peak flow rate and international prostate symptom score. Statistical analisys have been done partially by Sinpe(r) and also by a professional team. twenty patients in HoLEP group and 21 at TURP were operated. Baseline urinary peak flow rate was 8 ml/s in both groups and preoperative international prostate symptom score was 22 in HoLEP and 20 in TURP, very similar. Operative time was 85 minutes in HoLEP and 60 in TURP, p<0.05. Hospital stay was 47 hours for HoLEP and 48 hours to TURP, p<0.05. At 90 day the urinary peak flow rate was raised to 21.5 ml/s in HoLEP group and to 20 ml/s in TURP and the median of international prostate symptom score had been reduced to score 3 in both groups. HoLEP is a feasible technique and is as effective as TURP on symptomatic prostatic hyperplasia surgical treatment.

  9. Factors affecting de novo urinary retention after Holmium laser enucleation of the prostate.

    Directory of Open Access Journals (Sweden)

    Sung Han Kim

    Full Text Available OBJECTIVE: Patients can experience urinary retention (UR after Holmium laser enucleation of the prostate (HoLEP that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP. MATERIALS AND METHODS: 336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37 and the non-urinary retention (non-UR; n = 299 groups. RESULTS: The mean age of patients was 68.3 (±6.5 years and the mean operative time was 75.3 (±37.4 min. Thirty seven patients (11.0% experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7 days after UR. With regard to the causes of UR, 24 (7.1% and 13 (3.9% patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p0.05. CONCLUSIONS: De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

  10. Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center.

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    Zhang, Fengbo; Shao, Qiang; Herrmann, Thomas R W; Tian, Ye; Zhang, Yuhai

    2012-04-01

    To compare the clinical outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) (70 W) and holmium laser transurethral enucleation of the prostate (HoLEP) (90 W) in a prospective randomized trial with 18 months of follow-up. Both ThuLEP and HoLEP effectively relieve the obstructive symptoms due to benign prostatic hyperplasia (BPH). A total of 133 consecutive patients with BPH were randomized to either ThuLEP (n = 71) or HoLEP (n = 62). An energy setting of 70 W and 90 W was used for the thulium and holmium laser in the enucleation procedure, respectively. The mushroom technique was used to fragment the enucleated lobes with the resection loop. The preoperative and postoperative parameters were compared. ThuLEP required a longer operation time (72.4 vs 61.5 minutes, P = .034) but resulted in less blood loss than HoLEP (130.0 vs 166.6 mL, P = .045). The catheterization time was comparable. At 18 months, the lower urinary tract symptom indexes were improved significantly in both groups compared with the baseline values. The International Prostate Symptom Score decreased to 5.2 in the ThuLEP group and 6.2 in the HoLEP group. The quality of life score and peak urinary flow rate were similar between the 2 groups (1.3 vs 1.2 and 23.4 vs 24.2 mL/s) and the postvoid residual urine volume decreased by 82.50% and 81.73% in the ThuLEP and HoLEP groups, respectively. The mean prostate-specific antigen decrease after HoLEP and ThuLEP was 30.43% and 43.36%, respectively. No urethral or bladder neck stricture were found in either group. Both ThuLEP (70 W) and HoLEP (90 W) relieve lower urinary tract symptoms equally with high efficacy and safety. ThuLEP was statistically superior to HoLEP in blood loss and inferior to HoLEP in operation time, although the differences were clinically negligible. The mushroom technique could be adequate, without an additional mechanical tissue morcellator. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: A prospective randomized study.

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    Jhanwar, Ankur; Sinha, Rahul J; Bansal, Ankur; Prakash, Gaurav; Singh, Kawaljit; Singh, Vishwajeet

    2017-01-01

    Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g. This prospective randomized study includes 164 patients. Inclusion criteria were age 60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery. Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up. HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria.

  12. Predictive risk factors of postoperative urinary incontinence following holmium laser enucleation of the prostate during the initial learning period.

    Science.gov (United States)

    Kobayashi, Shuichiro; Yano, Masataka; Nakayama, Takayuki; Kitahara, Satoshi

    2016-01-01

    To determine the predictive factors for postoperative urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP) during the initial learning period. We evaluated 127 patients with benign prostatic hyperplasia who underwent HoLEP between January 2011 and December 2013. We recorded clinical variables, including blood loss, serum prostate-specific antigen levels, and the presence or absence of UI. Blood loss was estimated as a decline in postoperative hemoglobina levels. The predictive factors for postoperative UI were determined using a multivariable logistic regression analysis. Postoperative UI occurred in 31 patients (24.4%), but it cured in 29 patients (93.5%) after a mean duration of 12 weeks. Enucleation time >100 min (p=0.043) and blood loss >2.5g/dL (p=0.032) were identified as significant and independent risk factors for postoperative UI. Longer enucleation time and increased blood loss were independent predictors of postoperative UI in patients who underwent HoLEP during the initial learning period. Surgeons in training should take care to perform speedy enucleation maneuver with hemostasis. Copyright© by the International Brazilian Journal of Urology.

  13. Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up

    Science.gov (United States)

    Alkan, Ilter; Ozveri, Hakan; Akin, Yigit; Ipekci, Tumay; Alican, Yusuf

    2016-01-01

    ABSTRACT Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at ptransurethral resection of the prostate. PMID:27256184

  14. Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literature.

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    Shah, Hemendra N; Hegde, Sunil S; Shah, Jignesh N; Mahajan, Amol P; Bansal, Manish B

    2007-03-01

    To report experience with holmium laser enucleation of the prostate (HoLEP) simultaneously with transurethral holmium laser cystolithotripsy (HLC) for managing bladder outlet obstruction (BOO) and associated vesical calculi; we also review previously reported cases of managing vesical calculi and associated BOO. The high-powered holmium laser is a very efficient multifunctional endourological instrument that effectively fragments calculi of all compositions and is capable of haemostatic cutting of tissue, resulting in minimal bleeding after prostatic resection. A prospective study was conducted from April 2003 that included 32 men who underwent simultaneous HoLEP with transurethral HLC at our institution. Demographic, laboratory, peri-operative and follow-up data were analysed. Complications during and after surgery were identified to assess the morbidity of procedure. The mean (range) size of bladder calculi was 34.6 (12-70) mm and the preoperative weight of the prostate was 51.9 (11-172) g. Combined HoLEP with transurethral HLC was technically feasible in all patients, and all were stone-free after surgery. The mean operative duration was 97.7 (40-230) min, the weight of prostate tissue removed 34.6 (5-88) g, and the duration of catheterization and hospital stay 29.3 h and 34.8 h, respectively. Complications during and after surgery occurred in 12.5% and 15.6% of patients, respectively; all complication were minor and none caused any residual disability to the patient. No patient required a blood transfusion or developed clot retention. Managing bladder stones and BOO with simultaneous transurethral HLC and HoLEP should be considered the treatment of choice for such cases. Stones of any size and composition, and prostates of practically any size can be treated endoscopically using the holmium laser, with acceptable morbidity once the technique is mastered. The review of previous reports suggested a need for a prospective study comparing endoscopic management of

  15. One-year Surgical Outcomes of Complete or Incomplete Enucleation of Prostate by Monopolar Electrocoagulation, Photoselective Vapoenucleation of 120-W GreenLight Laser, and Holmium Laser.

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    Cho, Sung Yong; Park, Juhyun; Yoo, Sangjun; Cho, Min Chul; Jeong, Hyeon; Son, Hwancheol

    2017-10-01

    To evaluate surgical outcomes of patients who underwent complete or incomplete enucleation technique during a short-term postoperative period. Patients having intractable lower urinary tract symptoms/benign prostatic hyperplasia and prostates >30 g with obstructed pattern in the urodynamic examinations were included. They underwent transurethral resection of prostate (TUR-P), 120 W GreenLight laser high power system-photoselective vapoenucleation of prostate (HPS-PVEP), or holmium laser enucleation of prostate (HoLEP). Patients with the size of remnant prostates minus surgical defects enucleated group (group C), and others were grouped into the partially enucleated group (group P). Mean prostate-specific antigen value was 3.5 ± 4.5 ng/mL, and mean prostate volume was 58.4 ± 31.0 mL. Complete enucleation rates in TUR-P, HPS-PVEP, and HoLEP groups were 39% (37 out of 95), 54.6% (83 out of 152), and 54.4% (31 out of 57), respectively. Complete enucleation rate of the TUR-P was significantly lower than those of the other 2 groups. Compared with group C, group P had lower maximal flow rate, higher bladder outlet obstruction index, and higher overactive bladder symptom scores. Multivariate logistic regression analyses showed that smaller prostate, presence of intravesical prostatic protrusion, HoLEP operation, and surgeons' experience were significant predictors for achieving complete enucleation of prostate. Voiding subscores of group C were significantly higher than those of group P at postoperative 12 months. The performance of HoLEP was superior to other surgical techniques. However, HPS-PVEP with vapoenucleation showed the comparable enucleation rate with that of HoLEP. Complete enucleation was effective in maintaining outcomes of prostate resection, especially voiding subscores. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP).

    Science.gov (United States)

    Robert, Grégoire; Cornu, Jean-Nicolas; Fourmarier, Marc; Saussine, Christian; Descazeaud, Aurélien; Azzouzi, Abdel-Rahmène; Vicaut, Eric; Lukacs, Bertrand

    2016-03-01

    To describe the step-by-step learning curve of the holmium laser enucleation of the prostate (HoLEP) surgical technique. A prospective, multicentre observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy but never having performed HoLEP. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation within transurethral resection of the prostate (TURP), with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Of nine centres, three abandoned HoLEP before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful HoLEP procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time >90 min (n = 51), followed by conversion to TURP (n = 14), incomplete morcellation (n = 8), significant stress (n = 9), or difficulty (n = 14) during HoLEP. Ignoring operating time, 64% of procedures were successful and four out of five centres did four consecutive successful cases. Of the five centres that completed the study, four chose to continue HoLEP. Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the procedure. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  17. Holmium Laser Enucleation of the Prostate versus Laparoscopic Transcapsular Prostatectomy: Perioperative Results and Three-Month Follow-Up.

    Science.gov (United States)

    Baldini, Arnaud; Fassi-Fehri, Hakim; Duarte, Ricardo C; Crouzet, Sebastien; Ecochard, René; Abid, Nadia; Martin, Xavier; Badet, Lionel; Colombel, Marc

    2017-07-01

    Symptomatic benign prostatic hypertrophy greater than 70 cc used to be treated by invasive procedures. Holmium laser enucleation of prostate (HoLEP) and laparoscopic transcapsular prostatectomy (LTP) are two techniques whose efficacy has been demonstrated compared to standard onesmore invasive standard procedures. The objective was to evaluate and compare perioperative results from these two techniques for the treatment of benign prostatic hypertrophy greater than 70 cc. This was a non-randomized retrospective study comparing the HoLEP technique with LTP. From January 2012 to January 2015, 39 patients had HoLEP and 28 had LTP. Perioperative outcomes, complications, and functional results at 3 months were compared. A chi-2 squared test and Student's t test were used for statistical analysis. In multivariate analysis, there was a statistically significant difference in favor of HoLEP for the duration of catheterization (1.9 vs. 3.7 days; p = 0.004) and the average length of stay (2.8 vs. 4.0 days, p = 0.010). There was a trend towards a greater decrease in postoperative hemoglobin levels in LTP (138 vs. 218 g/l; p = 0.082), which was statistically significant in univariate analysis (p = 0.033). Other endpoints were not significant, particularly the enucleated prostate volume compared to the total prostate volume (61.8 vs. 68.4%; p = 0.319) and postoperative complications. There was no increased morbidity for LTP compared to the HoLEP technique. However, the HoLEP technique appeared to be a less invasive technique, reducing the duration of catheterization, blood loss, and the average length of stay while maintaining good efficacy for the enucleated prostate volume.

  18. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients.

    Science.gov (United States)

    Kuntz, Rainer M; Ahyai, Sascha; Lehrich, Karin; Fayad, Amr

    2004-09-01

    Transurethral electrocautery resection (TURP) is generally regarded as the gold standard surgical treatment for bladder outflow obstruction due to benign prostatic hyperplasia despite its rather high morbidity. The high powered holmium:YAG laser can be used endoscopically to enucleate obstructing prostatic tissue in a relatively bloodless manner. The technique of transurethral holmium laser enucleation of the prostate (HoLEP) was compared to standard TURP for the surgical management of prostate adenomas in a randomized, prospective clinical trial. A total of 200 urodynamically obstructed patients with a prostate of less than 100 gm on transrectal ultrasound were randomized to HoLEP or TURP. All patients were assessed preoperatively, and 1, 6 and 12 months postoperatively. Patient baseline characteristics, perioperative data and postoperative outcome were compared. All complications were noted. HoLEP was significantly superior to TURP in terms of catheter time, hospital stay and hemoglobin loss but operative time was longer. HoLEP and TURP resulted in a significant improvement in American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes with symptoms scores and residual volume significantly better in the holmium group. Effects on continence and potency were similar in the 2 groups but adverse events were less frequent in the holmium group. HoLEP and TURP are highly effective procedures for removing obstructing prostatic adenomas. HoLEP resulted in significantly better micturition parameters and less perioperative morbidity.

  19. Laser prostate enucleation techniques.

    Science.gov (United States)

    Lerner, Lori B; Rajender, Archana

    2015-10-01

    Laser treatment of benign prostatic hyperplasia (BPH) through enucleation techniques has become increasingly more utilized in the field of urology. Laser enucleation of the prostate (LEP) is a transurethral procedure that employs several different types of lasers to dissect the adenoma from the surgical capsule in a retrograde fashion. We review basic laser physics and current laser prostate enucleation techniques. Holmium-LEP (HoLEP), Thulium-LEP (ThuLEP), Greenlight-LEP (GreenLEP) and Diode-LEP (DiLEP) applications are discussed. We summarize the current literature with respect to functional outcomes and complications. Although each laser device used for prostate enucleation has the same goal of removal of the adenoma from the surgical capsule, each has unique characteristics (i.e. wavelength, absorption rates) that must be understood by the practicing surgeon. Mastery of one LEP technique does not necessarily translate into facile use of an alternative enucleation energy source and/or approach. The various LEP techniques have demonstrated similar, if not superior, postoperative results to transurethral resection of the prostate (TURP), the current gold standard in the treatment of BPH. This article outlines the current LEP techniques and should serve as a quick reference for the practicing urologist.

  20. Holmium laser enucleation of the prostate: initial report of the first 230 Egyptian cases performed in a single center.

    Science.gov (United States)

    Abdel-Hakim, Amr M; Habib, Enmar I; El-Feel, Ahmed S; Elbaz, Ahmed G; Fayad, Amr M; Abdel-Hakim, Mahmoud A; Meshref, Alaa W

    2010-08-01

    To report our experience with the first 230 cases of holmium laser enucleation of the prostate (HoLEP) performed in a single center. A total of 230 cases of HoLEP were performed between June 2007 and June 2008. Mean age of patients was 69.8 +/- 10.3 years, and 21.3% of patients were either on anticoagulant or antiplatelet treatment. There was no limit for prostate size, with a mean prostate size of 86.5 +/- 65.4 g (range: 20-350 g). Follow-up was performed regularly at 1, 3, 6, and 12 months, assessing the Q(max), PVR, and International Prostate Symptom Score. Weight of prostate chips retrieved after morcellation was 78.6 +/- 61.3 g (range: 10-350), with enucleation time 102.2 +/- 55.4 minutes and morcellation time 19.3 +/- 10.1 minutes, leading an estimated efficiency rate of 0.64 g/min. The rate of decrease in prostate volume and prostate-specific antigen was 90.8% and 82.5%, respectively. At 1 month, mean Q(max) increased from 7.7 +/- 2.3 to 25.8 +/- 10.1 mL/s (P Kegel exercises, respectively. Only 1 patient with pancytopenia required blood transfusion and there was no case for transurethral resection syndrome. HoLEP is a safe and an effective modern modality for the treatment of symptomatic BPH regardless of the gland size, with satisfactory clinical outcome. Copyright 2010 Elsevier Inc. All rights reserved.

  1. Transurethral surgical anatomy of the arterial bleeder in the enucleated capsular plane of enlarged prostates during holmium laser enucleation of the prostate.

    Science.gov (United States)

    Choo, Min Soo; Lee, Hahn-Ey; Bae, Jungbum; Cho, Sung Yong; Oh, Seung-June

    2014-09-01

    To identify the endoscopic vascular anatomy of the prostate during Holmium laser enucleation of the prostate (HoLEP), and analyze the clinical risk factors associated with significant arterial bleeding. We identified 107 consecutive patients with benign prostatic hyperplasia who underwent HoLEP between September 2009 and August 2010, performed by a single surgeon (S.J.O.). Two independent reviewers reviewed the surgery video database and completed a prespecified form. The location of bleeding arteries was marked at the level of the bladder neck, proximal prostate, distal prostate, and verumontanum. Arterial bleeding was classified into one of three grades according to bleeding severity (grades 2 and 3 indicate significant bleeding). The mean prostate volume was 65.1±31.5 mL, and the mean prostate-specific antigen (PSA) level was 3.69±3.58 ng/mL. During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. The average number of bleeding arteries was 12.1±7.9 per procedure, and 1.93±1.20 per 10 mL of prostate volume. Multivariate analysis revealed that prostate volume and serum PSA were significant parameters for estimating the number of bleeding vessels. During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. Prostate volume was associated with the number of bleeders. A careful approach to the capsular plane of the proximal prostate facilitates early hemostasis during the HoLEP procedure, especially with larger adenomas.

  2. Comparison of Photoselective Vaporization versus Holmium Laser Enucleation for Treatment of Benign Prostate Hyperplasia in a Small Prostate Volume.

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    Kim, Kang Sup; Choi, Jin Bong; Bae, Woong Jin; Kim, Su Jin; Cho, Hyuk Jin; Hong, Sung-Hoo; Lee, Ji Youl; Kim, Sang Hoon; Kim, Hyun Woo; Cho, Su Yeon; Kim, Sae Woong

    2016-01-01

    Photoselective vaporization of the prostate (PVP) using GreenLight and Holmium laser enucleation of the prostate (HoLEP) is an important surgical technique for management of benign prostate hyperplasia (BPH). We aimed to compare the effectiveness and safety of PVP using a 120 W GreenLight laser with HoLEP in a small prostate volume. Patients who underwent PVP or HoLEP surgery for BPH at our institutions were reviewed from May 2009 to December 2014 in this retrospective study. Among them, patients with prostate volumes < 40 mL based on preoperative trans-rectal ultrasonography were included in this study. Peri-operative and post-operative parameters-such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and complications-were compared between the groups. PVP was performed in 176 patients and HoLEP in162 patients. Preoperative demographic data were similar in both groups, with the exception of PVR. Operative time and catheter duration did not show significant difference. Significant improvements compared to preoperative values were verified at the postoperative evaluation in both groups in terms of IPSS, QoL, Qmax, and PVR. Comparison of the postoperative parameters between the PVP and HoLEP groups demonstrated no significant difference, with the exception of IPSS voiding subscore at 1 month postoperatively (5.9 vs. 3.8, P< 0.001). There was no significant difference in postoperative complications between the two groups. Our data suggest that PVP and HoLEP are efficient and safe surgical treatment options for patients with small prostate volume.

  3. Comparison of Photoselective Vaporization versus Holmium Laser Enucleation for Treatment of Benign Prostate Hyperplasia in a Small Prostate Volume.

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    Kang Sup Kim

    Full Text Available Photoselective vaporization of the prostate (PVP using GreenLight and Holmium laser enucleation of the prostate (HoLEP is an important surgical technique for management of benign prostate hyperplasia (BPH. We aimed to compare the effectiveness and safety of PVP using a 120 W GreenLight laser with HoLEP in a small prostate volume.Patients who underwent PVP or HoLEP surgery for BPH at our institutions were reviewed from May 2009 to December 2014 in this retrospective study. Among them, patients with prostate volumes < 40 mL based on preoperative trans-rectal ultrasonography were included in this study. Peri-operative and post-operative parameters-such as International Prostate Symptom Score (IPSS, quality of life (QoL, maximum urinary flow rate (Qmax, post-void residual urine volume (PVR, and complications-were compared between the groups.PVP was performed in 176 patients and HoLEP in162 patients. Preoperative demographic data were similar in both groups, with the exception of PVR. Operative time and catheter duration did not show significant difference. Significant improvements compared to preoperative values were verified at the postoperative evaluation in both groups in terms of IPSS, QoL, Qmax, and PVR. Comparison of the postoperative parameters between the PVP and HoLEP groups demonstrated no significant difference, with the exception of IPSS voiding subscore at 1 month postoperatively (5.9 vs. 3.8, P< 0.001. There was no significant difference in postoperative complications between the two groups.Our data suggest that PVP and HoLEP are efficient and safe surgical treatment options for patients with small prostate volume.

  4. Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity.

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    Woo, Myeong Jin; Ha, Yun-Sok; Lee, Jun Nyung; Kim, Bum Soo; Kim, Hyun Tae; Kim, Tae-Hwan; Yoo, Eun Sang

    2017-03-24

    Currently, holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the standard surgical procedures used to treat benign prostatic hyperplasia (BPH). Several recent studies have demonstrated that the surgical management of BPH in patients with detrusor underactivity (DU) can effectively improve voiding symptoms, but comparative data on the efficacy of HoLEP and TURP are insufficient. Therefore, we compared the short-term surgical outcomes of HoLEP and TURP in patients with DU. From January 2010 to May 2015, 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients with both BPH and DU were enrolled in this study (HoLEP, n=24; TURP, n=32). Surgical outcomes were retrospectively compared between the 2 groups. DU was defined as a detrusor pressure at maximal flow rate of <40 cm H2O as measured by a pressure flow study. The preoperative characteristics of patients and the presence of comorbidities were comparable between the 2 groups. The TURP group showed a significantly shorter operative time than the HoLEP group (P=0.033). The weight of the resected prostate was greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoid residual urine volume were significantly better in the HoLEP group than in the TURP group. HoLEP can be effectively and safely performed in patients with DU and can be expected to have better surgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.

  5. Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up

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    Ilter Alkan

    2016-04-01

    Full Text Available ABSTRACT Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL outcomes after Holmium laser enucleation of the prostate (HoLEP in patients with symptomatic benign prostatic hyperplasia (BPH. Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs, prostate-specific antigen (PSA levels, QoL scores, peak uroflowmetric data (Qmax values, and post-voiding residual urine volumes (PVR volumes, were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05. Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001. The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3% required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%. All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up. Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.

  6. Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial.

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    Ahyai, Sascha A; Lehrich, Karin; Kuntz, Rainer M

    2007-11-01

    To report 3-yr follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP). A total of 200 patients with urodynamic obstruction and a prostate volume of less than 100 cc were prospectively randomised and assigned to HoLEP or TURP. All patients were assessed preoperatively and followed at 1, 6, 12, 18, 24, and 36 mo postoperatively. American Urological Association Symptom Score (AUA SS), maximum flow rate (Q(max)), and postvoid residual (PVR) [urine] volume were obtained at each follow-up. Perioperative data and postoperative outcome were compared. All complications were recorded. AUA SS were significantly better 2 yr postoperatively in the HoLEP group (1.7 vs. 3.9, p<0.0001) and similar at 3 yr (2.7 vs. 3.3, p=0.17). PVR volume was significantly better 2 yr (5.6 vs. 19.9 ml, p<0.001) and 3 yr (8.4 vs. 20.2 ml, p=0.012) postoperatively in HoLEP patients. Q(max) was similar in the HoLEP and TURP groups at 2 yr (28.0 vs. 29.1 ml/s, p=0.83) and at 3 yr (29.0 vs. 27.5 ml/s, p=0.41) postoperatively. Late complications consisted of urethral strictures, bladder-neck contractures, and BPH recurrence; reoperation rates were 7.2% in the HoLEP and 6.6% in the TURP group (p=1.0). After 2 and 3 yr of follow-up, HoLEP micturition outcomes compare favourably with TURP. Late complications are equally low. HoLEP may be a real alternative to TURP.

  7. Predictors of urgency improvement after Holmium laser enucleation of the prostate in men with benign prostatic hyperplasia

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    Won Sok Hur

    2016-11-01

    Full Text Available Purpose: To investigate the change in urinary urgency and predictors of urgency improvement after holmium laser enucleation of the prostate (HoLEP in men with benign prostatic hyperplasia (BPH. Materials and Methods: We retrospectively analyzed the medical records of patients who were treated with HoLEP for BPH and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Those with prostate cancer diagnosed prior to or after HoLEP, a history of other prostatic and/or urethral surgery, moderate to severe postoperative complications, and neurogenic causes were excluded. Patients who had improved urgency with antimuscarinic medication after HoLEP were excluded. We divided the patients into 2 groups based on urgency symptoms 3 months after HoLEP: improved and unimproved urgency. Improved urgency was defined as a reduction of 2 or more points on the 5-point urinary sensation scale. Preoperative clinical and urodynamic factors as well as perioperative factors were compared between groups. Results: In total, 139 patients were included in this study. Voiding parameters in all patients improved significantly after HoLEP. Seventy-one patients (51.1% had improved urgency, while 68 (48.9% did not show any improvement. A history of acute urinary retention (AUR and postvoid residual were associated with postoperative urgency improvement in univariate analysis. In multivariate analysis, a history of AUR was an independent factor affecting urgency improvement. Conclusions: A preoperative history of AUR could influence the change in urgency after HoLEP surgery in patients with BPH.

  8. Introducing holmium laser enucleation of the prostate alongside transurethral resection of the prostate improves outcomes of each procedure.

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    Wilson, N; Mikhail, M; Acher, P; Lodge, R; Young, A

    2013-07-01

    Holmium laser enucleation of the prostate (HoLEP) is recognised as an alternative to transurethral resection of the prostate (TURP). HoLEP has been demonstrated to be at least as effective as TURP with less morbidity but its introduction to practice has been limited in part by the learning curve of a novel procedure. This study examined the effects of introducing HoLEP alongside an established practice of TURP on early morbidity and length of hospital stay (LOS). A retrospective review of all patients who underwent HoLEP and TURP between April 2007 and July 2011 was undertaken. HoLEP was introduced in April 2008; patients undergoing TURP before this were considered as a historical control group. Data were collected concerning resection/enucleation weight, blood transfusions and LOS. Overall, 772 patients underwent HoLEP or TURP within the 52-month study period: 164 underwent TURP prior to the introduction of HoLEP (TURP-A), 425 had TURP after the introduction of HoLEP (TURP-B) and 183 underwent HoLEP. The mean removed weight was 24g (standard deviation [SD]: 21g) for TURP-A, 19g for TURP-B (SD: 16g) and 38g (SD: 32g) for HoLEP (p<0.005). Blood transfusion rates were 5.5%, 2.2% and 1.6% for the TURP-A, TURP-B and HoLEP groups respectively (p<0.05). For TURP-A patients, the mean LOS was 5.6 days (SD: 3.5 days, 95% confidence interval [CI]: 5.3-6.0 days). The mean LOS for TURP-B patients was 4.4 days (SD: 4.4 days, 95% CI: 4.2-4.8 days). HoLEP patients had a mean LOS of 3.0 days (SD: 3.0 days, 95% CI: 2.6-3.4 days). The introduction of HoLEP alongside TURP is associated with lower rates of blood transfusion and shorter LOS for all patients. This is likely to be due to the use of HoLEP rather than TURP in patients with larger prostates, who are more likely to have complications.

  9. [Transurethral holmium enucleation of prostatic adenoma].

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    Martov, A G; Maksimov, V A; Iarovoĭ, S Iu; Ergakov, D V; Kornienko, S I; Fakhredinov, G A

    2011-01-01

    Laser (holmium) enucleation of the prostate (LEP) for infravesical obstruction caused by prostatic adenoma up to 60 cm3 in size was made in 42 patients in the Moscow city urological hospital N 47 from January to July 2009. Transurethral resection (TUR) of the prostate was made in 42 matched controls. All the patients from both groups have undergone the same standard clinical and laboratory examination before the treatment, 1, 3 and 6 months after it. Duration of surgery was shorter in the TUR group (42.4 +/- 26.1 min vs. 74.8 +/- 39.7 min). Washing system operated longer in the TUR group (23 +/- 7 vs. 10 +/- 5 h). The LEP group patients stayed in the hospital for much shorter time (3.1 +/- 1.2 days vs 4.6 +/- 1.8 days). No significant differences between the groups by basic postoperative parameters were found 1, 3 and 6 months after the operation. Postoperative complications were rare in both groups. Hemorrhagic complications were absent in the LEP group. This makes it possible to recommend LEP for patients with coagulopathy. Trauma of the bladder occurred in 1 case of LEP because of a complicated technique of LEP and the absence of conventional endoscopic reference points characteristic for TUR. Thus, our initial experience with transurethral LEP in comparison with TUR leads us to the conclusion that LEP is effective and safe in surgical treatment of patients with prostatic adenoma. Further gain of experience with LEP conduction may make this method alternative to open adenomectomy.

  10. Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH).

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    Elshal, Ahmed M; Elmansy, Hazem M; Elhilali, Mostafa M

    2012-12-01

    Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The major advantage of holmium laser enucleation of the prostate (HoLEP) depends on the ability to use the native anatomical plane between the prostate adenoma and surgical capsule, peeling each prostatic lobe from the capsule. HoLEP is associated with less catheterisation time, hospital stay and blood loss than transurethral resection of the prostate (TURP) or open prostatectomy. Urodynamic relief of obstruction has been reported to be better with HoLEP than TURP. However, surgical treatment of recurrent prostatic obstruction after previous transurethral surgery for symptomatic benign prostatic hyperplasia is more challenging because of loss of anatomical landmarks resulting in either incomplete removal or incontinence. HoLEP for recurrent symptoms due to residual or re-growing prostatic adenoma seems to be as safe, feasible and efficient as HoLEP for de novo cases. The surgical plane between the adenoma and the surgical capsule was still accessible resulting in a durable long-term outcome with minimal side-effects. Previous transurethral prostatic surgery is not a contraindication for HoLEP. • To assess the technical feasibility, functional outcome and morbidity of holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia (BPH) in patients with previous transurethral prostate surgery. 'Redo' surgery for recurrent or residual BPH poses a technical challenge with uncertain outcome as a result of disturbed anatomical landmarks with no clear surgical limits. • We retrospectively reviewed 1054 patients who underwent HoLEP for symptomatic BPH. • Patients were stratified into two groups, group-I with no previous prostate surgery or primary-HoLEP (978 patients) and group-II with history of previous prostate surgery or secondary-HoLEP (76). • All patients' variables as well as follow-up data were assessed and

  11. Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature.

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    Elshal, Ahmed M; Mekkawy, Ramy; Laymon, Mahmoud; El-Assmy, Ahmed; El-Nahas, Ahmed R

    2015-01-01

    We assess different approaches to retrieve the enucleated adenoma after transurethral enucleation of the prostate, particularly using the holmium laser. A retrospective review through our prospectively maintained database was performed looking for safety and efficacy of two morcellators. The enucleation phase of the holmium laser enucleation of the prostate (HoLEP) was classically performed followed by retrieval of the intravesical adenoma using either the Piranha (Wolf Inc., Knittlingen, Germany) or VersaCut (Lumenis) morcellator. A PubMed-MEDLINE search was conducted for all transurethral enucleation procedures and relevant data regarding methods of prostate tissue retrieval were extracted. Strictly limiting the study to 3 reusable blades with each morcellator, we performed 67 and 55 consecutive procedures with Piranha and VersaCut, respectively. There was no significant difference between the two morcellators regarding perioperative complications, apart from 5 bladder mucosal injuries with the VersaCut (9%). Furthermore, there were similar retrieved tissue weight, mechanical problems-rate, catheter-time and hospital-stay in both morcellators. However, the Piranha morcellator needed significantly less morcellation-time, needed to use cold loop to remove non-morcellated pieces and to score the adenoma by laser for better bite of the adenoma, and had a higher median morcellation-rate 6.2 (rate: 2.8-12) g/min. Despite little reporting on morcellation, we had data on the tissue retrieval rate (2.6 to 6.5 g/min with Piranha and 1.9 to 11 g/min with VersaCut. Furthermore, bladder mucosal injury was reported in 1.4% and 0.7 to 5.7% with Piranha and VersaCut, respectively; bladder perforation with VersaCut was experienced in about 0.1 to 1.5% of patients. Our study is limited by its non-randomization. The Piranha morcellator was the most efficient and safe way to retrieve tissue after a transurethral enucleation of a prostate adenoma.

  12. Efficacy and Safety of 120-W Thulium:Yttrium-Aluminum-Garnet Vapoenucleation of Prostates Compared with Holmium Laser Enucleation of Prostates for Benign Prostatic Hyperplasia

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    Kai Hong

    2015-01-01

    Full Text Available Background: This study compared the efficacy and safety between 120-W thulium:yttrium-aluminum-garnet (Tm:YAG vapoenucleation of prostates (ThuVEP and holmium laser enucleation of prostates (HoLEP for patients with lower urinary tract symptoms (LUTS due to benign prostatic hyperplasia (BPH. Methods: A retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score (IPSS, quality of life (QoL score, maximum flow rate (Qmax, postvoid residual urine volume (PVR, and rates of peri-operative and late complications. Results: The patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation (58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003, and resulted in a significant superiority in laser efficiency (resected prostate weight/laser enucleation time for 120-W Tm:YAG laser compared to holmium:YAG laser (0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048. During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR (P > 0.05. Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group (17.1 ± 12.0 g/L vs. 15.2 ± 10.1 g/L, P = 0.415. Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients (P > 0.05. Conclusions: 120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W ThuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.

  13. Transurethral holmium laser enucleation of prostates (HoLEP) larger than 80 g

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    Kuntz, Rainer M.; Lehrich, Karin; Fayad, Amr

    2001-05-01

    In this prospective study, the efficiency of HoLEP inpatients with prostates larger than 80 grams was to be evaluated. 64 urodynamically obstructed patients with prostate glands of 103 (80-230) grams of weight underwent HoLEP (80 W, 2.0 J, 40 Hz, 550 nm bare laser fibers). The resected weight was 70 (50-200) grams, the resection time was 120.5 (83-170) min., the average resection weight was 0.7 gm/min. The postoperative catheter time was 1.3 (1-3) days. The postoperative hospital stay was 2.5 (1-7) days. HoLEP induced a significant, pronounced and immediate improvement of lower urinary tract symptoms and micturition. The symptom score decreased from 22.3 preoperatively to 5.7 one week and 2.8 one year postoperatively. The peak urinary flow rate of 4.3 ml/sec preoperatively increased to 22 ml/sec one week and 32 ml/sec one year postoperatively. The residual urine dropped from 267 ml preoperatively to 11.5 ml one week and 5.0 ml one year postoperatively. There was one incident of postoperative arterial bleeding, one patient developed urethral stricture and two patients needed a second HoLEP. HoLEP appeared to be a highly effective treatment for prostates larger than 80 grams, with excellent functional results, minor blood loss, low complication rate and very short catheter time and hospital stay.

  14. Holmium Laser Enucleation of the Prostate (HoLEP: Our Experience with the Learning Curve and the Development of the ‘En-Bloc No-Touch’ Technique

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    Cesare Marco Scoffone

    2015-05-01

    Full Text Available Background: Holmium laser enucleation of the prostate (HoLEP is a safe and effective therapeutic option in patients suffering from benign prostatic hyperplasia (BPH of any size. In spite of its excellent and durable outcomes, HoLEP is gaining widespread acceptance very slowly, since it is perceived as requiring significant endoscopic skill and having a steep learning curve. Here we present our 4-year experience with this technique after more than 200 cases, describing our learning curve with the traditional three-lobe technique of Gilling, and its progressive modification into the so-called ‘en-bloc no-touch’ technique. Methods: From January 2011 to December 2014, 200 consecutive patients diagnosed with symptomatic and obstructive BPH underwent HoLEP in our department. Demographic and clinical data were prospectively collected. Age, total operating time, enucleation time and efficiency, morcellation time, energy employed, adenoma weight, hospital stay, and complications were recorded. Results: The HoLEP learning curve in our department included an initial 1-year experience with the traditional technique of Gilling, and its progressive modification with the development of the socalled ‘en-bloc no-touch’ approach, subsequently standardised step by step. At the beginning of the learning curve short time intervals between the procedures are relevant for faster learning. With time and experience, adenomas of all sizes are treated, with significantly shorter total operating and enucleation times, significantly increased enucleation efficiency, decreased use of energy (meaning fewer postoperative voiding symptoms, and fewer complications. Morcellation time is more devicedependent than surgeon-dependent, and is also influenced by the composition of the adenomatous tissue. Conclusion: The ‘en-bloc no-touch’ technique seems to simplify the procedure, making it easier to teach and to learn. HoLEP safety and efficacy are improved by increasing

  15. A focused review on the effects of preoperative 5α-reductase inhibitors treatment in patients undergoing holmium laser enucleation of the prostate. What do we know so far?

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    Dimopoulos, Panagiotis; Christopoulos, Panagiotis; Kampantais, Spyridon

    2017-11-22

    The effects of medical therapy with finasteride or dutasteride during transurethral enucleation of prostate and tissue morcellation are not well defined. In theory, the risk of prostatic fibrosis versus the potential benefit of reduced intraoperative bleeding have been addressed as potential competing factors. The aim of this review was to provide evidence if 5a-reductase inhibitors put the surgeon at a disadvantage or impacts on patient outcomes. We performed a literature search of PubMed, Scopus and Web of science databases. All articles in English language related to the topic were reviewed to provide data on the influence of preoperative 5a reductase inhibitors in Holmium Laser enucleation of prostate. Parameters of surgical efficiency such as enucleation time and efficiency, morcellation time, operating time, prostate tissue volume resected, energy and saline usage were evaluated in the included studies. The review failed to show any definite impact of preoperative 5a reductase inhibitor use on the above parameters. One study, assessing the surgical difficulty using retrospective video recording analysis, showed that use of dutasteride increases the difficulty of enucleation step which did not translate in statistical difference of surgical efficiency in an experienced level of surgeons. Overall, 5a-reductase inhibitors do not seem to affect Holmium laser enucleation of prostate. However, the quality of evidence is still quite poor in comparison with other surgical techniques. Further well designed studies are required prior to making any definite recommendations on the use of 5a-reductase inhibitors in patients undergoing Holmium laser enucleation of prostate.

  16. Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial.

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    Kuntz, Rainer M; Lehrich, Karin; Ahyai, Sascha

    2004-03-01

    This ongoing randomized study aims to find out whether transurethral holmium laser enucleation of the prostate (HoLEP) could be an alternative to open transvesical prostatectomy in patients with prostates >100 g. A series of 120 urodynamically obstructed patients were randomized to HoLEP or open prostatectomy, 60 patients to each group. The HoLEP was performed with high-powered Ho:YAG lasers at 80 to 100 W (2.0 J, 40-50 Hz) and 550-nm bare laser fibers. The American Urological Association Symptom Scores, peak urinary flow rates, and postvoiding residual urine volumes were evaluated preoperatively and at 1, 3, 6, 12, and 18 months postoperatively. All complications were noted. By the Mann-Whitney test, there was no significant difference between the HoLEP and open surgery groups in patient age (69.0 years HoLEP v 71.0 years open surgery), prostate volume (115 cc [range 100-230 cc] v 113 cc [100-230 cc], or weight of resected tissue (94 g [range 57-220 g] v 96 g [range 61-220 g]). There were significant differences in the mean operative time (136 v 91 minutes; P< 0.0001), mean hemoglobin loss (1.9 v 2.8 g/dL; P< 0.0001), median catheter time (1 day v 6 days; P< 0.0001), and median hospital stay (2 days v 10 days; P< 0.0001). Both HoLEP and open prostatectomy resulted in pronounced and lasting postoperative improvements in Symptom Scores, peak urinary flow rates, and postvoiding residual volumes (P< 0.0001). The differences between HoLEP and open prostatectomy were not significant at any interval for any parameter. Blood transfusions were required in 0 HoLEP patients v 8 open surgery patients. Arterial bleeding occurred in three patients in each group. Secondary apical resection was required in two HoLEP patients and no open surgery patients. Bladder neck contracture occurred in none of the HoLEP patients and two of those having open surgery. Thus, the total number of patients having complications was 7 with HoLEP and 13 with open surgery. There were no deaths in

  17. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years.

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    Gilling, Peter J; Wilson, Liam C; King, Colleen J; Westenberg, Andre M; Frampton, Christopher M; Fraundorfer, Mark R

    2012-02-01

    To assess the durability of holmium laser enucleation of prostate in comparison to transurethral resection of the prostate (TURP). Patients were enrolled in the present study between June 1997 and December 2000 and followed per protocol. All patients were urodynamically obstructed with a prostate volume of between 40 and 200 mL. At long-term follow-up, variables assessed included Benign Prostatic Hyperplasia Impact Index (BPHII), International Continence Society Short Form Male questionnaire (ICSmale-SF) and the International Index of Erectile Function (IIEF). Adverse events, including the need for retreatment, were specifically assessed. Thirty-one (14 holmium laser enucleation of the prostate [HoLEP] and 17 TURP) of the initial 61 patients were available, with 12 deceased and 18 lost to follow-up. The mean (range) follow-up was 7.6 (5.9-10.0) years and the mean (±sd) age at follow-up was 79.8 (±6.2) years. The mean (±sd) values (HoLEP vs TURP) were as follows: maximum urinary flow rate (Q(max)), 22.09 ± 15.47 vs 17.83 ± 8.61 mL/s; American Urological Association (AUA) symptom score, 8.0 ± 5.2 vs 10.3 ± 7.42; quality of life (QOL) score 1.47 ± 1.31 vs 1.31 ± 0.85; BPHII, 1.53 ± 2.9 vs 0.58 ± 0.79; IIEF-EF (erectile function), 11.6 ± 7.46 vs 9.21 ± 7.17; ICSmale Voiding Score (VS), 4.2 ± 3.76 vs 3.0 ± 2.41; ICSmale Incontinence Score (IS), 3.07 ± 3.3 vs 1.17 ± 1.4. There were no significant differences in any variable between the two groups beyond the first year. Of the assessable patients, none required re-operation for recurrent BPH in the HoLEP arm and three (of 17) required re-operation in the TURP arm . The results of this randomized trial confirm that HoLEP is at least equivalent to TURP in the long term with fewer re-operations being necessary. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  18. Prostatic vascular damage induced by cigarette smoking as a risk factor for recovery after holmium laser enucleation of the prostate (HoLEP).

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    Xu, Huan; Liu, Chong; Gu, Meng; Chen, Yanbo; Cai, Zhikang; Chen, Qi; Wang, Zhong

    2017-02-21

    To evaluate the relationship between prostatic vessel changes induced by cigarette smoking and the perioperative outcome of holmium laser enucleation of the prostate (HoLEP). A total of 268 postoperative patients with benign prostatic hyperplasia (BPH) were prospectively analysed in our department. They were divided into two groups (smokers and non-smokers) according to smoking history. Transrectal colour Doppler ultrasound was performed to evaluate the prostate vascular changes. Pathologically, HE staining, CD31 and CD34 were analysed in prostatic section chips. Furthermore, postoperative outcomes were determined during a 6-month follow-up period. The preoperative prostate volume was significantly decreased in smoking patients (P = 0.04). CPI was significantly lower in smoking BPH patients (P smoking BPH individuals presenting an increased number of microvessels. The HoLEP duration was increased in smokers. Interestingly, we identified significantly increased overactive bladder syndrome score (OABSS) and decreased Qmax in smoking individuals during the 6-month follow-up with no difference being observed preoperatively. However, no significant difference between the groups was observed for the International Prostate Symptom Score (IPSS). The significantly lower CPI and higher RI values in smoking BPH patients indicated the presence of considerable vascular damage in these subjects. Moreover, cigarette smoking extended the surgical duration and prolonged the recovery period of overactive bladder (OAB) syndrome. Thus, integrated treatment should be suggested for various BPH individuals.

  19. Comparison of fluid absorption during transurethral resection of prostate and Holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration.

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    Bapat, Shivadeo; Umranikar, Salil; Satav, Vikram; Bapat, Abhijeet; Joshi, Arun; Ranade, Gauri

    2007-04-01

    We conducted a study to detect, quantify and compare irrigation fluid absorption in transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP), using BEC. The study included 50 patients of lower urinary tract symptoms, secondary to benign enlargement of prostate. The patients were nonrandomly allocated to undergo TURP and HoLEP. Twenty-six patients underwent TURP and the remaining 24 underwent HoLEP. Sterile water tagged with 1% ethanol w/v was used for irrigation. Absorption was detected and quantified every 10min by BEC levels. Data was analyzed using standard nomograms. In HoLEP, 14/24 had no fluid absorption. The remaining 10/24 showed fluid absorption ranging from 95 ml to 300 ml. In TURP, all had fluid absorption ranging from 250-980 ml. Three TURP patients developed overt symptoms, while none did in the HoLEP group. Fluid absorption observed in our study in the HoLEP group was lower than in the TURP group.

  20. Comparison of fluid absorption during transurethral resection of prostate and Holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration

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    Shivadeo Bapat

    2007-01-01

    Full Text Available Objective: We conducted a study to detect, quantify and compare irrigation fluid absorption in transurethral resection of the prostate (TURP and Holmium laser enucleation of the prostate (HoLEP, using BEC. Materials and Methods: The study included 50 patients of lower urinary tract symptoms, secondary to benign enlargement of prostate. The patients were nonrandomly allocated to undergo TURP and HoLEP. Twenty-six patients underwent TURP and the remaining 24 underwent HoLEP. Sterile water tagged with 1% ethanol w/v was used for irrigation. Absorption was detected and quantified every 10min by BEC levels. Data was analyzed using standard nomograms. Results: In HoLEP, 14/24 had no fluid absorption. The remaining 10/24 showed fluid absorption ranging from 95 ml to 300 ml. In TURP, all had fluid absorption ranging from 250-980 ml. Three TURP patients developed overt symptoms, while none did in the HoLEP group. Conclusions: Fluid absorption observed in our study in the HoLEP group was lower than in the TURP group.

  1. Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

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    Kim, Myong; Piao, Songzhe; Lee, Hahn-Ey; Kim, Sung Han

    2015-01-01

    Purpose To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates. Materials and Methods Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPVenucleation and morcellation times were longer in group C (penucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture. Conclusions HoLEP in patients with an extremely large prostate can be performed efficiently and safely. PMID:25763126

  2. Efficacy of holmium laser enucleation of the prostate (HoLEP in men with bladder outlet obstruction (BOO and non-neurogenic bladder dysfunction

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    Jong Hyun Pyun

    2017-09-01

    Full Text Available We aimed to compare the short-term outcomes of men who had urodynamic evidence of detrusor underactivity (DU or detrusor overactivity (DO of a non-neurogenic etiology as well as bladder outlet obstruction (BOO and who underwent Holmium Laser Enucleation of the prostate (HoLEP. A database of 322 patients who underwent HoLEP between 2010 and 2014 was analyzed. Patients were classified into three groups according to the results of a preoperative urodynamic study. Preoperative parameters such as International Prostate Symptom Score (IPSS, Quality of Life (QoL index, IPSS grade, uroflowmetry were compared with postoperative parameters measured at 6 months. There were 138 patients with BOO-only and 89 patients with BOO and detrusor dysfunction including 56 with DO and 33 with DU. The degree of improvement in IPSS-total (BOO: 10.7, DO: 8.3, DU: 7.0; p = 0.023 was greater in the BOO-only group than in the DU group. There were more patients whose IPSS grade improved in the BOO-only group (71% than in the detrusor dysfunction group (DO: 53.6% and DU: 45.5%. Postoperative IPSS-voiding (4.5 vs 7.0, and Qmax (18 vs 13.7 in the BOO-only group were significantly better than those in the DU group. Additionally, postoperative IPSS-storage (4.7 vs 6.7, and IPSS-total (9.1 vs 12.3 in the BOO-only group were significantly better than in the DO group (all p < 0.05. In conclusion, early surgical management for men with severe LUTS and associated BPH before secondary degeneration occurs may be beneficial for preserving detrusor function and yield better treatment outcomes.

  3. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials.

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    Yin, Lei; Teng, Jingfei; Huang, Chien-Jung; Zhang, Xiangmin; Xu, Danfeng

    2013-05-01

    To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP) for relief of bladder outlet obstruction (BOO) on benign prostatic hyperplasia (BPH). A systematic literature search for randomized controlled trials (RCTs) comparing HoLEP and TURP in several databases from 1996 to 2011 were performed. Meta-analysis was conducted with the Review Manager Software. Of 248 potential citations, 6 RCTs were included into our meta-analysis. There was no significant difference between the two groups in the maximum urinary flow rate (Qmax) and international prostate symptom score (IPSS) at 1 month (p=0.41 and p=0.87) or 6 months (p=0.07 and p=0.37) after treatment. However, at 12 months postoperatively, the Qmax and IPSS in the HoLEP group were significantly better than those in the TURP group (p<0.0001 and p=0.01). The results also suggested a benefit of HoLEP over TURP in blood loss (p=0.001), catheterization time (p<0.0001), hospital stay (p=0.001), and blood transfusion rate (p=0.04), while the results favored TURP over HoLEP for operative time (p=0.001) and the incidence of postoperative dysuria (p=0.003). Comparing with TURP, HoLEP showed slightly better postoperative results in Qmax and IPSS during 12-month follow-up, as well as significantly better perioperative results and similarly low complication rates. However, the operative time and the incidence of postoperative dysuria favor TURP. Generally, HoLEP is a promising minimal invasive alternative to TURP for treatment of BPH.

  4. Holmium Laser Enucleation of the Prostate is Effective in the Treatment of Symptomatic Benign Prostatic Hyperplasia of Any Size Including a Small Prostate

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    Lee, Min Ho; Yang, Hee Jo; Kim, Doo Sang; Lee, Chang Ho

    2014-01-01

    Purpose Although transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size. Materials and Methods We retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at our institute. All patients were categorized into 3 groups on the basis of prostate size (group 1, 80 g), and 45 patients were selected for each method. Results No major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume. Conclusions HoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that of TURP. PMID:25405016

  5. Holmium laser enucleation of the prostate is safe in patients with prostate cancer and lower urinary tract symptoms--a retrospective feasibility study.

    Science.gov (United States)

    Becker, Andreas; Placke, Anne; Kluth, Luis; Schwarz, Rudolf; Isbarn, Hendrik; Chun, Felix; Heuer, Roman; Schlomm, Thorsten; Seiler, Daniel; Engel, Oliver; Fisch, Margit; Graefen, Markus; Ahyai, Sascha A

    2014-03-01

    To evaluate the outcome of holmium laser enucleation of the prostate (HoLEP) in the known presence of prostate cancer (PCa) and concomitant lower urinary tract symptoms (LUTS). We retrospectively identified 62 patients who underwent HoLEP for LUTS in the known presence of PCa at our center. Perioperative data were assessed including complications, functional outcomes, and quality of life (QoL). Giving respect to different disease characteristics, patients were stratified according to treatment strategy setting into palliative (I), radiation (II), and surveillance (III) groups and compared accordingly. Median follow-up (FU) of the entire study cohort was 27 months (range 2-65 mos). Medians of functional parameters (International Prostate Symptom Score): 18.5 vs 4.5, QoL: 4 vs 1, maximal flow rate: 9.0 vs 18.8 mL/s and residual urine: 100 vs 0 mL, all P<0.05) improved significantly in all groups. Perioperative complications were low and without any statistically significant difference between the groups. Postoperatively, voiding was successful in 90.3% of all patients; at last FU, 17% had some degree of urinary incontinence. Treatment strategy groups showed comparable functional outcomes after HoLEP. In the presence of PCa and LUTS, HoLEP represents a feasible, safe, and effective treatment option for patients unfit or without indication for radical prostatectomy. This applies as well in a palliative situation of advanced, obstructive PCa as for patients with LUTS who are scheduled for radiation therapy or surveillance in presumably indolent disease.

  6. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial.

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    Kuntz, Rainer M; Lehrich, Karin; Ahyai, Sascha A

    2008-01-01

    To report 5-year follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with open prostatectomy (OP). One hundred twenty patients with prostates greater than 100g in weight according to transrectal ultrasound were randomised to either the HoLEP or the OP group (ie, 60 patients to each group). Preoperative and postoperative assessments included American Urological Association Symptom Score (AUA-SS), maximum urinary flow rates (Qmax), and postvoid residual urine (PVRU) volumes. Measurements were performed at 1, 3, 6, 12, 18, 24, 36, 48, and 60 mo. Postoperative outcome data were compared. All complications were recorded. Five years postoperatively, a total of 46 patients (38.3%) were lost to follow-up or had to be excluded from the study. All the remaining 74 patients (42 HoLEP vs. 32 OP patients, p=0.11) had undergone the 5-yr follow-up assessments. Mean AUA-SS was 3.0 in both groups (p=0.98), mean Qmax was 24.4 ml/s in both groups (p=0.97) and PVRU volume was 11 ml in the HoLEP and 5 ml in the OP group (p=0.25). Late complications consisted of urethral strictures and bladder-neck contractures; reoperation rates were 5% in the HoLEP and 6.7% in the OP group (p=1.0). No patient developed benign prostatic hyperplasia recurrence. Five years after the operation, the improvements in micturition obtained with HoLEP and OP were equally good, and reoperation rates similarly low. HoLEP seems to be a true endourological alternative to OP.

  7. Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis.

    Science.gov (United States)

    Li, Sheng; Zeng, Xian-Tao; Ruan, Xiao-Lan; Weng, Hong; Liu, Tong-Zu; Wang, Xiao; Zhang, Chao; Meng, Zhe; Wang, Xing-Huan

    2014-01-01

    Holmium laser enucleation (HoLEP) in surgical treatment of benign prostate hyperplasia (BPH) potentially offers advantages over transurethral resection of the prostate (TURP). Published randomized controlled trials (RCTs) were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014). After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA) 0.9 software. Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a) efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05), but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b) safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47), but there was no significant difference in early and late postoperative complications (P>0.05), and c) perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min), shorter catheterization time (WMD -19.97 h, 95% CI -24.24 to -15.70 h) and hospital stay (WMD -25.25 h, 95% CI -29.81 to -20.68 h). In conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.

  8. [Transurethral resection of the prostate versus transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia with bladder detrusor overactivity].

    Science.gov (United States)

    Shen, Jun-Wen; DU, Chuan-Jun; Bai, Fu-Ding; Wang, Rong-Jiang

    2016-08-01

    To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity. his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively. There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group ([315±59] vs [287±76] ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time ([2.7±0.8] vs [5.1±1.2] d, P<0.05), postoperative bladder contracture time ([4.1±1.9] vs [5.8±2.4] d, P<0.05), postoperative hospital stay ([4.4±1.8] vs [5.9±2.5] d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05). Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.

  9. Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis.

    Directory of Open Access Journals (Sweden)

    Sheng Li

    Full Text Available BACKGROUND: Holmium laser enucleation (HoLEP in surgical treatment of benign prostate hyperplasia (BPH potentially offers advantages over transurethral resection of the prostate (TURP. METHODS: Published randomized controlled trials (RCTs were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014. After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA 0.9 software. RESULTS: Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05, but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47, but there was no significant difference in early and late postoperative complications (P>0.05, and c perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min, shorter catheterization time (WMD -19.97 h, 95% CI -24.24 to -15.70 h and hospital stay (WMD -25.25 h, 95% CI -29.81 to -20.68 h. CONCLUSIONS: In conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.

  10. Enucleation is enucleation is enucleation is enucleation.

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    Herrmann, Thomas R W

    2016-10-01

    The latest update of the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction in 2016 announced a novel acronym for transurethral Endoscopic Enucleation of the Prostate (EEP). This was inspired by a meta-analysis on randomized controlled trials on Holmium Laser Enucleation of the Prostate (HolEP) and bipolar enucleation versus open simple prostatectomy. EEP codes for the common ground of both techniques: "anatomical enucleation." Although study quality with regard to the availability of long-term randomized controlled trials is at the moment mostly available for HoLEP, and bipolar enucleation, the existing data of all other enucleating techniques that have been demonstrated to perform anatomical enucleation as well should also been summarized under the same term. This editorial is a call for embracing this acronym of EEP for all anatomical enucleating techniques in order to serve for the transition from the age of TURP and open prostatectomy toward the age of EEP.

  11. Holmium laser for treatment of benign prostatic hyperplasia: old wine in a new bottle?

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    Nelius, Thomas; de Riese, Werner T. W.

    2003-06-01

    Urinary tract symptoms related to benign prostatic hyperplasia affect 70% of men older than 70 years. Complications are common problems and a significant cause of morbidity in this population, placing a considerable burden on health services. In the early 1990s laser treatment of benign prostatic hyperplasia became widely used after the introduction of the side-firing neodym: YAG laser. However, because of technical limitations and inferior results compared to classical transurethral resection of the prostate many Urologists became desinterested in this device. With the introduction of the holmium: YAG laser a new laser generation became available for use in Urology. Beside several other applications the holmium: YAG laser can be used for incision, ablation, resection, and more recently enucleation of the prostate. In this paper we reviewed the current literature regarding the holmium: YAG laser resection and enucleation of the prostate compared to transurethral resection of the prostate and open prostatectomy. The holmium: YAG laser technique is an effective and durable surgical alternative to standard transurethral resection of the prostate. Interestingly, enucleation of the prostate with this device seems to be a safe and effective procedure for large prostatic adenomas, it may become an attractive alternative to open prostatectomy.

  12. Urological applications of the holmium laser

    Science.gov (United States)

    Beaghler, Marc A.; Poon, Michael W.; Ruckle, Herbert C.; Stewart, Steven C.; Weil, Dane

    1998-07-01

    While the role of endoscopy was initially diagnostic, the advent of improved endoscopes and working instruments have increased its therapeutic applications. One of the most recent advances is the holmium laser. It has a broad range of urological applications due to its ability to fragment all urinary calculi and its soft tissue effects. This laser is based on laser energy delivered in a pulsatile fashion at 2100 nm. The purpose of this study is to report our experience with the holmium laser. A retrospective study of patients undergoing endourological procedures with the holmium laser was performed. One hundred and forty patients underwent 157 procedures. The holmium laser was used for the treatment of urinary calculi in 122 patients. Stone location included 61 renal, 64 ureteral, and 17 bladder stones. Renal stone burden was 17 mm (range 3-50), ureteral stone size averaged 10 mm (range 3 - 35), and mean bladder stone size was 31 mm (range 10 - 60). Other uses included treatment of transitional cell carcinoma of the renal pelvis, ureter, and bladder, incision of ureteral strictures, ureterocele, and prostate, and ablation of renal hemangiomas. Intraoperative and post operative complications were noted. Follow-up for calculi consisted of a plain film of the abdomen at one week and an ultrasound or intravenous pyelogram at six to eight weeks post procedure. No ureteral perforations or strictures occurred. The Holmium laser was capable of fragmenting all urinary calculi in this study. No complications were directly attributable to the Holmium laser. In our initial experience, the Holmium laser is safe and effective in the treatment of urinary pathology. It is the most effective lithotrite available and is able to incise and coagulate soft tissue as well. This combination allows the urologist to treat a variety of urinary pathology using a single modality. Its main limitation is the ability to access lower pole lesions in the upper urinary tract due to the fiber

  13. Holmium laser for multifunctional use in urology

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    Watson, Graham M.; Shroff, Sunil; Thomas, Robert; Kellett, Michael

    1994-05-01

    The holmium laser pulsed at 350 microsecond cuts tissue and fragments calculi. It has been assessed for minimally invasive urological intervention. It is useful for partly excising and partly coagulating tumors, incising strictures and the obstructed PUJ. It partly drill and partly fragments urinary calculi however hard. Other lasers are more effective at any one particular application, but this laser is a useful compromise as a multifunctional device.

  14. Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses

    Science.gov (United States)

    Lee, Chan Ho; Ku, Ja Yoon; Park, Young Joo; Lee, Jeong Zoo

    2015-01-01

    Purpose Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. Materials and Methods From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. Results Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. Conclusions Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage. PMID:25685303

  15. Transurethral GreenLight laser enucleation of the prostate--a feasibility study.

    Science.gov (United States)

    Brunken, Claus; Seitz, Christian; Tauber, Stephan; Schmidt, Rainer

    2011-07-01

    GreenLight laser vaporization is established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia. Despite good functional results, it may be difficult to achieve adequate tissue removal for large prostates. In this study, we evaluated whether a transurethral enucleation technique is feasible with the GreenLight laser as a possible way to improve the amount of tissue removed. Following the technique described by Gilling for the holmium laser, we carried out transurethral enucleation of prostate adenoma with the 120W HPS GreenLight laser in 21 consecutive patients. Preoperative data were collected prospectively; prostate volume, International Prostate Symptom Score (IPSS), postvoid residual (PVR), prostate-specific antigen level, peak urinary flow rate, operative time, catherization period, length of hospitalization, and perioperative complications were recorded as well as the weight of the enucleated tissue and the applied laser energy. For follow-up, IPSS and PVR were recorded. Data are presented as mean±standard deviation. Fifty-two percent of the patients had preoperative urinary retention. Preoperative prostate volume was 74.6±21.7 cc; 34.7±21.7 g of tissue were enucleated. IPSS was reduced from 25±6 to 5±9 (P=0.0001), PVR from 126±80 to 11±18 (P=0.002) by GreenLight laser enucleation. Serious complications were not observed. Operative time was 112±27 minutes. Catheter time was 1.2±0.4 days. The length of hospitalization was 3.6±0.9 days. GreenLight laser enucleation is feasible and safe. Tissue reduction is complete, and good functional results are achieved. All patients were able to void properly. Major complications were not observed. The procedure is technically demanding, resulting in long operative times at the first interventions.

  16. New application system for the holmium laser resection of the prostate

    Science.gov (United States)

    Eichenauer, Rolf H.; Doehn, Christian; Droege, Gerit; Brinkmann, Ralf; Salamon, Manfred; Jocham, Dieter

    1999-06-01

    The clinical outcome of the holmium laser resection of the prostate (HoLRP) shows similar results when compared to the transurethral resection of the prostate (TURP). Our efforts had ben to solve certain problems in the clinical application, e.g. the angle fiber/tissue in the apex area of the prostate and the movements of the shaft during the resection. The authors present a new application system for the laser resection and review their own experience in the development and clinical application system for the laser resection and review their own experience in the development and clinical application of Holmium:YAG laser technology for prostatectomy. Between 3/97 and 12/98, 79 patients were treated with the holmium laser resection of the prostate. The laser resections with the specially designed laser-resectoscope were performed from 5/98-12/98 (n-28 patients). With the new resectoscope a proper instrumentation became available. A ceramic tip mounted lever provided a deflection at an angle of 20° of the fiber without any damage of the applicator during the laser application. The manipulation of the fiber within the shaft in all three directions makes an enucleation of the prostate possible. The mean operating time was 63 minutes. There were no acute perioperative complications. The mean postoperative AUA symptom score was 9.1 compared to 22.5 preoperatively. The mean postoperative peak flow rate was 19.1 ml/s compared to 7 ml/s preoperatively. The new technical device improves holmium laser prostate resection and a combination of techniques provides an effective method with minimal complications and morbidity.

  17. Clinical research of holmium laser therapy in extramammary Paget's disease.

    Science.gov (United States)

    Ziyao, Li; Deyong, Yang; Xiangyu, Che; Huafeng, Zong; Hafeez, Adnan; Jianbo, Wang; Xishuang, Song

    2014-11-01

    This study aims to investigate the safety and efficiency of the holmium laser therapy in extramammary Paget's disease. The clinical data of 61 patients was collected since 2002 to 2012, confirmed as non-subcutaneous invasive extramammary Paget's disease by biopsy and underwent surgery. All patients were divided into two groups. Group A included 30 patients who underwent the holmium laser therapy. Group B included 31 patients who underwent the traditional surgical therapy. The clinical data of all patients included preoperative, intraoperative, and postoperative management and follow-up records. Compared with the traditional operation group, the holmium laser group had a shorter operation time and was easier to perform. There were no significant differences between the two groups in cases of intraoperative and postoperative complications, the recurrence-free survival, and the disease-specific survival. But the holmium laser group had a longer recovery time than the traditional operation group in large and deep nidus. Multiple-factor analysis of prognostic parameters of 61 patients confirmed that any of these two methods chosen was not a prognostic parameter for recurrence-free survival. The holmium laser therapy might prove to be a preferable alternative to the traditional operative therapy of extramammary Paget's disease. However, the holmium laser therapy did not demonstrate to have an obvious advantage over traditional operative therapy in the recurrence-free survival and the disease-specific survival.

  18. Use of the holmium:YAG laser in urology

    Science.gov (United States)

    Mattioli, Stefano

    1997-12-01

    The Holmium-YAG is a versatile laser with multiple soft- tissue applications including tissue incision and vaporization, and pulsed-laser applications such as lithotripsy. At 2140 nanometers, the wavelength is highly absorbed by tissue water. Further, like CO2 laser, the Holmium produces immediate tissue vaporization while minimizing deep thermal damage to surrounding tissues. It is an excellent instrument for endopyelotomy, internal urethrotomy, bladder neck incisions and it can be used to resect the prostate. The Holmium creates an acute TUR defect which gives immediate results like the TURP. More than 50 patients were treated from Jan. 1996 to Jan. 1997 for obstructive symptoms due to benign prostatic hyperplasia, bladder neck stricture, urethral stenosis, and superficial bladder tumors.

  19. Electrohydraulic versus Holmium Laser Lithotripsy for bladder and ...

    African Journals Online (AJOL)

    The children were divided into two groups according to the treatment modality: 50 children (Group A) were treated by electrohydraulic lithotripsy (EHL) using either pediatric cystoscopes or the short ureteroscope, 7 F, while in 62 children (Group B) Holmium laser was used through a 7.5 F pediatric endoscope without any ...

  20. From "gold standard" resection to reproducible "future standard" endoscopic enucleation of the prostate: what we know about anatomical enucleation.

    Science.gov (United States)

    Naspro, Richard; Gomez Sancha, Fernando; Manica, Michele; Meneghini, Agostino; Ahyai, Sascha; Aho, Tevita; Fiori, Cristian; Vavassori, Ivano; DA Pozzo, Luigi F; Pansadoro, Vito; Montorsi, Francesco; Herrmann, Thomas R

    2017-10-01

    Open prostatectomy (OP) and transurethral resection of the prostate (TURP) have traditionally been the most common surgical approaches for the treatment of benign prostatic hyperplasia causing bladder outlet obstruction and have certainly passed the test of time. In time, many endoscopic surgical procedures have been described as an alternative mini-invasive treatment. Holmium laser enucleation (HoLEP) guaranteed functional outcomes similar to OP and TURP with lower perioperative complication rates for any prostate size. With the development of different kinds of lasers (such as thulium, "green light" and diode) and bipolar energy, the feasibility of endoscopic enucleation using these energies has been explored. In this paper, recent techniques to perform true prostate enucleation have been reviewed through a search of PubMed and Web of Science, including articles published in the last 20 years in clinical journals. The review is based on a peer-review process of the authors after a structured data search. Search terms included "Thulium prostate enucleation, THULEP, TmLEP/Tm Yag enucleation" OR "Greenlight enucleation/prostate enucleation/vapo-enucleation/KTP prostate enucleation, PVP prostate enucleation, GreenLep/" OR "bipolar prostate enucleation" OR "HoLEP, Holmium prostate enucleation" OR "monopolar prostate enucleation" OR "Diode prostate enucleation" OR "DiLEP" OR "Eraser prostate enucleation" OR "ELEP". Following the example of HoLEP, many techniques have been described in the literature using a variety of energy sources and instruments either in a pure enucleative or a hybrid (mixed) fashion. However, the levels of evidence are too low and follow-up still too short to offer solid recommendations. HoLEP has become the conceptual and practical paradigm for the wide spread of enucleation thanks to the evidence provided by the literature and excellent outcomes. Higher level of evidence is required to assess efficacy of alternative enucleative techniques.

  1. Management of a vesicovaginal fistula using holmium laser ablation.

    Science.gov (United States)

    Singh, Ruchira; Schmitt, Jennifer J; Knoedler, John J; Occhino, John A

    2016-06-01

    The objective was to demonstrate a surgical technique for the management of a small vesicovaginal fistula (VVF) involving a combination of cystoscopic holmium laser ablation and vaginal repair. A 55-year-old morbidly obese female presented with complaints of menometrorrhagia and complex adnexal mass. She underwent an attempted robotic hysterectomy, which was converted to open hysterectomy, omentectomy, and lymphadenectomy owing to an intraoperative diagnosis of endometrioid carcinoma of the endometrium and dense pelvic adhesions. Postoperatively, the patient developed intermittent urinary leakage associated with position change. On evaluation, a speculum examination did not reveal any fistulous tract or leakage of fluid in the vagina. A tampon test was positive, but no evidence of a fistula was noted on a CT urogram. Cystourethroscopy was performed and identified a small VVF. The patient subsequently underwent repair of her VVF using a combination of cystoscopic holmium laser ablation and transvaginal excision of the suspected fistula opening. About 2 weeks after the surgery, a tampon test was negative and cystourethroscopy revealed healing bladder mucosa. The patient remains fistula-free at 12 months post-operatively. Holmium laser ablation combined with partial vaginal excision may be considered as a management option for a small VVF.

  2. Treatment of pulmonary diseases with Holmium:YAG laser

    Science.gov (United States)

    Zhang, Mei-Jue; Zhu, Jing; Zhang, Hui-Guo; Wang, Fu-Juan; Ke, Lin; Ma, Wei; Luo, Qun-Hua; Zhang, Yue-E.

    1998-11-01

    We report 5 cases of pulmonary disease treated with Holmium:YAG laser through fibrous bronchoscope. 1 inflammatory granuloma was cured after three times of treatment. Compared with conventional methods such as electrocautery and microwave treatment, laser has the merit of good hemostasis effect and quick recovery of the operation area. The other 4 patients who were suffered late lung cancer received 3-7 times of palliative treatment. After the treatment, the tumor tissues become smaller variably, and tact were unobstructed, symptoms of tract- obstructed obviously alleviated. We think that laser treatment has some practical significance in alleviating tract blocking of pulmonary diseases of late stage, and therefore raise the life quality.

  3. Thermal Response to High-Power Holmium Laser Lithotripsy.

    Science.gov (United States)

    Aldoukhi, Ali H; Ghani, Khurshid R; Hall, Timothy L; Roberts, William W

    2017-12-01

    The aim of this study was to investigate "caliceal" fluid temperature changes during holmium laser activation/lithotripsy using settings up to 40 W power output with different irrigation flow rates. The experimental system consisted of a glass test tube (diameter 10 mm/length 75 mm) filled with deionized water, to mimic a calix. Real-time temperature was recorded using a thermocouple (Physitemp, NJ) positioned 5 mm from the bottom of the tube. A 200 μm laser fiber (Flexiva; Boston Scientific, MA) was introduced through the working channel of a disposable ureteroscope (LithoVue; Boston Scientific) and the laser fiber tip was positioned 15 mm above the bottom of the test tube. Deionized water irrigation (room temperature) through the working channel of the ureteroscope was delivered at flow rates of 0, 7-8, 14-15, and 38-40 mL/minute. A 120-W holmium laser (pulse 120; Lumenis, CA) was used. The following settings were explored: 0.5 J × 10 Hz, 1.0 J × 10 Hz, 0.5 J × 20 Hz, 1.0 J × 20 Hz, 0.5 J × 40 Hz, 1.0 J × 40 Hz, and 0.5 J × 80 Hz. During each experiment, the laser was activated continuously for 60 seconds. Temperature increased with increasing laser power output and decreasing irrigation flow rate. The highest temperature, 70.3°C (standard deviation 2.7), occurred with laser setting of 1.0 J × 40 Hz and no irrigation after 60 seconds of continuous laser firing. None of the tested laser settings and irrigation parameters produced temperature exceeding 51°C when activated for only 10 seconds of continuous laser firing. High-power holmium settings fired in long bursts with low irrigation flow rates can generate high fluid temperatures in a laboratory "caliceal" model. Awareness of this risk allows urologist to implement a variety of techniques (higher irrigation flow rates, intermittent laser activation, and potentially cooled irrigation fluid) to control and mitigate thermal

  4. Holmium:YAG laser angioplasty: treatment of acute myocardial infarction

    Science.gov (United States)

    Topaz, On

    1993-06-01

    We report our clinical experience with a group of 14 patients who presented with acute myocardial infarction. A holmium:YAG laser was applied to the infarct-related artery. This laser emits 250 - 600 mJ per pulse, with a pulse length of 250 microseconds and repetition rate of 5 Hz. Potential benefits of acute thrombolysis by lasers include the absence of systemic lytic state; a shortened thrombus clearing time relative to using thrombolytics; safe removal of the intracoronary thrombus and facilitation of adjunct balloon angioplasty. Potential clinical difficulties include targeting the obstructive clot and plaque, creation of debris and distal emboli and laser-tissue damage. It is conceivable that holmium:YAG laser can be a successful thrombolytic device as its wave length (2.1 microns) coincides with strong water absorption peaks. Since it is common to find an atherosclerotic plaque located under or distal to the thrombotic occlusion, this laser can also be applied for plaque ablation, and the patient presenting with acute myocardial infarction can clearly benefit from the combined function of this laser system.

  5. Dynamics of pulsed holmium:YAG laser photocoagulation of albumen

    Energy Technology Data Exchange (ETDEWEB)

    Pfefer, T.J. [Biomedical Engineering Program, The University of Texas at Austin, Austin, TX 78712 (United States). E-mail: jpfefer at helix.mgh.harvard.edu; Chan, K.F.; Hammer, D.X. [Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712 (United States); Welch, A.J. [Biomedical Engineering Program, The University of Texas at Austin, Austin, TX 78712 (United States); Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712 (United States)

    2000-05-01

    The pulsed holmium:YAG laser ({lambda} = 2.12 {mu}m, {tau}{sub p} = 250 {mu}s) has been investigated as a method for inducing localized coagulation for medical procedures, yet the dynamics of this process are not well understood. In this study, photocoagulation of albumen (egg white) was analysed experimentally and results compared with optical-thermal simulations to investigate a rate process approach to thermal damage and the role of heat conduction and dynamic changes in absorption. The coagulation threshold was determined using probit analysis, and coagulum dynamics were documented with fast flash photography. The nonlinear computational model, which included a Beer's law optical component, a finite difference heat transfer component and an Arrhenius equation-based damage calculation, was verified against data from the literature. Moderate discrepancies between simulation results and our experimental data probably resulted from the use of a laser beam with an irregular spatial profile. This profile produced a lower than expected coagulation threshold and an irregular damage distribution within a millisecond after laser onset. After 1 ms, heat conduction led to smoothing of the coagulum. Simulations indicated that dynamic changes in absorption led to a reduction in surface temperatures. The Arrhenius equation was shown to be effective for simulating transient albumen coagulation during pulsed holmium:YAG laser irradiation. Greater understanding of pulsed laser-tissue interactions may lead to improved treatment outcome and optimization of laser parameters for a variety of medical procedures. (author)

  6. Laser-assisted hair transplantation: histologic comparison between holmium:YAG and CO2 lasers

    Science.gov (United States)

    Chu, Eugene A.; Rabinov, C. Rose; Wong, Brian J.; Krugman, Mark E.

    1999-06-01

    The histological effects of flash-scanned CO2 (λ=10.6μm) and pulsed Holmium:YAG (Ho:YAG, λ=2.12μm) lasers were evaluated in human scalp following the creation of hair transplant recipient channels. Ho:YAG laser irradiation created larger zones of thermal injury adjacent to the laser channels than irradiation with the CO2 laser device. When the two lasers created recipient sites of nearly equal depth, the Holmium:YAG laser caused a larger region of lateral thermal damage (589.30μm) than the CO2 laser (118.07μm). In addition, Holmium:YAG irradiated specimens exhibited fractures or discontinuities beyond the region of clear thermal injury. This shearing effect is consistent with the photoacoustic mechanism of ablation associated with pulsed mid-IR laser irradiation. In contrast, channels created with the CO2 exhibited minimal epithelial disruption and significantly less lateral thermal damage. While the Holmium:YAG laser is a useful tool for ablation soft tissue with minimal char in select applications (sinus surgery, arthroscopic surgery), this study suggests that the use of the CO2 laser for the creation of transplantation recipient channels result in significantly less lateral thermal injury for the laser parameters employed.

  7. [Endoscopic ureterolithotripsy with the holmium laser].

    Science.gov (United States)

    Lopatkin, N A; Mazo, E B; Chepurov, A K; Dondukov, Ts V; Safarov, R M; Dreval', A A

    1997-01-01

    One of the clinical and experimental investigations performed in the urological clinic of the Moscow Medical University and Research Institute of Urology aimed at elucidation of Ho-YAG-laser potential in endoscopic lithotripsy (EL). Russian Ho-YAG laser surgical units CTH-10 and LLT-3 with wave length 2.09 mu were employed. The studies showed that the developed laser units satisfied relevant medical and technical requirements. Low depth of laser impulse penetration (0.4 mm) obtained at EL warrants safety of the adjacent tissues which is essential in crushing fixed ureteroliths in the presence of severe inflammation in the ureteral wall. The conclusion is made that Ho-YAG laser EL is an effective treatment of ureteroliths. Further tests for EL efficacy in affections of the upper urinary tracts are advocated to define a proper place of EL in endoscopic urology.

  8. Holmium-doped laser materials for eye-safe solid state laser application

    Science.gov (United States)

    Kim, Woohong; Bowman, Steven R.; Baker, Colin; Villalobos, Guillermo; Shaw, Brandon; Sadowski, Bryan; Hunt, Michael; Aggarwal, Ishwar; Sanghera, Jasbinder

    2014-06-01

    Trivalent holmium has 14 laser channels from 0.55 to 3.9 μm. The laser emission of most interest is the transition 5I7→5I8 near 2 μm because of its potential for use in eye-safe systems and medical applications. In this paper, we present our recent results in the development of Ho3+ doped laser materials for eye-safe solid state lasers. We report a calorimetric study of non-radiative losses in two micron pumped holmium doped laser host materials such as silica glass, yttrium aluminum garnet (YAG) crystal and Lu2O3 ceramics. Optical, spectral and morphological properties as well as the lasing performance from highly transparent ceramics are presented.

  9. Common trend: move to enucleation-Is there a case for GreenLight enucleation? Development and description of the technique.

    Science.gov (United States)

    Gomez Sancha, Fernando; Rivera, Vanesa Cuadros; Georgiev, Georgi; Botsevski, Alexander; Kotsev, Julian; Herrmann, Thomas

    2015-04-01

    Transurethral laser prostatectomy has evolved as a viable alternative for the management of benign prostate enlargement. Since the renaissance of laser prostatectomy with the advent of the holmium:yttrium-aluminum-garnet laser in the 1990s, various lasers and subsequent procedures have been introduced. These techniques can be categorized as vaporizing, resecting, and enucleating approaches. Photoselective vaporization of the prostate (PVP) is dominated by high-power lithium triborate (LBO) crystal lasers (GreenLight XPS). The mainstay of this technique is for the treatment of small to medium prostate volumes whereas enucleating techniques, such as holmium laser enucleation of the prostate and thulium enucleation of the prostate, focus on large-volume glands. In order to perspectively "delimit" LBO into the field of large-volume prostates, we developed LBO en bloc enucleation to render it as a competing transurethral enucleating approach. We present a detailed stepwise progressive technique developed in Madrid, Spain, for the complete removal of the transitional zone by vapoenucleation. The steps include exposition of the prostatic capsule by PVP toward the peripheral zone, thereby identifying the anatomical limits of enucleation. Subsequently, the transitional zone is excised in a single bloc and morcellated after its placement into the bladder. This new GreenLight en bloc enucleation technique allows to treat larger prostates than those previously treated with the PVP technique.

  10. Holmium:YAG laser in dentistry: photoconditioning of dentinal surfaces

    Science.gov (United States)

    Holt, Raleigh A.; Nordquist, Robert E.

    1994-09-01

    This in vitro study was undertaken to determine energy levels necessary to produce tubule closure and surface smoothing on dentinal surfaces of human teeth and their resultant temperature increases within the pulpal canals with the Holmium:YAG laser. An optimal working spot size and even absorption pattern were produced by defocusing the laser beam and evaluated by images produced on light exposed and developed photographic paper. The surface effects on dentin were examined by scanning electron microscopy. A thermocouple was positioned in the canals of fresh dissected dog jaws and attached to a recorder which produced a graph of the temperature changes. The in vitro research model for intrapulpal temperatures changes was verified by comparing premortem and postmortem temperature readings. The same protocol was used to evaluate temperature changes in fresh human extracted teeth. In vivo histological studies were conducted to evaluate the effects of HO:YAG laser energy on pulpal tissues. The results of these studies indicate the HO:YAG laser at a wavelength of 2.12 microns can be safely and effectively used for photoconditioning of the dentinal surfaces of teeth in clinical conditions.

  11. Ablation of skin tissue by holmium:YAG laser

    Science.gov (United States)

    Chen, Wei R.; Holt, Andrew; Nordquist, Robert E.

    1994-08-01

    Surface epithelial damage by Ho:YAG laser and recovery were studied using histology and electron microscopy. Rabbit skin was irradiated with fluence varying from 55 J/cm2 to 680 J/cm2. Laser damage was determined by histological measurement of three major injury indicators: surface lesion width, depth of photocoagulation, and depth of thermal damage. When the fluence increased, the surface lesion widened and the photocoagulation zone extended deeper into the dermis. The thermally damaged zone (60 degree(s)C muscle and nerve tissues appeared to remain intact under most of our irradiance except at 500 J/cm2 and greater. Thermally injured tissues began recovery within a short period and eventually returned to normal; electron microscopic findings indicated that severe swelling occurred in the individual collagen fibrils, but they were not disrupted and usually recovered to appear normal. A layer of new epithelium started growing underneath the photocoagulated zone around day 3. After 7 days, most photocoagulated tissue was partially, in some cases completely, separated from the skin by the new epithelium. The damage and recovery parameters established should aid in the clinical use of Holmium laser in treating lesions, benign or malignant, in hollow tubular organs and on surface epithelia.

  12. Proximal fiber tip damage during Holmium:YAG and thulium fiber laser ablation of kidney stones

    Science.gov (United States)

    Wilson, Christopher R.; Hardy, Luke A.; Irby, Pierce B.; Fried, Nathaniel M.

    2016-02-01

    The Thulium fiber laser (TFL) is being studied as an alternative to Holmium:YAG laser for lithotripsy. TFL beam originates within an 18-μm-core thulium doped silica fiber, and its near single mode, Gaussian beam profile enables transmission of higher laser power through smaller fibers than possible during Holmium laser lithotripsy. This study examines whether TFL beam profile also reduces proximal fiber tip damage compared to Holmium laser multimodal beam. TFL beam at wavelength of 1908 nm was coupled into 105-μm-core silica fibers, with 35-mJ energy, 500-μs pulse duration, and pulse rates of 50-500 Hz. For each pulse rate, 500,000 pulses were delivered. Magnified images of proximal fiber surfaces were taken before and after each trial. For comparison, 20 single-use, 270-μm-core fibers were collected after clinical Holmium laser lithotripsy procedures using standard settings (600 mJ, 350 μs, 6 Hz). Total laser energy, number of laser pulses, and laser irradiation time were recorded, and fibers were rated for damage. For TFL studies, output power was stable, and no proximal fiber damage was observed after delivery of 500,000 pulses at settings up to 35 mJ, 500 Hz, and 17.5 W average power. In contrast, confocal microscopy images of fiber tips after Holmium lithotripsy showed proximal fiber tip degradation in all 20 fibers. The proximal fiber tip of a 105-μm-core fiber transmitted 17.5 W of TFL power without degradation, compared to degradation of 270-μm-core fibers after transmission of 3.6 W of Holmium laser power. The smaller and more uniform TFL beam profile may improve fiber lifetime, and potentially reduce costs for the surgical disposables as well.

  13. Treatment of Ureteral Fibroepithelial Polyp by Ureteroscopy Combined with Holmium Laser or Thulium Laser: A Retrospective Study.

    Science.gov (United States)

    Sheng, Lu; Zhang, Zhong-Yun; Qian, Wei-Qing; Zhang, Hao-Jie; Sun, Zhong-Quan

    2016-10-01

    Ureteral fibroepithelial polyps (UFPs) are rare benign tumors and ureteroscopy has been used for treatment. We compared the effect of UFP by ureteroscopy combined with holmium laser or thulium laser. Twenty-five patients with UFPs were treated in our hospital between May 2003 and April 2013. All patients received ultrasound check and intravenous urography (IVU). We performed ureteroscopy operation and found ureteral polyps, so we resected the polyps with holmium laser (12 cases) or thulium laser (13 cases). During the 3-year follow-up, all patients received IVU 2 or 3 months after the double-J stent was removed, and ultrasonic checks every 3-6 months after that. All patients had UFPs resected. Three patients in the holmium laser group had ureteral perforation during operation, and four patients in the holmium laser group developed ureterostenosis. No patients in thulium laser group experienced any severe complications during the procedure. Further, during follow-up, there was no indication of an increase of hydronephrosis in any patients. These findings lead to conclude there were no developments of ureterostenosis nor an experience of any reoccurrence in thulium laser group. Ureteroscopy operations, combined with holmium or thulium laser resection, are effective methods for treating UFP, but thulium laser does better in reducing the incidence of ureterostenosis.

  14. [Laser enucleation of the prostate (HOLEP and THULEP): a comparative effectiveness analysis in treating recurrent prostatic hyperplasia].

    Science.gov (United States)

    Enikeev, D V; Glybochko, P V; Alyaev, Yu G; Rapoport, L M; Sorokin, N I; Enikeev, M E; Dymov, A M; Sukhanov, R B; Khamraev, O Kh; Taratkin, M S; Dymova, A V; Inoyatov, J S

    2017-09-01

    The estimated recurrence rate of benign prostatic hyperplasia (BPH) after transurethral resection of the prostate is about 5 to 15%. Laser enucleation of the prostate results in a much lower recurrence rate (not exceeding 1-1.5%). At the same time, laser enucleation of the prostate is still not widely used for recurrent prostatic hyperplasia since it believed to be technically difficult in cases. To describe the distinctive features of thulium and holmium laser enucleations of the prostate in the management of recurrent BPH and show that the technical difficulties are not an obstacle to the wide application of this technique. This was a retrospective study comprising 676 patients aged 54 to 87 years with clinically pronounced infravesical obstruction due to prostatic hyperplasia (IPSS>20, Qmaxenucleations of the prostate, respectively. Groups 2 (n=23) and 4 (n=11) included patients with BPH recurrence after HoLEP (group 2) and ThuLEP (group 4). All patients underwent diagnostic evaluation at baseline and at 6 months after surgery. The mean ThuLEP operating time was shorter than that of HoLEP (p=0.02). The mean duration of repeat and primary ThuLEP and HoLEP did not differ statistically significantly (p>0.05). There was no difference in the length of hospitalization and catheterization between the four groups (p>0.05). At six months after surgery, a statistically significant improvement in I-PSS, Qmax, QoL, and RUV was observed in all groups compared with preoperative values (p>0.05)). We found that the technical difficulties of the re-operation, such as the difficult separation of adenomatous tissue from the prostate capsule, the multinodular nature of the adenoma, increased tissue density are easy to overcome and do not confer a significant complexity. In turn, better completeness of resection, low complication and recurrence rates and the possibility of surgery, even in elderly patients with multiple comorbidities - these features allow us to conclude that laser

  15. Laser enucleation of the prostate: Overview of our results after the ...

    African Journals Online (AJOL)

    Y. Kharbach

    2017-08-01

    Aug 1, 2017 ... prostate hyperplasia for many decades [4]. Despite the good treat- ment results, there is a significant risk of complications for both techniques, thus explaining the unceasing efforts in researching alternative therapeutic options such as laser therapy methods [5]. It is clear that Holmium laser treatments can ...

  16. Holmium laser lithotripsy (HoLL) of ureteral calculi

    Science.gov (United States)

    Kuntz, Rainer M.; Lehrich, Karin; Fayad, Amr

    2001-05-01

    The effectiveness and side effects of ureteroscopic HoLL of ureteral stones should be evaluated. In 63 patients (17 female, 46 males) a total of 75 stones of 3-20 mm diameter were treated with ureteroscopic HoLL. 18.7 percent of stones were located in the proximal third, 24.0 percent in the middle third and 57.3 percent in the distal third of the ureter. HoLL was performed with small diameter semirigid and flexible ureteroscopes, 220 or 365 nm flexible laser fibers and a holmium:YAG laser at a power of 5-15 W (0.5-1.0 J, 10- 15 Hz). 47 of 63 patients (74.6 percent) were immediately free of stones, and 8 others (12.6 percent) lost their residual fragments spontaneously within two weeks. Another 2 patients received additional chmolitholysis for uric acid stone fragments, i.e. 90.5 percent of patients were stone free by one sitting of ureterscopic HoLL. Of the remaining 6 patients (9.5 percent) who still had residual calculi 4 weeks after HoLL, 2 asymptomatic patients refused any additional treatment, 2 patients preferred treatment with ESWL, and 2 patients had a successful second HoLL, thereby raising the success rate of ureteroscopic HoLL to 93.7 percent. 2 patients showed contrast medium extravasation on retrograde ureterograms, due to guide wire perforation. No ureteral stricture occurred. In conclusion, transurethral ureteroscopic HoLL proved to be a safe and successful minimal invasive treatment of ureteral calculi.

  17. Combination of fiber-guided pulsed erbium and holmium laser radiation for tissue ablation under water.

    Science.gov (United States)

    Pratisto, H; Frenz, M; Ith, M; Altermatt, H J; Jansen, E D; Weber, H P

    1996-07-01

    Because of the high absorption of near-infrared laser radiation in biological tissue, erbium lasers and holmium lasers emitting at 3 and 2 µm, respectively, have been proven to have optimal qualities for cutting or welding and coagulating tissue. To combine the advantages of both wavelengths, we realized a multiwavelength laser system by simultaneously guiding erbium and holmium laser radiation by means of a single zirconium fluoride (ZrF(4)) fiber. Laser-induced channel formation in water and poly(acrylamide) gel was investigated by the use of a time-resolved flash-photography setup, while pressure transients were recorded simultaneously with a needle hydrophone. The shapes and depths of vapor channels produced in water and in a submerged gel after single erbium and after combination erbium-holmium radiation delivered by means of a 400-µm ZrF(4) fiber were measured. Transmission measurements were performed to determine the amount of pulse energy available for tissue ablation. The effects of laser wavelength and the delay time between pulses of different wavelengths on the photomechanical and photothermal responses of meniscal tissue were evaluated in vitro by the use of histology. It was observed that the use of a short (200-µs, 100-mJ) holmium laser pulse as a prepulse to generate a vapor bubble through which the ablating erbium laser pulse can be transmitted (delay time, 100 µs) increases the cutting depth in meniscus from 450 to 1120 µm as compared with the depth following a single erbium pulse. The results indicate that a combination of erbium and holmium laser radiation precisely and efficiently cuts tissue under water with 20-50-µm collateral tissue damage.

  18. Wound repair in rat urinary bladder following electrocautery or holmium laser incision

    Science.gov (United States)

    Venzi, Giordano; Schmidlin, Franz R.; Gabbiani, Giulio; Delacretaz, Guy P.; Pittet, Brigitte; Leisinger, Hans-Juerg; Iselin, Christoph E.

    1999-06-01

    Woundhealing is a complex phenomenon which varies according the type of tissue but is also depending from the type of tissue injury. Electrocautery mainly induces coagulation necrosis while thermal damages induced by the Holmium laser primarily lead to tissue vaporization which may induce less tissue injury. The aim of this study was to evaluate the healing process of the Holmium laser induced lesions compared to electrocautery induced lesions in urothelial tissue by assessing the inflammatory response and myofibroblast behavior in sequential healing phases. A surgical wound was created in the urinary rat bladder of 32 rats either by electrocautery or by laser (N=16). The inflammatory response, the total lesion depth and the myofibroblast activity during woundhealing was then analyzed on a qualitative basis on days 0/2/4/8. The overall inflammatory response was comparable in both groups up to days two and four. However, at day eight less cellular inflammatory reaction and less myofibroblast activity was found in the specimen of lesions created by the Holmium laser. These results suggest that wound repair may be a less invasive process after Holmium laser than electrocautery.

  19. Efficacy of percutaneous treatment of biliary tract calculi using the holmium:YAG laser.

    Science.gov (United States)

    Hazey, J W; McCreary, M; Guy, G; Melvin, W S

    2007-07-01

    Few Western studies have focused on percutaneous techniques using percutaneous transhepatic choledochoscopy (PTHC) and holmium:yttrium-aluminum-garnet (YAG) laser to ablate biliary calculi in patients unable or unwilling to undergo endoscopic or surgical removal of the calculi. The authors report the efficacy of the holmium:YAG laser in clearing complex biliary calculi using percutaneous access techniques. This study retrospectively reviewed 13 non-Asian patients with complex secondary biliary calculi treated percutaneously using holmium:YAG laser. Percutaneous access was accomplished via left, right, or bilateral hepatic ducts and upsized for passage of a 7-Fr video choledochoscope. Lithotripsy was performed under choledochoscopic vision using a holmium:YAG laser with 200- or 365-microm fibers generating 0.6 to 1.0 joules at 8 to 15 Hz. Patients underwent treatment until stone clearance was confirmed by PTHC. Downsizing and subsequent removal of percutaneous catheters completed the treatment course. Seven men and six women with an average age of 69 years underwent treatment. All the patients had their biliary tract stones cleared successfully. Of the 13 patients, 3 were treated solely as outpatients. The average length of percutaneous access was 108 days. At this writing, one patient still has a catheter in place. The average number of holmium:YAG laser treatments required for stone clearance was 1.6, with no patients requiring more than 3 treatments. Of the 13 patients, 8 underwent a single holmium:YAG laser treatment to clear their calculi. Prior unsuccessful attempts at endoscopic removal of the calculi had been experienced by 7 of the 13 patients. Five patients underwent percutaneous access and subsequent stone removal as their sole therapy for biliary stones. Five patients were cleared of their calculi after percutaneous laser ablation of large stones and percutaneous basket retrieval of the remaining stone fragments. There was one complication of pain

  20. Efficacy of Semi-Rigid Ureteroscopy and Holmium:YAG Laser ...

    African Journals Online (AJOL)

    Background: Urolithiasis is a common worldwide health problem. Many endosurgical treatments became available for urinary calculi. Objectives: To find out the success clearance and complication rates of ureteric stone treatment using semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy as a day case procedure.

  1. Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones.

    Directory of Open Access Journals (Sweden)

    Yon Cui

    Full Text Available BACKGROUND: There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. OBJECTIVE: To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. METHODS: Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. RESULTS: Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. CONCLUSION: ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

  2. Comparison of ESWL and Ureteroscopic Holmium Laser lithotripsy in Management of Ureteral Stones

    Science.gov (United States)

    Shen, Hua; Xie, Jianjun; Adams, Tamara S.; Zhang, Yuanyuan; Shao, Qiang

    2014-01-01

    Background There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. Objective To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. Methods Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8–15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. Results Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. Conclusion ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio. PMID:24498344

  3. Successful Treatment of Stent Knot in the Proximal Ureter Using Ureteroscopy and Holmium Laser

    Directory of Open Access Journals (Sweden)

    Masters M. Richards

    2011-01-01

    Full Text Available Knotted ureteral stent is rare yet tedious complication that might represent a treatment challenge to the endourologist. Only twelve cases of knotted stent have been reported. Different management options have been reported, including simple traction, ureteroscopy, percutaneous removal, and open surgery. In this paper, we present the successful untying of the knot using ureteroscopy with holmium laser.

  4. Stone/tissue differentiation for Holmium laser lithotripsy using autofluorescence: Clinical proof of concept study.

    Science.gov (United States)

    Lange, Birgit; Jocham, Dieter; Brinkmann, Ralf; Cordes, Jens

    2017-04-01

    Holmium laser lithotripsy is the gold standard for intracorporeal fragmentation of urinary calculi. Usually, a visible beam is superimposed on the IR treatment laser as an aiming beam to guide the surgeon. In vitro tests showed that this aiming beam (532 nm, power proof of concept study with eight patients. For this, a modulated excitation/detection scheme (lock-in technique) was implemented. A frequency-doubled, diode-pumped solid-state laser module (532 nm, modulation frequency 66 Hz, average power 0.3 mW) was coupled via a dichroic mirror with the Holmium lithotripsy laser into the treatment fiber. The fluorescence signal entering the treatment fiber was detected via another dichroic mirror with a photodiode and a lock-in amplifier. In most instances (94%), the calculus of a patient gave a signal which was at least twice the maximum signal of ureteral tissue. The results of our proof of concept study indicate that measuring the fluorescence signal of a green aiming beam could be used to implement a feedback loop for Holmium laser lithotripsy. Preventing the laser being fired on tissue, this would increase the safety of the procedure. Lasers Surg. Med. 49:361-365, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. Safety and efficacy of Eraser laser enucleation of the prostate: preliminary report.

    Science.gov (United States)

    Lusuardi, Lukas; Myatt, Andrew; Sieberer, Manuela; Jeschke, Stefan; Zimmermann, Reinhold; Janetschek, Günter

    2011-11-01

    We ascertained the safety and efficacy of the 1,318 nm diode Eraser laser (Rolle and Rolle, Salzburg, Austria) for transurethral enucleation of the prostate. This laser has been successfully used to resect lung metastasis. It cuts and coagulates vascular rich tissue safely and effectively. We describe a prospective, randomized trial of Eraser laser prostate enucleation vs bipolar transurethral prostate resection. A total of 60 patients with lower urinary tract symptoms suggesting bladder outlet obstruction and a mean prostate size of 59.5 ml on transrectal ultrasound were randomized to Eraser laser prostate enucleation or bipolar transurethral prostate resection. Patients were assessed preoperatively, and 1 and 6 months postoperatively. Eraser laser prostate enucleation was equivalent to bipolar transurethral prostate resection in improvement in International Prostate Symptom Score, maximal flow rate and quality of life. Laser enucleation was significantly superior to bipolar transurethral resection for measured blood loss (mean ± SD 116.83 ± 97.02 vs 409.83 ± 148.61 ml), catheter time (mean 32.80 ± 8.74 vs 65.73 ± 13.72 hours) and hospital time (mean 45.13 ± 14.77 vs 91.20 ± 11.76 hours, each p enucleation and bipolar transurethral prostate resection were equally safe and effective to relieve bladder outflow obstruction and lower urinary tract symptoms. This laser technique has the advantage of less blood loss, and shorter catheter time and hospital stay. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Soft-tissue applications of the holmium:YAG laser in urology

    Science.gov (United States)

    Denstedt, John D.; Razvi, Hassan A.; Chun, Samuel S.; Sales, Jack L.

    1995-05-01

    The ideal surgical laser for the treatment of soft tissue pathology should possess both ablative and hemostatic abilities. As well, for use in urologic conditions the laser must also be suitable for endoscopic use. The Holmium:YAG laser possesses these qualities and in preliminary clinical use has demonstrated a variety of potential urologic applications. In this study we review our initial experience with the Holmium:YAG laser over a 18 month period. A total of 51 patients underwent 53 procedures for a variety of soft tissue conditions including: bladder tumor ablation (25), incision of ureteral stricture (15), incision of urethral stricture (6), treatment of ureteropelvic junction obstruction (3), incision of bladder neck contracture (2), and ablation of a ureteral tumor (2). Satisfactory hemostasis was achieved in all cases. Procedures were considered successful (no further intervention being required to treat the condition) in 81% of the cases. Two patients with dense bladder neck contractures required electroincision under the same anesthetic for completion of the procedure. A single complication, that of urinary extravasation following incision of a urethral stricture resolved with conservative management. In summary, the Holmium:YAG laser has demonstrated safety and proficiency in the treatment of a variety of urologic soft tissue conditions.

  7. Percutaneous transhepatic lithotripsy with the holmium: YAG laser for the treatment of refractory biliary lithiasis.

    Science.gov (United States)

    Schatloff, Oscar; Rimon, Uri; Garniek, Alex; Lindner, Uri; Morag, Roy; Mor, Yoram; Ramon, Jacob; Winkler, Harry

    2009-04-01

    Fourteen patients who failed at least 1 endoscopic retrograde cholangiopancreatograpy attempt underwent Holmium laser biliary lithotripsy between 2003 and 2007. Ten had prior biliary surgeries, 7 harbored multiple stones, and 6 had common bile duct strictures. Mean age at surgery was 63.6 years (50 to 80 y), biggest stone burden 30 mm, mean operative time 58.4 minutes (24 to 105), and stone free rate 85.7%. One patient had postoperative bleeding from the choledochostomy tube that eventually resolved spontaneously and 3 patients had postoperative cholangitis managed conservatively. Neither conversions to open surgery nor mortality was recorded. Two patients were diagnosed with cholangiocarcinoma missed by previous endoscopic retrograde cholangiopancreatograpy. After a mean follow-up of 18.9 months (2 to 43) no de novo strictures were recorded. Percutaneous choledochoscopy with holmium laser lithotripsy is a safe and effective minimally invasive technique to treat complex biliary stone disease and may preclude high-risk open biliary tract surgery.

  8. Diode-Pumped Thulium (Tm)/Holmium (Ho) Composite Fiber 2.1-Micrometers Laser

    Science.gov (United States)

    2015-09-01

    ARL-TR-7452 ● SEP 2015 US Army Research Laboratory Diode -Pumped Thulium (Tm)/Holmium (Ho) Composite Fiber 2.1-μm Laser by G...is no longer needed. Do not return it to the originator. ARL-TR-7452 ● SEP 2015 US Army Research Laboratory Diode -Pumped Thulium...ADDRESS. 1. REPORT DATE (DD-MM-YYYY) Sep 2015 2. REPORT TYPE Final 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE Diode -Pumped Thulium (Tm

  9. Safety of holmium laser prostatectomy in patients with cardiac pacemaker implant

    Directory of Open Access Journals (Sweden)

    Narmada P Gupta

    2006-01-01

    Full Text Available Objectives: The use of the standard monopolar electrocautery is associated with significant risks of implant malfunction in patients on a cardiac pacemaker. It is also associated with a risk of adverse cardiac events due to blood loss and fluid absorption. The properties of the holmium laser prevent the occurrence of these adverse events. We report the successful use of this technology in resecting the gland in patients on a permanent cardiac pacemaker implant. MATERIALS AND Methods: Six patients with permanent cardiac pacemaker implant were treated with holmium laser resection of prostate over a period of two years. Treated patients had bothersome prostatic symptoms and failed to respond to medical therapy. All patients were operated under spinal anesthesia using a high power VersaPulse ® PowerSuiteTM Holmium laser source. Normal saline was used as irrigant. Intravesical tissue morcellator was also used to remove the larger fragments in two of the patients. Results : Median patient age was 60 years (range 56-73 and median prostate volume was 40cc (range 20-48cc. None of the patient required blood transfusion or had significant hyponatremia or Transurethral resection syndrome. No patients had any pacemaker malfunction or hemodynamic instability during the procedure or in immediate postoperative period. Improvement in maximum urine flow rate was observed from an average of 7 ml/sec in preoperative period to 22 ml/sec postoperatively at 3 month followup. Conclusions: Holmium laser prostatectomy offers the ideal modality of surgery in patients on a cardiac pacemaker. It helps to avoid additional preparation and minimizes the risk of device malfunction and adverse post operative events.

  10. Office Hysteroscopic Laser Enucleation of Submucous Myomas without Mass Extraction: A Case Series Study

    Directory of Open Access Journals (Sweden)

    Sergio Haimovich

    2015-01-01

    Full Text Available Background and Objectives. A new two-step hysteroscopic myomectomy carried out in the office setting and without anesthesia was feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas from the uterine cavity after hysteroscopic laser enucleation is necessary. Methods. Between June 2009 and April 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used. Results. Sixty-one women (mean age: 47.3 years were included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5 mm. In 29 cases (47.5%, the diameter of the resected myoma was >20 mm and in 10 cases (16.4% >30 mm. After a mean follow-up of 68.2 (16.5 days, none of the patients showed a residual myoma inside the uterine cavity. Conclusions. The present results indicate that leaving laser-enucleated submucous myoma in the uterine cavity is a feasible and safe therapeutic option.

  11. An experimental model of urethral stricture in rabbits using holmium laser under urethroscopic direct visualization.

    Science.gov (United States)

    Hu, Wei-Feng; Li, Cui-Ling; Zhang, Hui-Ping; Li, Ting-Ting; Zeng, Xiao-Yong

    2014-01-01

    To establish an experimental rabbit model of urethral stricture using holmium laser under direct urethroscopic visualization. Sixteen adult male New Zealand rabbits were divided into equally-sized control and experimental groups. All rabbits underwent retrograde urethrography and transurethral endoscopy with a 7.5 F urethroscope after intramuscular anesthetic injection. We used a holmium:YAG laser to injure the distal urethra in all rabbits in the experimental group under direct visualization. Thirty days after surgery, all animals were evaluated with retrograde urethrography and urethroscopy. The flow rate of the isolated urethras was measured to evaluate urethral stricture formation. One rabbit in the experimental group (12.5%) died of infection 4 days after surgery. Thirty days after surgery, retrograde urethrography and urethroscopy revealed strictures in all seven surviving rabbits (87.5%) in the experimental group. The mean flow rate of the isolated urethras was significantly lower in the experimental group than in the control group. A rabbit model of urethral stricture can be successfully established using holmium laser under direct urethroscopic visualization, providing an ideal object for research concerning the pathogenesis and molecular biology of urethral strictures. © 2014 S. Karger AG, Basel.

  12. Percutaneous endoscopic holmium laser lithotripsy for management of complicated biliary calculi.

    Science.gov (United States)

    Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter; Ogan, Kenneth

    2009-01-01

    Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and post-operatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.

  13. Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust?

    Science.gov (United States)

    Aldoukhi, Ali H; Roberts, William W; Hall, Timothy L; Ghani, Khurshid R

    2017-01-01

    Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are then extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval. Use of the long PW mode during lithotripsy can reduce stone retropulsion and is increasingly available in new generation lasers. During non-contact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. In this review, we discuss the effect of different holmium laser settings on stone fragmentation, and the clinical implications in a very much evolving field.

  14. Effect of pulse width on object movement in vitro using holmium:YAG laser.

    Science.gov (United States)

    Kalra, Pankaj; Le, Ngoc-Bich; Bagley, Demetrius

    2007-02-01

    The holmium:YAG laser is an effective modality for intracorporeal lithotripsy. The fiber tip needs to be in contact with the calculus for maximal effect. Laser energy can cause stone retropulsion, necessitating cumbersome repositioning of the fiber. We examined the effect of varying the laser pulse width on object movement in vitro. Two experiments were conducted using a holmium:YAG laser at the 350-microsec and 700-microsec pulse-width settings. In the first experiment, one pulse was delivered to a non-fragmentable ball bearing at increasing energy settings, and object displacement was measured. In the second experiment, a train of pulses was delivered to a fragmentable soda lime phantom at increasing energy settings, and the total energy delivered before movement from the tip of the fiber was determined. The mean ball bearing movement was significantly greater at the 350-microsec setting with a 200-microm fiber (P waves from Ho:YAG lithotripsy are less than with other modalities, yet some retropulsion occurs. The duration of the laser pulse can influence shockwave generation and object migration. Longer pulse width results in less object movement after one shock and more energy delivery during repetitive shocks. Clinically, this regimen may reduce the need for fiber readjustment and lead to more efficient stone fragmentation.

  15. Treatment of ureteric lithiasis with retrograde ureteroscopy and holmium: YAG laser lithotripsy vs extracorporeal lithotripsy.

    Science.gov (United States)

    Arrabal-Polo, Miguel A; Arrabal-Martín, Miguel; Miján-Ortiz, José L; Valle-Díaz, Francisco; López-León, Víctor; Merino-Salas, Sergio; Zuluaga-Gómez, Armando

    2009-10-01

    To analyse the efficiency of extracorporeal shockwave lithotripsy (ESWL) vs retrograde ureteroscopy and holmium:YAG laser lithotripsy, as ESWL is successful in 67-90% of cases but endoscopic lithotripsy with pneumatic lithotrites or lasers is successful in 90-96% of distal ureteric calculi, and holmium:YAG lithotripsy is effective in proximal ureteric calculi. From April 2006 to April 2008 we assessed 164 patients undergoing ureteric lithiasis in two homogeneous groups: group A included 83 treated with retrograde ureteroscopy and holmium:YAG endoscopic lithotripsy, and group B, 81 treated by ESWL. For laser lithotripsy we used 2071 mJ pulses at 3-6 Hz, with a mean of 1105 pulses and 2.5 kJ of total energy. ESWL was carried out using 37.5-87.5 mJ shock waves, a mean of 3650 shock waves and 187.6 J, with a radioscopy time of 1-4 min. The results were assessed after 3 weeks with plain films and ultrasonography, or urography. The efficiency of each procedure was assessed by calculating the relative risk, and results compared using the chi-square or Student's t-test. The efficiency quotient (EQ) was determined for both procedures, and the focal applied energy quotient (FAEQ) used to assess ESWL. The overall success rate for retrograde ureteroscopy and laser lithotripsy was 96.4% (80/83 patients), with an EQ of 0.52; a JJ catheter was placed in 67 patients. The success rate for the first ESWL session was 48%, and after repeat ESWL was 64% (52/81 patients), giving an EQ of 0.39. For successful treatments the FAEQ was 9.22, vs 6.47 for the failures (P laser lithotripsy, with an absolute benefit of 46% (95% confidence interval 33.8-57.9%), and number needed to treat of 2 (2-3), but no significant differences for lumbar ureteric calculi. Endoscopic lithotripsy with the holmium laser is more effective than ESWL, but for lumbar ureteric calculi ESWL is therapeutically recommended as it is less invasive.

  16. Optimization of dosimetry and safety using the holmium laser for urology

    Science.gov (United States)

    van Swol, Christiaan F. P.; Verdaasdonck, Rudolf M.; Zeijlemaker, Bram Y. W.; Grimbergen, Matthijs C. M.; Boon, Tom A.

    1998-07-01

    The holmium laser has become accepted as a versatile instrument for urological applications, such as prostate resection, urethrotomy, tumor coagulation and lithotripsy. Presently, more powerful lasers have become available generating pulses up to 4 J at 80 W. The necessity of these high power systems in urology is ambiguous. In this study, the dosimetry as to efficacy and especially safety was investigated for various applications. The holmium laser ((lambda) equals 2.1 micrometer) emits its energy in 350 microsecond pulses which instantly turn water into vapor. Using high-speed photography explosive vapor bubbles with diameters over 10 mm were captured. The mechanical force of these bubbles, effectively fragments stones but may dilate and rupture a small lumen like the ureter. After implosion of the bubble, the energy of vaporization turns into heat. Depending on pulse energy and pulse repetition rate, tissue can be thermally affected up to 5 mm. For soft tissue applications, e.g., urethrotomy, prostatectomy or tumor coagulation, pulse energies of 0.5 - 1.5 J were applied at a high repetition rate (20 - 40 Hz) to provide sufficient coagulative and hemostatic effects. At higher pulse energies, the fiber tip was vibrating vigorously and the tissue was ripped to pieces decreasing hemostasis and visibility. For hard tissue applications, bursts of 0.5 J pulses at 5 Hz, proved to be sufficient to fragment all types of stones (including cystine) in the ureter and the bladder without mechanical or thermal damage to surrounding tissue. At higher settings, targeting the stone was less controlled and effective due to 'jumping' of the fiber tip with resulting mechanical and thermal trauma to the surrounding tissue. The holmium laser can be used effectively to coagulate and cut soft tissue and fragment stones at relatively low energy and power settings, thus minimizing the risk of complications.

  17. Semiconductor saturable absorber Q-switching of a holmium micro-laser.

    Science.gov (United States)

    Lan, Ruijun; Mateos, Xavier; Wang, Yicheng; Serres, Josep Maria; Loiko, Pavel; Li, Jiang; Pan, Yubai; Griebner, Uwe; Petrov, Valentin

    2017-03-06

    We report on a Holmium micro-laser passively Q-switched by a semiconductor saturable absorber (SSA), for the first time to the best of our knowledge. It is based on a 1 at.% Ho:YAG ceramic with good energy storage capability and several commercial transmission-type SSAs with 0.24% modulation depth. Under in-band pumping by a Tm fiber laser at 1910 nm, the Ho micro-laser generated 450 mW at 2089 nm with 37% slope efficiency. Stable 89 ns, 3.2 μJ pulses are achieved at a repetition rate of 141 kHz. Further shortening of the laser pulses is feasible with the increase of the modulation depth of the SSA while power scaling may lead to Q-switching at MHz-range repetition rates.

  18. Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Francisco Botelho

    2012-01-01

    Full Text Available Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction.

  19. Vaporization vs. enucleation techniques for BPO: do we have a standard?

    Science.gov (United States)

    Netsch, Christopher; Bach, Thorsten

    2015-01-01

    This article discusses enucleation and vaporization procedures which have been developed on the surgical techniques of holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP) by reviewing the most recent publications. Enucleation procedures have been described using holmium, thulium, diode or GreenLight lasers in addition to bipolar energy sources. Most of the current literature for these enucleation procedures consists of initial descriptions of the surgical techniques or prospective series from single centres, although the availability of prospective randomized trial for these procedures other than HoLEP is limited. PVP have been described using 80-W, 120-W, or 180-W GreenLight lasers. To date, only sparse literature is available for thulium or bipolar vaporization of the prostate. A variety of alternative vaporization and enucleation procedures are available for transurethral treatment of benign prostatic obstruction. Only very few PRT have been published for these procedures limiting their evidence for the treatment of benign prostatic obstruction. To date, best evidence is still available for the HoLEP and PVP procedure.

  20. High power operation of cladding pumped holmium-doped silica fibre lasers.

    Science.gov (United States)

    Hemming, Alexander; Bennetts, Shayne; Simakov, Nikita; Davidson, Alan; Haub, John; Carter, Adrian

    2013-02-25

    We report the highest power operation of a resonantly cladding-pumped, holmium-doped silica fibre laser. The cladding pumped all-glass fibre utilises a fluorine doped glass layer to provide low loss cladding guidance of the 1.95 µm pump radiation. The operation of both single mode and large-mode area fibre lasers was demonstrated, with up to 140 W of output power achieved. A slope efficiency of 59% versus launched pump power was demonstrated. The free running emission was measured to be 2.12-2.15 µm demonstrating the potential of this architecture to address the long wavelength operation of silica based fibre lasers with high efficiency.

  1. Experience with endoscopic holmium laser in the pediatric population

    Science.gov (United States)

    Merguerian, Paul A.; Reddy, Pramod P.; Barrieras, Diego; Bagli, Darius J.; McLorie, Gordon A.; Khoury, Antoine E.

    1999-06-01

    Introduction: Due to the unavailability of suitable endoscopic instruments, pediatric patients have not benefited fully from the technological advances in the endoscopic management of the upper urinary tract. This limitation may be overcome with the Holmuim:Yttrium-Aluminum-Garnet(Ho:YAG) laser delivered via small instruments. To date, there is no published report on the use of this modality in children. Purpose: We evaluated the indications, efficacy, and complications of endourological Ho:YAG laser surgery in the treatment of pediatric urolithiasis, posterior urethral valves, ureterocele and ureteropelvic junction obstruction. Methods: The patient population included 10 children with renal, ureteral and bladder calculi, 2 children with posterior urethral valves, 2 children with obstructing ureteroceles, 2 children with ureteropelvic junction obstruction and 1 child with a urethral stricture. Access to the lesions was either antegrade via a percutaneous nephrostomy tract or retrograde via the urethra. A solid state Ho:YAG laser with maximum output of 30 watts (New Star lasers, Auburn, CA) was utilized as the energy source. Results: A total of 10 patients underwent laser lithotripsy. The means age of the patients was 9 yrs (5-13 yrs). The average surface area of the calculi as 425.2 mm2 (92-1645 mm2). 8 of the patients required one procedure to render them stone free, one patient had a staghorn calculus filling every calyx of a solitary kidney requiring multiple treatments and one other patient with a staghorn calculus required 2 treatments. There were no complications related to the laser lithotripsy. Two newborn underwent successful ablation of po sterious urethral valves. Two infants underwent incision of obstructing ureteroceles with decompression of the ureterocele on postoperative ultrasound. Two children underwent endypyelotomy for ureteropelvic junction obstruction. One was successful an done required an open procedure to correct the obstruction. One child

  2. PNEUMATIC LITHOTRIPSY VERSUS HOLMIUM:YAG LASER LITHOTRIPSY I N THE MANAGEMENT OF URETERAL STONES

    Directory of Open Access Journals (Sweden)

    Sebastiano Cimino

    2013-04-01

    Full Text Available Background: Pneumatic lithotripsy (PL and Holmium:YAG laser lithotripsy (LL are two valid mini-invasive approaches in the treatment of urologic stones disease. The aim of this study was to compare stone free rates between these two treatment options. Material and methods: From January 2010 to January 2011, 120 consecutive patients with single and primary ureteral stones were prospectively enrolled in this prospective study. The study was single-blinded and none of the patients knew which approach for stone fragmentation would be used. Results: The ureteral stone-free rate (SFRs in the PL group was 80.7% and 86.1 % in the LL group (p=0.002. The mean operating time was 60 (± 25 minutes in the LL group and 61 (± 21 minutes in the PL group, without significant differences (p=0.68. Multivariate logistic analysis revealed that stone location was not significantly predictive of SFRs (p=0.47. None of the patients had blood transfusions and no other severe complications appeared in either group. Conclusions: In our study LL was significantly associated with a stone 80.7% in the PL group and 86.1% in the LL group (p<0.05. Also, Holmium:YAG laser lithotripsy was demonstrated to be the more efficacious endoscopic procedure for the treatment of ureteral stones, allowing stones to be successfully fragmented, with few complications.

  3. Clinical effects of FURL and PCNL with holmium laser for the treatment of kidney stones.

    Science.gov (United States)

    Li, Zhi-Gang; Zhao, Yan; Fan, Tao; Hao, Lin; Han, Cong-Hui; Zang, Guang-Hui

    2016-12-01

    In the present study, the clinical effects of flexible ureteroscopy lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) for the treatment of kidney stones of ≤2 cm was studied. Seventy-two patients with kidney stones were randomly divided into the FURL group (n=39) under ureteroscope lithotripsy with holmium laser and PCNL group (n=33) under PCNL with holmium laser and compared their clinical effects. At 3 months after the operation, the stone removal rate of the FURL group was significantly higher than that of the PCNL group. The subgroup analysis revealed that the difference in the lower kidney calyx was more obvious (Pkidney stones was not statistically significant (P>0.05). The incidence of complications of the FURL group was significantly lower than that of the PCNL group (P0.05). Additionally, 3 and 7 days after operation, the cystatin C levels of the FURL group were significantly higher than those of the PCNL group, and the KIM-1 levels were significantly lower than the PCNL group (Pkidney stones ≤2 cm. Therefore, the method is worthy of wide application in clinic.

  4. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study.

    Science.gov (United States)

    Fan, Song; Gong, Binbin; Hao, Zongyao; Zhang, Li; Zhou, Jun; Zhang, Yifei; Liang, Chaozhao

    2015-01-01

    We aimed to evaluate the effectiveness of flexible ureteroscope for treating kidney stones and the risk factors for infectious complications following flexible ureteroscope (FURS) with a holmium laser. We retrospectively reviewed the data of 227 patients with kidney stones who underwent flexible ureteroscope with a holmium laser at our hospital from January 2012 to September 2014, including gender, age, comorbidity, urine analysis results, urine culture results, blood test results, stone size, operative duration, and residual stones. Patients with and without infectious complications were assigned to groups A and B, respectively. The dependent variables were postoperative infectious complications, and the risk factors for infectious complications following FURS were assessed using Chi-square tests and multivariate logistic regression analyses. All the surgeries were successfully completed. The total stone-free rate was 81.9% (n = 186), and the incidence of infectious complications after FURS was 8.37% (n = 19). Fifteen patients (6.61%) developed fever postoperatively, 10 patients (4.41%) developed systemic inflammatory response syndrome (SIRS), 6 patients with fever were considered to have SIRS (2.64%), and 2 patients had sepsis (0.88%). Univariate analyses of groups A and B indicated that pyuria, stone size, operative duration, and infectious stones were risk factors for infectious complications after FURS (P infectious stones (P = 0.030) were independently related to infectious complications. Pyuria, operative duration, and infectious stones were risk factors for infectious complications following FURS. Hence, routine urinalysis findings should be carefully considered, particularly the finding of pyuria.

  5. Ablation of oral mucosa by erbium:YAG and holmium:YAG laser radiation

    Science.gov (United States)

    Nuebler-Moritz, Michael; Gutknecht, Norbert; Sailer, Hermann F.; Hering, Peter; Prettl, Wilhelm

    1997-05-01

    The in vitro tissue ablation characteristics of two pulsed mid-infrared lasers were studied, especially, with the intent to evaluate photomechanical and photothermal side effects. The Erbium:YAG laser emitted radiation at 2.94 micrometers in a spiking mode. The free-running beam from the laser was focused onto freshly-excised porcine samples via a 108-mm sapphire lens. The spot size was determined by a photosensitive metallic foil. The Holmium:YAG laser emitted radiation at 2.10 micrometers . The radiation was coupled to a 400- micrometers core quartz fiber. Both lasers were operated at 5 Hz, and 6 pulses were delivered to each porcine specimen using 'dry' and 'wet' ablation mode, respectively. After irradiation, the samples were investigated by means of light and scanning electron microscopy. The results of this survey indicate that both laser types ablate porcine oral mucosa efficiently. The Er:YAG laser produces less surrounding mechanical and thermal damage. In contrast to safe and suitable optical fibers available for the Ho:YAG laser, fiber optical delivery systems for the Er:YAG laser are still in the development phase. Nevertheless, current research work in this field seems promising and the near future may hold an adequate optical transmission systems for the delivery of both wavelengths, 2.10 micrometers and 2.94 micrometers , in order to provide on the one hand atraumatic ablation and on the other hand sufficient hemostasis.

  6. Holmium:YAG laser ablation combined intraurethral fluorouracil perfusion as treatment option for intraurethral Condyloma acuminata in men.

    Science.gov (United States)

    Ge, C-G; Jiang, J; Jiang, Q; Liu, C; Hu, Z-L; Liang, P-H; Zhang, W-L

    2014-03-01

    Intraurethral condylomata acuminata (CA) is caused by human papilloma virus (HPV) infection which is transmitted by close physical and sexual contact. CA is often difficult to cure. There is limited research on the treatment of the patients with intraurethral CA. Here, we have reviewed our experiences on the treatment of intraurethral condylomatous with Holmium:YAG Laser ablation. A new and convenient mean of administering fluorouracil and lidocaine for the treatment of intraurethral condyloma acuminata is discussed. This study aimed to evaluate the experience and efficacy of Holmium:YAG Laser ablation with ureteroscopy and local administration of fluorouracil in the treatment of patients with intraurethral CA. The effects were investigated based on the rate of cure and relapse and the incidence of complications. The study included patients with intraurethral condylomatous who had undergone Holmium:YAG Laser ablation and intraurethral perfusion of fluorouracil. From May 2005 to October 2008, 25 patients (mean age 31.3 years, 19-63 years) with cystourethroscopy confirmed extensive lesions at the anterior urethra and biopsy of the lesions was compatible with condyloma acuminata. They all underwent Holmium:YAG Laser ablation with a transurethral Wolf 8/9.8 Fr rigid ureteroscope. And a week later, the patients initially accepted intraurethral installation of the mixture containing 1% fluorouracil and 1% tetracaine hydrochloride gel (lubricating jelly) in a volume of 20 mL. This mixture was given intraurethrally once weekly, and tip of the penis was clamped immediately to close the urethral meatus after administration by using an occlusive penile clamp and was retained for 20 minutes. Six treatments were given initially and after six weeks of rest, another cycle of six weekly treatments was given. Ureteroscopic Holmium laser ablation was successfully performed in all patients with multifocal intraurethral CA. Mean CA warts body size was 3 mm (2-8) in diameter. Mean

  7. The use of holmium-yttrium aluminum garnet laser as pit and fissure cleaner

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    Armasastra Bahar

    2009-09-01

    Full Text Available Background: The prevention and management of pit and fissure caries has become relatively more important in recent times. There is a need for an effective preventive measure against pit and fissure caries. Purpose: The purpose of this study was to investigate the effect of laser beam as a cleaning method of pits and fissures. Methods: Ho-YAG laser which has a wavelength of 2.1 µm was used in this experiment. The specimens were extracted human teeth. The effect of three cleaning methods was examined comparatively by scoring the cleaned area of fissure, namely laser irradiation with Ho-YAG laser, chemico-mechanical with combination of 10% NaOCl and ultrasonic scaler and mechanical with ultrasonic scaler. Vertico-bucco-lingual serial ground sections of each tooth were observed under light microscopy. Scoring the depth of cleaned area was performed by comparing the depth of fissure. result: Progressive result was obtained on the cleaning effect of three methods laser irradiation methods which was the most effective compared to other methods but statistically was not significant. Cleaned area of laser irradiation method was 48.91%, chemico-mechanical method was 41.77% and mechanical method was 36.78%. Conclusion: Holmium -yttrium aluminum garner laser is a relatively new method for pit and fissure cleaning even though the effectivity is not yet maximal. More research is needed to maximize the use of this laser.

  8. Alternative Treatment of Osteoma Using an Endoscopic Holmium-YAG Laser

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    Ba Leun Han

    2012-07-01

    Full Text Available Osteoma is one of the most common tumors of the cranial vault and the facial skeleton. For osteoma in the facial region, endoscopic resection is widely used to prevent surgical scarring. Tumors in a total of 14 patients were resected using an endoscopic holmium-doped yttrium aluminium garnet (Ho:YAG laser with a long flexible fiber. Aside from having the advantage of not leaving a scar due to the use of endoscopy, this procedure allowed resection at any position, was minimally invasive, and caused less postoperative pain. This method yielded excellent cosmetic results, so the endoscopic Ho:YAG laser is expected to emerge as a good treatment option for osteoma.

  9. Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate.

    Science.gov (United States)

    Elshal, Ahmed M; Elkoushy, Mohamed A; Elmansy, Hazem M; Sampalis, John; Elhilali, Mostafa M

    2014-01-01

    We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques. A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study. From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate

  10. Are Histological Findings of Thulium Laser Vapo-Enucleation Versus Transurethral Resection of the Prostate Comparable?

    Science.gov (United States)

    Carmignani, Luca; Macchi, Alberto; Ratti, Dario; Finkelberg, Elisabetta; Casellato, Stefano; Bozzini, Giorgio; Maruccia, Serena; Marenghi, Carlo; Picozzi, Stefano

    2015-09-01

    We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue.

  11. Percutaneous transhepatic endoscopic holmium laser lithotripsy for intrahepatic and choledochal biliary stones.

    Science.gov (United States)

    Ierardi, Anna Maria; Fontana, Federico; Petrillo, Mario; Floridi, Chiara; Cocozza, Eugenio; Segato, Sergio; Abou El Abbas, Hatem; Mangano, Alberto; Carrafiello, Gianpaolo; Dionigi, Renzo

    2013-01-01

    To report our experience in treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Ten symptomatic patients with intrahepatic or common bile duct calculi underwent PTBL. Six of these patients had previously undergone unsuccessful endoscopic treatment; four patients were declared not suitable for endoscopic procedure. PTBL was performed with a flexible choledochoscopy inserted by way of the percutaneous access sheath. A holmium laser was used to fragment the biliary stones. Sphincteroplasty was performed when considered necessary and an occlusion balloon for the clearance of common bile duct (CBD) calculi was used when continuous warm saline irrigation at high pressure was not sufficient. Clinical follow up was performed by the referring physician. Technical success, clinical success and complications were evaluated. Technical success rate was 100%. The overall clinical success rate was 100%. No patients underwent additional procedures for retained stones or developed de novo strictures or other complications related to the procedure. Hospital stay was no more than 4 days after the procedure. Duration of follow-up was 6-25 months (mean 12.6). One patient died from unrelated causes. During this period, no recurrence and/or complications related to procedure were observed. No major complications were registered. Minor complications like temporary abdominal pain were considered not significant by the patients. Complicated or large biliary calculi can be treated successfully using PTBL. In selected patients, this approach should become the first choice of treatment after other treatments are rejected. Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd. All rights reserved.

  12. Benign Prostatic Hyperplasia Treatment by Transurethral Enucleation of the Prostate Using a 2-μm Laser

    OpenAIRE

    He-qing GUO; Zhou, Gao-Biao; Liu, Hong-Ming; Sun, Bin; Pan, Guang-Xin; Mu, Da-Wei; Yan, Jing-Ming; Xing, Ji-Zhang; Li, Di; Hong, Quan

    2015-01-01

    This study investigates the efficacy of benign prostatic hyperplasia (BPH) treatment by prostate transurethral enucleation using a 2-μm laser. A total of 107 patients with BPH were treated by prostate transurethral enucleation using a RevoLix 2-μm laser surgery system. Bleeding volume, operation time, catheterization time, voiding situation, maximum urinary flow rate, and hospital stay were observed. The mean operation time was 74 min ± 12 min (range 45 to 150 min), the mean follow-up period ...

  13. [Long-term outcome after endoscopic enucleation of the prostate : From monopolar enucleation to HoLEP and from HoLEP to EEP].

    Science.gov (United States)

    Herrmann, T R W

    2016-11-01

    In the last 20 years various transurethral endoscopic enucleation techniques (EEP) have been established as a substitute for open prostatectomy (OP) and TURP. Since the 2016 update of the "EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), including Benign Prostatic Obstruction (BPO)", Holmium laser enucleation of the prostate (HoLEP) and bipolar enucleation being summarized as anatomical enucleating techniques are proposed as first choice for the surgical management of BPO of large volume prostates. The purpose of this review is to demonstrate the available data on long-term outcomes of current EEP techniques. PubMed/Medline and Scopus were searched using the terms: long term, HoLEP, ThuLEP, ThuVEP, DiLEP, ELEP, GreenlEP, Greenlight enucleation, bipolar enucleation, plasmakinetic enucleation, monopolar enucleation, and transurethral enucleation. Studies with a follow-up ≥48 months were selected. In all, 5 randomized controlled trials (2 HoLEP, 2 bipolar enucleation, 1 Thulium laser resection of the prostate in tangerine technique [TmLR-TT]), 3 prospective cohort studies (2 thulium vapoenucleation [ThuVEP], 1 TmLRP-TT), and 2 retrospective studies with large patient cohorts were selected. All EEP were equivalent to OP with regard to effectivity and durability of results. The rate of secondary surgical procedures in HolEP, ThuVEP, bipolar enucleation and tangerine technique (TmLRP-TT) was 0-1.2 % for reTURP, 1.9-3.75 % for urethrotomy, and 0.9-4 % for bladder neck resection. No significant difference in the individual studies was found when compared to OP. For bipolar enucleation vs. TURP long-term results for uroflow, residual urine, and IPSS were significantly better at 60 months for bipolar enucleation. One RCT TmLRP-TT vs. TURP at the 48-month follow-up found no significant difference. Various transurethral EEP can be considered as equally safe and effective anatomical enucleation techniques. All

  14. Ureteroscopic holmium:YAG laser endopyelotomy is effective in distinctive ureteropelvic junction obstructions

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    Zhong Wu

    2011-09-01

    Full Text Available Aim: To evaluate the effectiveness and safety of holmium:YAG (Ho:YAG laser endopyelotomy in distinctive ureteropelvicjunction obstructions (UPJO with distinctive aetiologies.Thirty-one patients diagnosed with UPJO of distinctive causes were included. Aetiologyconsisted of 7 congenital UPJO, 10 post-pyeloplasty UPJO, 7 post-lithotomy obstructions, 4 ureteropelvic junctionobstructions post-extracorporeal shockwave lithotripsy stenoses and 3 post-ureteroscopic lithotriptic UPJO. Retrogradeureteroscopic Ho:YAG laser endopyelotomy was performed in all patients. Operation related parameters were studied.Average procedure duration was 46 min. Mean discharge was 1.81 days. There was no notable complicationsuch as perforation or haemorrhage. All patients were followed for at least 12 months. The single success rate was80.6%, leaving 6 patients undergoing secondary endopyelotomy, among whom 4 were successful while 2 requiredan open approach. The overall success rate was 93.5%. Failed pyeloplasty UPJO is more disposed to restenosis(p = 0.0075. Inversely implanted ureteral stent yielded a higher success rate (p = 0.0158.Ho:YAG laser endopyelotomy is a safe, minimally invasive approach effective in both primary and secondaryUPJO treatments. Implantation of inversed ureteral stents can be more beneficial.

  15. Laser dynamics of a mode-locked thulium/holmium fiber laser in the solitonic and the stretched pulse regimes

    Science.gov (United States)

    Kadel, Rajesh

    Mode-locked lasers that produce short optical pulses in the mid-infrared wavelength region have been sought out for a wide range of applications such as free space communication, molecular spectroscopy, medical diagnostics, and remote sensing. Here, a thulium and holmium (Tm/Ho) co-doped fiber laser that mode-locks in both the solitonic and stretched-pulse regimes is used to produce ultra-short pulses in the 2 mum region. Nonlinear polarization rotation technique is used where fiber nonlinearity is responsible to mode-lock the laser. The anomalous group velocity dispersion of both the single mode and gain fibers used limit the laser operation in the solitonic regime where spectral bandwidth is 10 nm and hence the pulse duration is limited to 996 fs. In order to increase the spectral bandwidth and hence get the shorter pulses the anomalous dispersion of these fibers has to compensate using normal group velocity dispersion fiber in the laser cavity. High numerical aperture fibers, which have normal group velocity dispersion around 2 mum due to its large and positive waveguide dispersion, can be used to compensate the anomalous dispersion of the gain and single mode fibers. We used a high numerical aperture fiber called UHNA4 in the laser cavity in order to compensate the anomalous dispersion of other fibers and mode-locked the laser in stretched pulse regime. The spectral bandwidth of the laser increased to 31 nm with corresponding pulse duration of 450 fs measured from the interferometric autocorrelation. The laser dynamics of the Tm/Ho co-doped fiber laser is also studied while going from the stretched-pulse to solitonic regime by fiber cut-back measurements of normal dispersion fiber. It was clearly observed that both the spectral bandwidth and the pulse duration changed significantly going from one region to the other.

  16. Management of calcular anuria in adults caused by ureteric stones: By using of ureteroscopy and holmium laser.

    Science.gov (United States)

    Abdel-Kader, Mohammad S

    2011-09-01

    To present our clinical outcomes in the management of anuria in adult patients caused by ureteral calculi by using of ureteroscopy and holmium laser. Nineteen patients presented with calcular anuria with ages between 19 and 48 years. The presentation was anuria with serum creatinine levels of 2-5.5 mg% (mean 3.5) and hyperkalemia in nine patients (5.2-6.1 mmol/L). There were bilateral ureteric stones in 14 (73.7%) and unilateral in five (26.3%) with single functioning kidney. Thirty-three ureteroscopic procedures were performed for 19 patients including bilateral ureteroscopy in 14. Laser lithotripsy was delivered using holmium laser via 356 μm laser fibre, with energy (1-1.2 J) and pulse rate (10 Hz). Post-operatively, monitoring of urine output, serum creatinine and K levels was done until normal values were obtained. Ureteroscopy was performed for all 19 patients (33 procedures), but laser lithotripsy was done successfully in 30 procedures. The operative time was 46 min (25-70). The successful fragmentation rate was (100%). The stone-free rate was 90.9%. There were mucosal abrasions in 6 (31.5%), and mild to moderate haematuria in 9 (47.4%), and high fever in two patients (10.5%). Serum creatinine and potassium levels returned to normal within 7-10 days. Urine output gradually reached normal level within a week. Ureteroscopy and holmium laser lithotripsy represent an effective and safe modality for the treatment of anuria caused by ureteral calculi.

  17. Transurethral lithotripsy with holmium-YAG laser of a large exogenous prostatic calculus.

    Science.gov (United States)

    Hasegawa, Masanori; Ohara, Rei; Kanao, Kent; Nakajima, Yosuke

    2011-04-01

    Prostatic calculi are classified into two types, endogenous and exogenous calculi, based on their origin. Endogenous calculi are commonly observed in elderly men; however, exogenous prostatic calculi are extremely rare. We report here the case of a 51-year-old man who suffered incontinence and pollakiuria with a giant exogenous prostatic calculus almost completely replacing the prostatic tissue. X-rays and computed tomography demonstrated a large calculus of 65 × 58 mm in the small pelvic cavity. The patient underwent a transurethral lithotripsy with a holmium-YAG laser and a total of 85 g of disintegrated stones was retrieved and chemical stone analysis revealed the presence of magnesium ammonium phosphate. The incontinence improved and the voiding volume increased dramatically, and no stone recurrence in the prostatic fossa occurred at the 2 years follow-up. The etiology of this stone formation seemed to be based on some exogenous pathways combined with urinary stasis and chronic urinary infection due to compression fracture of the lumbar vertebra.

  18. Initial Clinical Experience with a Modulated Holmium Laser Pulse—Moses Technology: Does It Enhance Laser Lithotripsy Efficacy?

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    Michael Mullerad

    2017-10-01

    Full Text Available Objective The Lumenis® High-power Holmium Laser (120H has a unique modulated pulse mode, Moses™ technology. Moses technology modulates the laser pulse to separate the water (vapor bubble, then deliver the remaining energy through the bubble. Proprietary laser fibers were designed for the Moses technology. Our aim was to compare stone lithotripsy with and without the Moses technology. Methods We designed a questionnaire for the urologist to fill immediately after each ureteroscopy in which the Lumenis 120H was used. We compared procedures with (n=23 and without (n=11 the use of Moses technology. Surgeons ranked the Moses technology in 23 procedures, in comparison to regular lithotripsy (worse, equivalent, better, much better. Laser working time and energy use were collected from the Lumenis 120H log. Results During 4 months, five urologists used the Lumenis 120H in 34 ureteroscopy procedures (19 kidney stones, 15 ureteral stones; 22 procedures with a flexible ureteroscope, and 12 with a semi-rigid ureteroscope. Three urologists ranked Moses technology as much better or better in 17 procedures. In 2 cases, it was ranked equivalent, and in 4 cases ranking was not done. Overall, laser lithotripsy with Moses technology utilized laser energy in less time to achieve a satisfying stone fragmentation rate of 95.8 mm3/min versus 58.1 mm3/min, P=0.19. However, this did not reach statistical significance. Conclusion The new Moses laser technology demonstrated good stone fragmentation capabilities when used in everyday clinical practice.

  19. Transurethral vapor enucleation and resection of the prostate with plasma vaporization button electrode for the treatment of benign prostatic hyperplasia: a feasibility study.

    Science.gov (United States)

    Xie, Liping; Mao, Qiqi; Chen, Hong; Qin, Jie; Zheng, Xiangyi; Lin, Yiwei; Wang, Xiao; Liu, Ben

    2012-10-01

    Various improvements and modifications to the surgical treatment of benign prostatic hyperplasia have emerged over the last decade. Most techniques often initially claimed superiority only to turn out to be mediocre with time. Holmium laser enucleation of the prostate has been associated with superior outcomes compared with transurethral resection of the prostate and demonstrated improvement in long-term outcomes, while its clinical use has limitations. We describe the first use of plasma vaporization button electrode combined with loop electrode for transurethral vapor enucleation and resection of the prostate.

  20. Outpatient simultaneous treatment of benign prostatic hyperplasia and bladder lithiasis with GreenLight™ and holmium laser.

    Science.gov (United States)

    de la Torre, Germán; Barusso, Gabriel; Chernobilsky, Víctor; Borghi, Marcelo; Montes de Oca, Luis; Becher, Edgardo

    2012-02-01

    To evaluate our experience in the combined treatment of benign prostatic hyperplasia (BPH) and bladder lithiasis with GreenLight(™) and holmium laser, respectively, on an outpatient basis. From August 2006 to May 2009, 20 patients with prostatic hyperplasia and bladder lithiasis were treated. First, the lithiasis was treated, and then the GreenLight laser vaporization of the prostate was performed, both at the same surgical time and under general anesthesia. Discharge of patients was scheduled 3 to 4 hours after completion of the procedure. The procedure was simultaneously completed in 19 of 20 patients. The mean stone size was 2.3 (1-4) cm, and the mean prostate volume was 56.5 (30-108) cc. The mean operating time was 115 (50-190) minutes. There was a significant percentage change in maximum flow, postmicturition residual volume, and International Prostate Symptom Score, which were 129.5%, 88.4%, and 68.3%, respectively. All patients were stone free after the procedure. The combined transurethral treatment of BPH associated with bladder lithiasis by means of GreenLight laser vaporization and holmium laser lithotripsy on an outpatient basis can be performed safely and yields excellent results.

  1. Holmium laser ablation of the prostate versus photoselective vaporization of prostate 60 cc or less: short-term results of a prospective randomized trial.

    Science.gov (United States)

    Elzayat, Ehab A; Al-Mandil, Majid S; Khalaf, Ismail; Elhilali, Mostafa M

    2009-07-01

    We report on the first randomized trial to our knowledge comparing holmium laser ablation and photoselective vaporization of the prostate in patients with a small to moderate size prostate. Between March 2005 and April 2007, 109 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and prostate size 60 cc or smaller were randomized to photoselective vaporization of the prostate (52) or holmium laser ablation of the prostate (57). All patients were evaluated by preoperative and postoperative International Prostate Symptom Score, peak flow rate and post-void residual urine volume, measurement of prostate specific antigen and transrectal ultrasound prostate volume. Followup evaluations were performed during visits at 1, 3, 6 and 12 months. Mean +/- SD preoperative prostate volume was 33.1 +/- 14.5 and 37.3 +/- 13.6 cc in the holmium laser ablation group and the photoselective vaporization group, respectively. Holmium laser ablation of the prostate required more operating time than photoselective vaporization (69.8 vs 55.5 minutes, p = 0.008). In the holmium laser ablation group the International Prostate Symptom Score improved from 20 +/- 6.8 to 6.2 +/- 3.9 and peak urinary flow rate increased from 6.7 +/- 3.9 to 17.2 +/- 8 ml per second. In the photoselective vaporization group the International Prostate Symptom Score improved from 18.4 +/- 6.6 to 8.2 +/- 6.2 and peak urinary flow rate increased from 6.4 +/- 3.9 to 18.4 +/- 8.4 ml per second. Urethral stricture rates were 1.7% vs 5.7%, bladder neck contractures were 3.5% vs 7.7% and revaporization rates were 3.5% vs 1.9% in the holmium laser ablation and photoselective vaporization groups, respectively. Holmium laser ablation and photoselective vaporization of the prostate are safe and effective in patients with benign prostatic hyperplasia with a small to moderate size prostate. Both procedures are easy to learn but holmium laser ablation of the prostate requires a longer operating

  2. Benign Prostatic Hyperplasia Treatment by Transurethral Enucleation of the Prostate Using a 2-μm Laser.

    Science.gov (United States)

    Guo, He-Qing; Zhou, Gao-Biao; Liu, Hong-Ming; Sun, Bin; Pan, Guang-Xin; Mu, Da-Wei; Yan, Jing-Ming; Xing, Ji-Zhang; Li, Di; Hong, Quan

    2015-12-01

    This study investigates the efficacy of benign prostatic hyperplasia (BPH) treatment by prostate transurethral enucleation using a 2-μm laser. A total of 107 patients with BPH were treated by prostate transurethral enucleation using a RevoLix 2-μm laser surgery system. Bleeding volume, operation time, catheterization time, voiding situation, maximum urinary flow rate, and hospital stay were observed. The mean operation time was 74 min ± 12 min (range 45 to 150 min), the mean follow-up period was 2 to 6 months, the mean catheter time was 5 days, and the mean peak urinary flow rate increased from 6.3 ± 0.6 to 17.5 ± 1.5 mL/s. The International Prostate Symptom Score and quality of life significantly declined (p transurethral enucleation using a 2-μm laser is safe and efficient for BPH treatment.

  3. Hypothesis and development of a minimally invasive approach for percutaneous transmyocardial revascularization with holmium laser.

    Science.gov (United States)

    Galli, M; Mameli, S; Butti, E; Bonatti, R; Politi, A; Zerboni, S; Ferrari, G

    2001-04-01

    Percutaneous transluminal myocardial revascularization (PTMR) is a new procedure to improve perfusion of the ventricular wall for patients with intractable angina and untreatable by surgery or conventional catheter-based intervention. Actually PTMR requires femoral approach to utilize 8F-9F system device. We now report the feasibility study of PTMR using a laser delivered through a novel Eclipse system and new 6F and 7F guiding catheters that allow to perform PTMR even in patients with peripheral vascular disease and particularly suitable for alternative small vascular access. Percutaneous vascular access for PTMR treatment was obtained via the femoral or radial artery. A 6F or 7F mono-directional catheter carrying flexible fiber optics was used with a Holmium laser (Eclipse system) and was placed across the aortic valve into the left ventricular cavity to create channels of 5 mm in depth from the endocardial surface into the myocardial tissue. From June 1999 to September 2000, 39 patients (28 males, 11 females, mean age 72 +/- 8 years, range 58-86 years) underwent PTMR with the Eclipse system. Preoperative mean Canadian Cardiovascular Society (CCS) angina class was 3.5 +/- 0.5 and previous myocardial procedures had been performed in 39 patients (18 coronary artery bypass graft and 31 coronary angioplasty). The procedure was well tolerated and a procedural success was obtained in all patients (100%). We performed a mean of 19 +/- 7 channels in a mean fluoroscopy time of 21 +/- 9 min. We report only one procedural complication: one embolic stroke (2.4%). No hospital major adverse cardiac events were observed. The average length of hospital stay was 3.1 days. The mean CCS angina class at entry was 3.5 and it declined from 3.5 +/- 0.5 to 1.25 +/- 0.8 at discharge. At the follow-up of 8.2 +/- 3.9 months the mean CCS was 1.5 +/- 0.7. This experience confirmed the safety and technical feasibility of PTMR with this mini-invasive approach with a reduction in operative and

  4. Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia

    Directory of Open Access Journals (Sweden)

    Luca Carmignani

    2015-01-01

    Full Text Available Treatment of patients with lower urinary tract symptoms (LUTS secondary to benign prostatic hyperplasia (BPH may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate (ThuLEP on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life (QoL, five validated questionnaires were used: the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System (IPSS questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients′ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH (e.g. transurethral resection of the prostate causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.

  5. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction.

    Science.gov (United States)

    Herrmann, Thomas R W; Bach, T; Imkamp, F; Georgiou, A; Burchardt, M; Oelke, M; Gross, A J

    2010-02-01

    Transurethral removal of prostatic tissue is the treatment choice for benign prostatic enlargement and benign prostatic obstruction. Urodynamic results are directly linked to the amount of removed tissue which, however, is directly associated with intra- and postoperative morbidity. Transurethral laser operations of the prostate offer the advantage of decreased bleeding complications and the possibility to treat patients with bleeding disorders or anticoagulative treatment. The aim of the article is to present a novel technique of complete transurethral removal of the transition zone (enucleation) with the support of the Thulium laser to combine complete anatomical enucleation and maximum urodynamic efficacy with minimal side-effects. We present five distinct surgical steps for transurethral complete removal of the transition zone of the prostate (Thulium laser enucleation of the prostate, ThuLEP). Surgical steps are presented in chronological order with the help of intraoperative pictures. Laser energy of 70-90 W is only used for the incision at the verumontanum and bladder neck for removal of the middle lobe, whereas laser energy of 30 W was only used for coagulation of small vessel crossing the surgical capsule towards the transition zone and bladder neck for dissection of the lateral lobes. The lobes themselves are liberated by blunt dissection. ThuLEP offers complete removal of the transition zone no matter what prostatic size. The techniques combine maximum efficacy with minimal side-effects. Clinical results comparing ThuLEP with open prostatectomy or transurethral resection are awaited.

  6. [Comparison of the diode laser and the thulium laser in transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia].

    Science.gov (United States)

    Zhang, Feng-bo; Shao, Qiang; Tian, Ye

    2013-08-18

    To compare the validity and safety of diode laser and thulium laser transurethral enucleation of the prostate in benign prostatic hyperplasia (BPH) patients. In our study, 63 BPH patients treated with transurethral enucleation of the prostate were divided randomly into 2 groups by diode laser (Di group) or thulium laser (Thu group) respectively. The operation time, bleeding volume, electrolyte, international prostatic symptomatic score (IPSS), post-voiding residual volume (PVR) and maximum urine flow rate (Qmax) were recorded and compared. No difference was found in the 2 groups in basic preoperative characteristics. Di group was superior to Thu group in mean operation time [(61.5±19.6) min vs. (71.4±16.5) min, P=0.026] notwithstanding little clinical sense. The mean time of removing catheter was 2.1 d and 2.3 d respectively. No difference in either electrolyte decrease or hemoglobin decrease [(5.0±1.1 g/L) vs. (4.4±0.9) g/L, P=0.32] peri-operation between the 2 groups were found and no transurethral resection (TUR) syndrome was encountered. Lower urinary tract symptom (LUTS) in both the groups were released the 1st and 3nd months post-operation effectively in IPSS, PVR and Qmax respectively and comparable (P>0.05). Both the Diode laser and the Thulium laser transurethral enucleation of the prostate released the LUTS effectively in BPH patients and comparable in the short-time follow-up. Further study about late complications related to enucleation is necessary.

  7. Comparison of techniques for transurethral laser prostatectomy: standard photoselective vaporization of the prostate versus transurethral laser enucleation of the prostate.

    Science.gov (United States)

    Elterman, Dean S; Chughtai, Bilal; Lee, Richard; Kurlander, Lauren; Yip-Bannicq, Marika; Kaplan, Steven A; Te, Alexis E

    2013-06-01

    Transurethral laser enucleation of the prostate (TLEP) using the potassium-titanyl-phosphate (KTP) laser offers an alternative technique to traditional photovaporization. The study objective was to determine the comparative efficacy between transurethral photovaporization of the prostate (PVP) with a TLEP technique using the 80W 532 nm KTP laser. A series of 97 vs 170 patients who underwent PVP vs TLEP, respectively, with the KTP laser system at Weill Cornell Medical College from September 2001 to May 2009 was studied retrospectively. Outcome measures included laser time, prostate volume lased per unit time, International Prostate Symptom Score (IPSS), postvoid residual (PVR), and maximum flow rate (Qmax). Statistical analyses were performed using the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and unpaired t tests. Baseline parameters were similar between groups, although volume was greater in the TLEP group (83 vs 63 cc, P=0.04). Median laser time was longer in the TLEP group (90 vs 50 min, P<0.001) with a higher median energy used (308 vs 165 kJ, P<0.001). The volume lased per unit time was shorter, however, for TLEP (0.92 cc/min) than for PVP (1.26 cc/min). A greater median number of fibers were used in TLEP (2.5 vs 2.0, P=0.001). Improvements in median IPSS and PVR were seen in the TLEP group (5.0, P<0.001; 55.5, P=0.02, respectively) but not in the PVP group (P=0.40 and 0.30). Median Qmax and prostate-specific antigen (PSA) level improved similarly in both groups. Final IPSS was lower for the TLEP group (P<0.001), but other final parameters were statistically equivalent. In our series, both PVP and TLEP techniques were safe and effective. Although changes in Qmax and PSA were similar between the two techniques, improvement in urinary symptoms and PVR was superior with the TLEP technique. The TLEP technique was a more efficient method for laser prostatectomy.

  8. Comparison of the efficacy and feasibility of laser enucleation of bladder tumor versus transurethral resection of bladder tumor: a meta-analysis.

    Science.gov (United States)

    Yang, Huan; Wang, Ning; Han, Shanfu; Male, Musa; Zhao, Chenming; Yao, Daqiang; Chen, Zhiqiang

    2017-12-01

    The transurethral resection of bladder tumor (TURBT) remains the most widely used method in the surgical treatment of the non-muscle invasive bladder tumor (NMIBT). Despite its popularity, the laser technique has been widely used in urology as an alternative, via the application of transurethral laser enucleation of bladder tumor. The aim of the present study was to compare the efficacy and feasibility between transurethral laser enucleation and transurethral resection of bladder tumor. A systematic search of the following databases was conducted: PubMed, Wed of Science, Cochrane Library, EMBASE, Google scholar, and Medline. The search included studies up to the 1st of January 2017. The outcomes of interest that were used in order to assess the two techniques included operation time, catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, 24-month-recurrence rate, and the postoperative adjuvant intravesical chemotherapy. A total of 13 trials with 2012 participants were included, of which 975 and 1037 underwent transurethral laser enucleation and transurethral resection of bladder tumor, respectively. No significant difference was noted in the operation time between the two groups, although significant differences were reported for the variables catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, and 24-month-recurrence rate. In the mitomycin and epirubicin subgroups, no significant differences were observed in the laser enucleation and TURBT methods with regard to the 24-month-recurrence rate. The laser enucleation was superior to TURBT with regard to the parameters obturator nerve reflex, bladder perforation, catheterization time, hospitalization time, and 24-month-recurrence rate. Moreover, laser enucleation can offer a more accurate result of the tumor's pathological stage and grade.

  9. Thulium laser enucleation of the prostate (TmLEP) vs. transurethral resection of the prostate (TURP): evaluation of early results.

    Science.gov (United States)

    Świniarski, Piotr Paweł; Stępień, Stanisław; Dudzic, Waldemar; Kęsy, Stanisław; Blewniewski, Mariusz; Różański, Waldemar

    2012-01-01

    The first decade of XXI century it is a time of the thulium laser implementation to a benign prostatic hyperplasia treatment. The objective of this paper is a comparative assessment of early results thulium laser enucleation of the prostate (TmLEP) versus transurethral resection of the prostate (TURP) in 3-months observation. PATIENTS WERE RANDOMIZED TO BPH SURGICAL TREATMENT: research group (TmLEP - 54 men) or control group (TURP - 52 men). Between 02.2007-09.2009 non-consecutive patients were examined before, one month, and 3-months after surgery. Perioperative data (age, PV, time of surgery, use of laser, morcellation, catheterization, hospitalization, used energy, Hgb loss and removed tissue weight) were assessed. Before and after surgery IPSS, QoL, Qmax and PVR were controlled. Hemoglobin loss was twice lower during TmLEP than TURP [0.95 ±0.77 (0-3.2) vs. 1.81 ±0.97 (0.1-4.7) g/dl, p enucleation of the prostate is safe and efficient BPH treatment method, comparable to the transurethral electroresection in 3-months observation. Lack of long-term research does not allow to form wider conclusions.

  10. [Comparison of 2 µm continuous-wave laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia].

    Science.gov (United States)

    Shao, Jin-kai; Wang, Yu-bin; Lü, Yong-an; Li, Xiao-dong

    2012-02-01

    To compare the safety and efficacy of RevoLix 120 W 2 µm continuous-wave (cw) laser enucleation of the prostate with transurethral resection of prostate (TURP) in patients with symptomatic benign prostatic hyperplasia (BPH). And to evaluate clinical value of 120 W 2 µm cw laser enucleation. All 168 patients with BPH underwent 2 µm cw laser enucleation (n = 88) or TURP (n = 80) between January 2010 and January 2011. The operative time, drop in hemoglobin, drop in serum sodium, indwelling catheterization time and operative complications were recorded. International prostate symptom score (IPSS), quality of life (QOL), urinary peak flow rate (Qmax) and post-voiding residual urine (PVR) were also compared. The mean operative time was slightly longer in the 2 µm laser group ((63.2 ± 21.6) min) than the TURP group ((59.4 ± 18.6) min) (P > 0.05). Transfusions were not necessary in 2 µm laser group. Catheter indwelling time were (1.8 ± 0.6) days vs. (3.5 ± 2.6) days in 2 µm laser group than in TURP group (t = 3.912, P enucleation is an novel excellent treatment for BPH as well as TURP, and has the advantage of significantly less blood loss, shorter hospitalization, shorter catheter indwelling time and rapid recovery after surgery.

  11. Holmium Oxide Film as a Saturable Absorber for 2 μm Q-Switched Fiber Laser

    Science.gov (United States)

    Rahman, M. F. A.; Rusdi, M. F. M.; Lokman, M. Q.; Mahyuddin, M. B. H.; Latiff, A. A.; Rosol, A. H. A.; Dimyati, K.; Harun, S. W.

    2017-05-01

    This work reports on the use of the holmium oxide (Ho {}2 O {}3 ) polymer film as a saturable absorber (SA) for generating stable Q-switching pulses operating in a 2-μm region in a thulium-doped fiber laser cavity. The SA is prepared by diluting a commercial Ho {}3 O {}2 powder and then mixing it with polyvinyl alcohol (PVA) solution to form a Ho {}2 O {}3 -PVA film. A tiny part of the film about 1 mm×1 mm in size is sandwiched between two fiber ferrules with the help of index matching gel. When incorporated in a laser cavity driven by a 1552-nm pump, stable Q-switching pulses are observed at 1955 nm within the pump power range of 363-491 mW. As the pump power increases within this range, the repetition rate rises from 26 kHz to 39 kHz, as the pulse width drops from 4.22 μs to 2.57 μs. The laser operates with a signal-to-noise ratio of 47 dB, and the maximum output power and the pulse energy obtained are 2.67 mW and 69 nJ, respectively. Our results successfully demonstrate that the Ho {}2 O {}3 film can be used as a passive SA to generate a 2-μm pulse laser.

  12. High- vs low-power holmium laser lithotripsy: a prospective, randomized study in patients undergoing multitract minipercutaneous nephrolithotomy.

    Science.gov (United States)

    Chen, Shushang; Zhu, Lingfeng; Yang, Shunliang; Wu, Weizhen; Liao, Lianming; Tan, Jianming

    2012-02-01

    To determine the efficacy and safety of high-power holmium: yttrium aluminum-garnet (Ho:YAG) laser lithotripsy for multitract modified minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of patients with large staghorn renal calculi. A randomized, prospective study was conducted. Two-hundred seventy-three consecutive patients (291 renal units) with large staghorn renal calculi were randomized to undergo multitract MPCNL with 30-W low-power or 70-W high-power Ho:YAG laser lithotripsy. Both groups were compared in terms of perioperative findings and postoperative outcomes, including procedure time, stone-free rate, length of hospital stay, transfusion rates, renal function recovery, and other complications. The average patient age was 49.2 years (range 22-73) and mean stone size was 5.54±0.7 cm. The 2 groups had some comparable perioperative findings and outcome, including tracts required per operated renal unit (n), blood loss, postoperative fever, postoperative hospital stay, stone-free rate, and improvement of operated renal function. The operation time in the high-power group was significantly shorter than that in the low-power group (129.20±17.2 vs 105.18±14.2, Phigh-power Ho:YAG laser lithotripsy can greatly decrease the operative time without increasing the intraoperative complications or delaying postoperative renal function recovery when compared with low-power Ho:YAG laser lithotripsy. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Diode laser (980 nm) enucleation of the prostate: a promising alternative to transurethral resection of the prostate.

    Science.gov (United States)

    Yang, Stephen S; Hsieh, Cheng-Hsing; Lee, Yi-Shin; Chang, Shang-Jen

    2013-02-01

    With good hemostatic ability, the end-firing continuous-wave diode laser at 980 nm was used to enucleate the prostate (DiLEP) for the treatment of benign prostatic obstruction (BPO). The study compared the patients' demographics and surgical outcomes between DiLEP and transurethral resection of the prostate (TURP). Patients with significant BPO and a total prostatic weight of 40 g or more who had undergone DiLEP (n = 74) or TURP (n = 52) during the same period at our hospital were enrolled for analysis. DiLEP was performed by a single surgeon (Yang), and TURP by three surgeons (Yang, Hsieh and Chang). The 4-U incision technique was developed for DiLEP. The diode laser ensured bloodless incision followed by blunt dissection using the resectoscope and laser fiber as an 'index finger' to enucleate the prostate. To prevent unexpected deep thermal damage, the power of the laser was set at 80 W and the laser beam was directed towards the bladder neck and not towards the prostatic capsule. Demographic data and perioperative parameters were comparable between the two groups, except that DiLEP resulted in a significantly lower drop in hemoglobin level (0.9 ± 1.0 vs. 1.6 ± 2.4 g/dl, p = 0.03), shorter catheterization time (41.2 ± 19.9 vs. 67.7 ± 33.3 h, p = 0.01), and shorter postoperative stay (2.9 ± 1.9 vs. 4.1 ± 6.2 days, p = 00.01). Delayed postoperative sloughing of necrotic tissue was not observed in the DiLEP group. Improvements in voiding parameters were comparable between the groups, and were sustained during a follow-up of up to 1 year. DiLEP provided better hemostasis than TURP as evidenced by less blood loss. The role of DiLEP treating BPO requires further investigation.

  14. Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

    Directory of Open Access Journals (Sweden)

    Ankur Jhanwar

    Full Text Available ABSTRACT Objective: To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients. Materials and methods: Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder was performed to assess stone free status. Results: A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38. Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87. Conclusion: Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative.

  15. Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser.

    Science.gov (United States)

    Cindolo, Luca; Ruggera, Lorenzo; Destefanis, Paolo; Dadone, Claudio; Ferrari, Giovanni

    2017-03-01

    GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients. Data were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients' perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used. We evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50-90) and 2.8 ng/ml (IQR 1.7-4.3), respectively. The median operative time and applied energy were 60 min (IQR 45-75) and 250 kJ (IQR 160-364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median Q max values increased for 8-19 ml/s (p < 0.05), median International Prostate Symptoms Score decreased from 24 to 7 (p < 0.05). A total of 7.4% urinary retention, 33.4% bothersome storage symptoms, 2.5% short-term stress incontinence were recorded. Three heart attacks, one pulmonary embolism and one death occurred. Prostate volume was a predictive factor for post-operative storage symptoms (p = 0.049). Nine percentage of patients experienced long-term complications (4, 0.9 and 0.9% of urethral stricture, bladder neck contracture and prostatic fossa sclerosis

  16. Management of Benign Prostatic Hyperplasia Larger than 100 ml: Simple Open Enucleation Versus Transurethral Laser Prostatectomy.

    Science.gov (United States)

    Elkoushy, Mohamed A; Elhilali, Mostafa M

    2016-06-01

    Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) in aging men. Over the age of 60, more than a half of men have BPH and/or bothersome LUTS. Contemporary guidelines advocate surgery as the standard of care for symptomatic BPH after failure of medical therapy, where the choice of the appropriate surgical procedure depends on the prostate size. Transurethral resection of the prostate (TURP) and simple open prostatectomy (OP) have been considered for decades the reference-standard techniques for men with prostate smaller and larger than 80 ml, respectively. However, both procedures are potentially associated with considerable perioperative morbidity which prompted the introduction of a variety of minimally invasive surgical techniques with comparable long-term outcomes compared to TURP and OP. Nevertheless, the management of prostates larger than 100 ml remains a clinical challenge. Transurethral anatomical enucleation of the prostate utilizing different laser energy represents an excellent alternative concept in transurethral BPH surgery. These procedures gained popularity and demonstrated similar outcomes to OP with the advantages of favorable morbidity profiles and shorter catheter time and hospital stay. Despite the fact that OP remains a viable treatment option for patients with bothersome LUTS secondary to very large prostates, this procedure has been to a large extent replaced by these emerging enucleation techniques. Given the advent of surgical alternatives, the current review presents an evidence-based comparison of the efficacy and safety profile of the currently available transurethral laser techniques with the standard OP for the management of BPH due to adenomas larger than 100 ml.

  17. Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.

    Science.gov (United States)

    Inoue, Takaaki; Murota, Takashi; Okada, Shinsuke; Hamamoto, Shuzo; Muguruma, Kouei; Kinoshita, Hidefumi; Matsuda, Tadashi

    2015-09-01

    This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.

  18. Mini-percutaneous nephrolithotomy with high-power holmium YAG laser in pediatric patients with staghorn and complex calculi.

    Science.gov (United States)

    Bujons, Anna; Millán, Félix; Centeno, Clara; Emiliani, Esteban; Sánchez Martín, Francisco; Angerri, Oriol; Caffaratti, Jorge; Villavicencio, Humberto

    2016-08-01

    Shock wave lithotripsy (SWL) is the treatment of choice for most cases of renal lithiasis in children. Some cases, however, are refractory to SWL and may be associated with anatomic and metabolic changes or a large stone burden. In these circumstances, mini-percutaneous nephrolithotomy (mini-PCNL) is an option. The aim was to assess the safety and efficacy of high-power holmium YAG (Ho:YAG) laser in mini-PCNL for staghorn calculi. The clinical records relating to 35 mini-PCNLs (Table) performed between January 2008 and December 2012 in 33 patients (27 boys and 6 girls; mean age 7 years, range 2-18 years) were retrospectively reviewed. Twenty-two (66.7%) of the patients had undergone a previous SWL (28.6% three sessions). The mini-PCNL puncture technique used involved fluoroscopic guidance with the C arm at 0-90° in the supine position. An 18F tract was used. Stone fragmentation was performed with a high-power Ho:YAG laser (Lumenis 100 W). Ten of the mini-PCNLs (28.6%) were right sided, and 25 were left sided (71.4%). Stones were located in the lower calyceal group in 64% of patients and in the renal pelvis in 50%. The mean stone size was 4.46 cm(2) (range 3-13.20 cm(2)). The number of stones varied between one and 20, and 83.3% were radiopaque. The laser was set at 70 W (range 50-100 W) (3.5 J/pulse with a frequency of 20 pulses/s). The mean surgical time was 150 min. In 78% of patients, complete stone clearance was achieved, and the overall stone-free rate rose to 85% when residual stones were treated with either SWL or retrograde intrarenal surgery. No perioperative complications were seen. There are few reports in the literature concerning the use of a high-power laser for treatment of complex stones and the few that do exist relate to adults have similar results, showing it to be highly effective and safe, with low morbidity. Some limitations of the present study must be acknowledged. It was retrospective and a relatively small number of patients were

  19. Effects of temperature generated from the Holmium: YAG laser on human osteoblasts in monolayer tissue culture.

    Science.gov (United States)

    Hafez, Moustafa I; Sandison, Anne; Coombs, Richard R H; McCarthy, Ian D; Hafez, Al-Shymaa M

    2012-01-01

    With the use of lasers for ablation purposes in spinal surgery, the tissue temperature increases above the boiling point of water, leading to tissue ablation by vaporisation. Due to the thermal environment engendered by the use of lasers, there is concern about the safety of the surrounding important structures, such as dura mater, dorsal root ganglia, and nerve roots.

  20. In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser.

    Science.gov (United States)

    Bell, John Roger; Penniston, Kristina L; Nakada, Stephen Y

    2017-09-01

    To compare the performance of variable- and fixed-pulse lasers on stone phantoms in vitro. Seven-millimeter stone phantoms were made to simulate calcium oxalate monohydrate stones using BegoStone plus. The in vitro setting was created with a clear polyvinyl chloride tube. For each trial, a stone phantom was placed at the open end of the tubing. The Cook Rhapsody H-30 variable-pulse laser was tested on both long- and short-pulse settings and was compared to the Dornier H-20 fixed-pulse laser; 5 trials were conducted for each trial arm. Fragmentation was accomplished with the use of a flexible ureteroscope and a 273-micron holmium laser fiber using settings of 1 J × 12 Hz. The treatment time (in minute) for complete fragmentation was recorded as was the total retropulsion distance (in centimeter) during treatment. Laser fibers were standardized for all repetitions. The treatment time was significantly shorter with the H-30 vs the H-20 laser (14.3 ± 2.5 vs 33.1 ± 8.9 minutes, P = .008). There was no difference between the treatment times using the long vs short pulse widths of the H-30 laser (14.4 ± 3.4 vs 14.3 ± 1.7 minutes, P = .93). Retropulsion differed by laser type and pulse width, H-30 long pulse (15.8 ± 5.7 cm), H-30 short pulse (54.8 ± 7.1 cm), and H-20 (33.2 ± 12.5 cm) (P laser fragmented stone phantoms in half the time of the H-20 laser regardless of the pulse width. Retropulsion effects differed between the lasers, with the H-30 causing the least retropulsion. Longer pulse widths result in less stone retropulsion. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Laser properties of holmium and erbium in thorium-, zinc- and yttrium-based fluoride glass

    Science.gov (United States)

    Eyal, M.; Reisfeld, R.; Jørgensen, C. K.; Bendow, B.

    Optical properties of Ho(III)- and Er(III)-doped thorium-, zinc- and yttrium-based fluoride glasses are determined. Due to the large number of luminescent levels, it is possible to determine the multiphonon relaxation rates even for energy gaps smaller than 1900 cm -. Peak cross sections for laser action and threshold powers for infrared laser emissions are calculated and compared with literature data. It is shown that addition of other lanthanides significantly decreases the threshold power for laser action. The results indicate that a rare-earth-doped fluoride glass is a promising candidate for an integrated fiber optics system in which the rare earth laser is a part of the fiber.

  2. Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high-power holmium laser versus ultrasonic lithotripsy.

    Science.gov (United States)

    El-Nahas, Ahmed R; Elshal, Ahmed M; El-Tabey, Nasr A; El-Assmy, Ahmed M; Shokeir, Ahmed A

    2016-08-01

    To compare high-power holmium laser lithotripsy (HP-HLL) and ultrasonic lithotripsy (US-L) for disintegration of staghorn stones during percutaneous nephrolithotomy (PCNL). A non-inferiority randomised controlled trial was conducted between August 2011 and September 2014. Inclusion criteria were patients' aged >18 years who had complete staghorn stones (branching to the three major calyces), without contraindications to PCNL. Eligible patients were randomised between two groups: HP-HLL and US- . A standard PCNL in the prone position was performed for all patients. The only difference between the treatment groups was the method of stone disintegration. In the first group (HP-HLL), a laser power of 40-60 W (2 J, 20-30 Hz) was used to pulverise the staghorn stone into very small fragments, which could pass through the Amplatz sheath with the irrigation fluid. US-L,with suction of the fragments, was used in the second group. The primary outcome (stone-free rate) was evaluated with non-contrast computed tomography after 3 months. Secondary outcomes of complications, blood transfusion, operative time, and haemoglobin deficit were compared. The outcome assessor was 'blinded' to the treatment arm. The study included 70 patients (35 in each group). The baseline characteristics (age, sex, body mass index, side, stone volume, and density) and operative technique (number, size of tracts, and need for second PCNL session) were comparable for both groups. Operative time was significantly shorter in US-L group, at a mean (SD) of 130 (34) vs 148.7 (35) min (P = 0.028). The haemoglobin deficit was significantly more with in the US-L group, at a mean (SD) of 1.7 (0.9) vs 1.3 (0.6) g/dL (P = 0.037). The differences in blood transfusion (17% for US-L vs 11% for HP-HLL) and the complication rates (34% for US-L vs 23% for HP-HLL) were not significant (P = 0.495 and P = 0.290, respectively). The stone-free rates at 3 months were comparable (60% for US-L and 66% for HPL-L; P = 0

  3. Do We Really Need to Wear Proper Eye Protection When Using Holmium:YAG Laser During Endourologic Procedures? Results from an Ex Vivo Animal Model on Pig Eyes.

    Science.gov (United States)

    Villa, Luca; Cloutier, Jonathan; Compérat, Eva; Kronemberg, Peter; Charlotte, Frederic; Berthe, Laurent; Rouchausse, Yann; Salonia, Andrea; Montorsi, Francesco; Traxer, Olivier

    2016-03-01

    We sought to evaluate the effect of holmium:yttrium-aluminum-garnet (Ho:YAG) laser exposure on ex vivo pig eyes and to test the protective action of different glasses in preventing eye lesions in case of accident. We pointed the tip of a Ho:YAG laser fiber from different distances (0, 3, 5, 8, 10, and 20 cm, respectively) toward the center of the pupil of the pig eye. The Ho:YAG laser was activated for 1 or 5 seconds at three different settings (0.5 J-20 Hz, 1 J-10 Hz, and 2 J-10 Hz, respectively). The experiment was repeated using laser safety glasses and eyeglasses. A total of 78 pig eyes were used. The effects of the Ho:YAG laser on pig eyes were assessed by histopathology. Comparable laser emission experiments were performed on thermal paper at different distances using different pulse energies. Ho:YAG laser-induced corneal lesions were observed in unprotected eyes, ranging from superficial burning lesions to full-thickness necrotic areas, and were directly related to pulse energy and time of exposure and inversely related to the distance from the eye. When the laser was placed 5 cm or more, no corneal damage was observed regardless of the laser setting and the time of exposure. Similar distance/energy level relationships were observed on thermal paper. No damage was observed to the lens or the retina in any of the Ho-YAG laser-treated eyes or in any of the eyes protected by laser safety and eyeglasses. Ho:YAG lasers can cause damage when set to high energy, but only to the cornea, from close distances (0-5 cm) and in the absence of eye protection. Eyeglasses are equally effective in preventing laser damage as laser safety glasses.

  4. Different lasers in the treatment of benign prostatic hyperplasia: a network meta-analysis

    Science.gov (United States)

    Zhang, Xingming; Shen, Pengfei; He, Qiying; Yin, Xiaoxue; Chen, Zhibin; Gui, Haojun; Shu, Kunpeng; Tang, Qidun; Yang, Yaojing; Pan, Xiuyi; Wang, Jia; Chen, Ni; Zeng, Hao

    2016-01-01

    All available surgical treatments for benign prostatic hyperplasia (BPH) have their individual advantages or disadvantages. However, the lack of head-to-head studies comparing different surgeries makes it unavailable to conduct direct analysis. To compare the efficacy and safety among different lasers and transurethral resection of prostate (TURP) for BPH, randomized controlled trials were searched in MEDLINE, EMBASE, Cochrane library, WHO International Clinical Trial Registration Platform, and Clinical Trial.gov by 2015.5; and the effectiveness-, perioperation- and complication-related outcomes were assessed by network meta-analysis. 36 studies involving 3831 patients were included. Holmium laser through resection and enucleation had the best efficacy in maximum flow rate. Thulium laser through vapo-resection was superior in improving international prostate symptom score and holmium laser through enucleation was the best for post-voiding residual volume improvement. Diode laser through vaporization was the rapidest in removing postoperative indwelling catheter, while TURP was the longest. TURP required the longest hospitalization and thulium laser through vapo-resection was relatively shorter. Holmium and thulium lasers seem to be relatively better in surgical efficacy and safety, so that these two lasers might be preferred in selection of optimal laser surgery. Actually, more large-scale and high quality head-to-head RCTs are suggested to validate the conclusions. PMID:27009501

  5. Stone Attenuation Values Measured by Average Hounsfield Units and Stone Volume as Predictors of Total Laser Energy Required During Ureteroscopic Lithotripsy Using Holmium:Yttrium-Aluminum-Garnet Lasers.

    Science.gov (United States)

    Ofude, Mitsuo; Shima, Takashi; Yotsuyanagi, Satoshi; Ikeda, Daisuke

    2017-04-01

    To evaluate the predictors of the total laser energy (TLE) required during ureteroscopic lithotripsy (URS) using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for a single ureteral stone. We retrospectively analyzed the data of 93 URS procedures performed for a single ureteral stone in our institution from November 2011 to September 2015. We evaluated the association between TLE and preoperative clinical data, such as age, sex, body mass index, and noncontrast computed tomographic findings, including stone laterality, location, maximum diameter, volume, stone attenuation values measured using average Hounsfield units (HUs), and presence of secondary signs (severe hydronephrosis, tissue rim sign, and perinephric stranding). The mean maximum stone diameter, volume, and average HUs were 9.2 ± 3.8 mm, 283.2 ± 341.4 mm3, and 863 ± 297, respectively. The mean TLE and operative time were 2.93 ± 3.27 kJ and 59.1 ± 28.1 minutes, respectively. Maximum stone diameter, volume, average HUs, severe hydronephrosis, and tissue rim sign were significantly correlated with TLE (Spearman's rho analysis). Stepwise multiple linear regression analysis defining stone volume, average HUs, severe hydronephrosis, and tissue rim sign as explanatory variables showed that stone volume and average HUs were significant predictors of TLE (standardized coefficients of 0.565 and 0.320, respectively; adjusted R2 = 0.55, F = 54.7, P attenuation values measured by average HUs and stone volume were strong predictors of TLE during URS using Ho:YAG laser procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Effects of retroperitoneal laparoscopic ureterolithotomy and flexible-ureteroscopic holmium laser lithotripsy for complex upper ureteral calculi].

    Science.gov (United States)

    Zhang, L J; Wu, B; Zha, Z L; Zhao, H; Yang, W; Chen, X H; Jiang, B; Huang, Q; Li, W J; Yuan, J

    2017-10-01

    Objective: To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. Methods: A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ(2)test. Results: The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ(2)=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ(2)=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Conclusions: Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of

  7. The safety and efficacy of front-firing green-light laser endoscopic en bloc photoselective vapo-enucleation of non-muscle-invasive bladder cancer

    Science.gov (United States)

    Cheng, Bo; Qiu, Xiaofu; Li, Huanhui; Yang, Guosheng

    2017-01-01

    Purpose Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer (NMIBC). However, the clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we investigated the efficacy and safety of the 120-W front-firing KTP laser for the treatment of NMIBC. Methods A total of 64 patients with NMIBC treated with either a 120-W front-firing KTP-photoselective vapo-enucleation of the bladder tumor (PVEBT, n=34) or transurethral resection of the bladder tumor (TURBT, n=30) were included. En bloc resection was applied to the patients in PVEBT group. Results There was no significant difference in rinsing time (P=0.292), indwelling catheter (P=0.080), pathologic type, and T stage (P=0.870) between the two groups. Compared with the TURBT group, patients treated with PVEBT had a shorter hospitalization stay (P=0.044), a shorter operation time (P=0.008), and a lower muscle miss rate (P=0.044). PVEBT is superior to TURBT in terms of the rate of 1-year recurrence (P=0.015) and tumor grade progression rate (P=0.019). Conclusion The 120-W front-firing KTP laser en bloc enucleation technique is a safe and feasible procedure for treating patients with NMIBC. Further external validation in larger cohorts with a long follow-up period is warranted. PMID:28860782

  8. The safety and efficacy of front-firing green-light laser endoscopic en bloc photoselective vapo-enucleation of non-muscle-invasive bladder cancer.

    Science.gov (United States)

    Cheng, Bo; Qiu, Xiaofu; Li, Huanhui; Yang, Guosheng

    2017-01-01

    Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer (NMIBC). However, the clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we investigated the efficacy and safety of the 120-W front-firing KTP laser for the treatment of NMIBC. A total of 64 patients with NMIBC treated with either a 120-W front-firing KTP-photoselective vapo-enucleation of the bladder tumor (PVEBT, n=34) or transurethral resection of the bladder tumor (TURBT, n=30) were included. En bloc resection was applied to the patients in PVEBT group. There was no significant difference in rinsing time (P=0.292), indwelling catheter (P=0.080), pathologic type, and T stage (P=0.870) between the two groups. Compared with the TURBT group, patients treated with PVEBT had a shorter hospitalization stay (P=0.044), a shorter operation time (P=0.008), and a lower muscle miss rate (P=0.044). PVEBT is superior to TURBT in terms of the rate of 1-year recurrence (P=0.015) and tumor grade progression rate (P=0.019). The 120-W front-firing KTP laser en bloc enucleation technique is a safe and feasible procedure for treating patients with NMIBC. Further external validation in larger cohorts with a long follow-up period is warranted.

  9. Application of the holmium:YAG laser for refractive surgery III

    Science.gov (United States)

    Thompson, Vance M.; Seiler, Theo; Sacharoff, Alex C.; Durrie, Daniel S.; Aran, Alberto J.; Barnet, Ronald W.; Dulaney, David D.; Hurt, Art C., III; Mann, P. M.; Sawelson, Harold; Yanoff, Myron; Muller, David F.

    1994-06-01

    We update the continued progress of laser thermokeratoplasty (LTK) clinical trials being conducted in the U.S. for the treatment of hyperopia and hyperopic astigmatism. Data from the Phase II hyperopia investigations on 25 patients and from Phase I astigmatism trials on 30 patients is reviewed. From the hyperopia Phase IIa study, the near uncorrected visual acuity of 13 patients for whom complete follow-up results are available at 1 year shows that all 13 patients gained 2 or more lines of visual acuity (Ave. gain 3.5 lines), which indicates a significant improvement in near vision. A survey given to these hyperopia patients finds 8% could read without glasses preoperatively versus 58.3% at 1 year post-operatively. The preoperative uncorrected visual acuity of those patients treated for astigmatism in the Phase I trial showed 2 out of 30 patients or 6.7% seeing better than 20/40 versus 10 out of 27 patients or 37% at one year post-op. The one year data in both studies indicates that after an initial period of partial regression of effect, the residual correction remains relatively stable between 6 months and 1 year. Continued follow-up will be carried out to see if the corrections remain stable beyond 1 year.

  10. Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis.

    Science.gov (United States)

    Redondo, C; Ramón de Fata, F; Gimbernat, H; Meilán, E; Andrés, G; Angulo, J C

    2015-06-01

    retrograde intrarenal surgery (RIRS) appears as a safe and effective technique as well as a good therapeutic alternative to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL). descriptive study in 50 patients surgically treated between November 2012 and April 2013. Demographic, operative and postoperative data as well as early and late complications data were collected. The minimum follow-up of patients was one year. Surgery was performed under general anesthesia. Flexible ureteroscopy with ureteral access sheath and laser fragmentation were employed. Surgery success was defined as stone free rate in postoperative control test and at three months after surgery (simple radiography, abdominal ultrasound or CT without contrast). mean age was 51.1±15.5 years old. The highest-frequency location was the lower calyceal group (26%), single stones were described in 58% of patients whilst multiple lithiasis were found in the 42%. Regarding the stone burden in 44% of the patients was low (3 cm) in 22% of the patients. The stone clearance rate was 89.7±17.5. Average surgery time was 96.6±35.2min. Complications were reported in 4 patients (8%), all of them early ones and minor in nature. RIRS is an effective and safe option whose results are comparable to ESWL and PCNL. RIRS can be considered as first-line treatment. These results are corroborated by numerous studies. To strengthen these findings, prospective studies focusing on quality of life, length of stay, complications and cost-effectiveness of different treatments are needed. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Titanium Dioxide (TiO2) film as a new saturable absorber for generating mode-locked Thulium-Holmium doped all-fiber laser

    Science.gov (United States)

    Mohd Rusdi, Muhammad Farid; Latiff, Anas Abdul; Paul, Mukul Chandra; Das, Shyamal; Dhar, Anirban; Ahmad, Harith; Harun, Sulaiman Wadi

    2017-03-01

    We report the generation of mode-locked thulium-holmium doped fiber laser (THDFL) at 1979 nm. This is a first demonstration of mode-locked by using Titanium Dioxide (TiO2) film as a saturable absorber (SA). A piece of 1 mm×1 mm TiO2 film was sandwiched in between two fiber ferrule in the cavity. Fabrication process of TiO2 film incorporated a TiO2 and a polyvinyl alcohol (PVA). The stable 9 MHz repetition rate of mode-locked mode operation with 58 dB SNR was generated under pump power of 902-1062 mW. At maximum pump power, the mode-locked THDFL has output power and pulse energy of 15 mW and 1.66 nJ, respectively. Our results demonstrate the TiO2 can be used promisingly in ultrafast photonics applications.

  12. Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia

    Directory of Open Access Journals (Sweden)

    Si-Jun Wang

    2017-01-01

    Full Text Available To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate (PKEP for the treatment of symptomatic benign prostatic hyperplasia (BPH compared with 160-W lithium triboride laser photoselective vaporization of the prostate (PVP. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time (38.14 ± 23.64 h vs 72.54 ± 28.38 h, P< 0.001 and hospitalization (2.32 ± 1.25 days vs 4.07 ± 1.23 days, P< 0.001 were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score (IPSS (4.07 ± 2.07 vs 5.00 ± 2.10; P< 0.001, quality of life (QoL (1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007, maximal urinary flow rate (Qmax (24.75 ± 5.87 ml s−1 vs 22.03 ± 5.04 ml s−1 ; P< 0.001, postvoid residual urine volume (PVR (14.29 ± 6.97 ml vs 17.00 ± 6.11 ml; P= 0.001, and prostate-specific antigen (PSA value (0.78 ± 0.57 ng ml−1 vs 1.27 ± 1.07 ng ml−1 ; P< 0.001. Both PKEP and PVP relieve low urinary tract symptoms (LUTS due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKEP. Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.

  13. The safety and efficacy of front-firing green-light laser endoscopic en bloc photoselective vapo-enucleation of non-muscle-invasive bladder cancer

    Directory of Open Access Journals (Sweden)

    Cheng B

    2017-08-01

    Full Text Available Bo Cheng,1,2 Xiaofu Qiu,1 Huanhui Li,1 Guosheng Yang1 1Department of Urology, Southern Medical University affiliated Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China Purpose: Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer (NMIBC. However, the clinical evidence for potassium-titanyl-phosphate (KTP laser en bloc resection is still limited. Here, we investigated the efficacy and safety of the 120-W front-firing KTP laser for the treatment of NMIBC.Methods: A total of 64 patients with NMIBC treated with either a 120-W front-firing KTP-photoselective vapo-enucleation of the bladder tumor (PVEBT, n=34 or transurethral resection of the bladder tumor (TURBT, n=30 were included. En bloc resection was applied to the patients in PVEBT group.Results: There was no significant difference in rinsing time (P=0.292, indwelling catheter (P=0.080, pathologic type, and T stage (P=0.870 between the two groups. Compared with the TURBT group, patients treated with PVEBT had a shorter hospitalization stay (P=0.044, a shorter operation time (P=0.008, and a lower muscle miss rate (P=0.044. PVEBT is superior to TURBT in terms of the rate of 1-year recurrence (P=0.015 and tumor grade progression rate (P=0.019.Conclusion: The 120-W front-firing KTP laser en bloc enucleation technique is a safe and feasible procedure for treating patients with NMIBC. Further external validation in larger cohorts with a long follow-up period is warranted. Keywords: bladder cancer, transurethral resection, en bloc, laser surgery, recurrence

  14. Ureteroscopic Holmium Lasertripsy for Treatment of Impacted ...

    African Journals Online (AJOL)

    Objective: To evaluate the effi cacy and safety of Holmium: YAG laser lithotripsy for the treatment of impacted ureteral stones. Patients and Methods: From January 2000 to January 2007, 150 patients (105 males and 45 females) with impacted ureteral stones were treated at the Urology Department of the Assiut University ...

  15. Original Article Ureteroscopic Holmium Lasertripsy for Treatment

    African Journals Online (AJOL)

    Objective: To evaluate the efiicacy and safety of Holmium: YAG laser lithotripsy for the treatment of impacted ureteral stones. Patients and Methods: From January 2000 to January 2007, 150 patients (105 males and 45 females) with impacted ureteral stones were treated at the Urology Department of the Assiut. University ...

  16. In vitro study of morphological and chemical modification threshold of bovine dental enamel irradiated by the holmium laser; Estudo in vitro das alteracoes morfologicas e quimicas do esmalte dental bovino irradiado pelo laser de holmio

    Energy Technology Data Exchange (ETDEWEB)

    Eduardo, Patricia Lerro de Paula

    2001-07-01

    The aim of this study is to investigate the Ho:YLF laser effects on the dental enamel surface with regards to its morphology, thermal variations during its irradiation in the pulp chamber and its increased resistance to demineralization through quantitative analysis of calcium and phosphorous atoms reactive concentrations in samples. Twenty samples of bovine enamel were used and divided in four groups: control - acidulated phosphate fluoride (APF) application followed by demineralization treatment with lactic acid; irradiation with Ho:YLF laser (100 J/cm{sup 2}) followed by APF topic application and demineralization treatment with lactic acid; irradiation with Ho:YLF laser (350 J/cm{sup 2}) followed by APF topic application and demineralization treatment with lactic acid: and irradiation with Ho:YLF laser ( 450 J/cm{sup 2}) followed by APF topic application and demineralization treatment with lactic acid. Ali samples were quantified according to their calcium and phosphorous atoms relative concentrations before and after the treatments above. X-Ray fluorescence spectrochemical analysis and scanning electron microscopy were carried out. It was observed an increase on the calcium and phosphorous atoms concentration ratio and therefore the enamel demineralization reduction as a result of the lactic acid treatment in the samples irradiated with the holmium laser followed by the APF application. In order to evaluate the feasibility of this study for clinical purposes, morphological changes caused by the holmium laser irradiation were analyzed. Such modifications were characterized by melted and re-solidified regions of the enamel with consequent changes on its permeability and solubility. Temperature changes of ten human pre-molars teeth irradiated with 350 J/cm{sup 2} and 450 J/cm{sup 2} were also monitored in the pulp chamber in real time. Temperature increases over 4,20 C did not occur. The results obtained from this study along with the results from previous

  17. Evolving transurethral resection of the prostate: enucleation-resection of the prostate.

    Science.gov (United States)

    Galanakis, Ioannis P; Celia, Antonio; Del Biondo, Dario; Zeccolini, Gugleilmo; Caruso, Adara; Silvestre, Pasquale; Giunta, Angelo; Breda, Guglielmo

    2010-12-01

    Enucleation-transurethral resection of the prostate (e-TURP) is our evolution of the conventional TURP. The aim of this study was to report our experience with e-TURP for the endoscopic management of benign prostatic hyperplasia (BPH). The e-TURP combines the basic steps of classic TURP with the technique of holmium laser enucleation of the prostate (HoLEP) but using only the bipolar resector. The charts of 64 patients who underwent e-TURP for BPH in our department between October 2005 and October 2009 were retrospectively studied. The mean resected tissue weight was 27.21 g, and the mean operative time was 75.7 min. The mean decreases in hemoglobin and serum sodium levels were 1.63 g/dL and 0.55 mEq/L, respectively. Mean catheter duration was 2.53 days, and the mean total hospitalization time was 3.75 days. There was a significant improvement in urinary peak flow rate (Qmax) 2 months postoperatively (P = 0.009718), as well as a significant decrease in the International Prostate Symptom Score during the same period (P < 0.0001). No major complications were observed, and the rates for early and late complications were 10% and 5%, respectively, at 14.75-month mean follow-up. The e-TURP seems to be a safe and effective method for the endoscopic management of BPH. Further investigation with randomized trials is needed on this matter.

  18. Optimized evaluation of a pulsed 2.09 microns holmium:YAG laser impact on the rat brain and 3 D-histomorphometry of the collateral damage.

    Science.gov (United States)

    Ludwig, H C; Bauer, C; Fuhrberg, P; Teichmann, H H; Birbilis, T; Markakis, E

    1998-12-01

    Since more than 20 years CO2 and Nd:YAG lasers are established in the microsurgery of the nervous system. CO2 lasers can be used handheld, but may be focused on the target area by mirror optics and sideports of the operating microscope's micromanipulator. Nd:YAG lasers have the disadvantage of deep penetration into the brain and provocation of a large collateral damage. The need is for a fibre conducted solid system for surgery in delicate areas as for brain stem surgery. Fibre conduction of near infrared lasers allows better exposure of the target area compared to hollow wave guides or mirror equipment. Fibres can be tapered and modified according to the purpose. The holmium:YAG (Ho:YAG) laser has acquired interest by introducing the system into microsurgery of parenchymal tissue. They have not been proven yet sufficiently for neurosurgical tasks. The effort to minimalize the collateral tissue damage has to be maximalized in the surgery of nervous tissue and functional low redundant brain stem or spinal cord tissue. Volumetric data may be more precise in comparison to depth and width data of the laser lesion even when the different levels of the tissue interaction have to be analyzed for estimation of the real side effects in nervous tissue. We have used 50-800 ml delivered Ho:YAG single pulses in cortical areas of Sprague-Dawley rats and investigated the different lesion zones by volumetric data. The functional lesion zone was detected and measured by immunohistological staining of the heat shock protein HSP 72. For further reduction of the focus area, we have used tapered 400 to 200 microns fibres.

  19. Low-power holmium:YAG laser urethrotomy for urethral stricture disease: Comparison of outcomes with the cold-knife technique

    Directory of Open Access Journals (Sweden)

    Mustafa Atak

    2011-11-01

    Full Text Available In this prospective randomized clinical trial, we aimed to evaluate the safety and efficacy of endourethrotomy with holmium:yttrium-aluminium-garnet (HO:YAG laser and compare the outcomes with the conventional cold-knife urethrotomy. Fifty-one male patients with single, iatrogenic, annular strictures of the urethra were randomly divided into two groups; 21 patients who underwent direct-vision endoscopic urethrotomy with Ho:YAG laser (15 W; 1,200–1,400 mJ; 8–12 Hz at 12 o’clock position (laser group and 30 patients who underwent direct-vision endoscopic urethrotomy with cold-knife incision at 12 o’clock position (cold-knife group. The results obtained were analyzed and compared at 3 months, 6 months, 9 months, and 12 months postoperatively by clinical evaluation, uroflowmetry, and retrograde urethrographies. Variables were compared among groups using Fisher’s exact and Mann Whitney U tests. There were no differences between two groups in terms of patient age, preoperative Qmax value, stricture location, and length. Operative time was shorter in laser group (16.4±8.04 minutes when compared with cold-knife group (23.8±5.47 minutes (p<0.001. Recurrence-free rate at 3 months was similar between two groups (p=0.122. However, recurrence-free rates at 6 months, 9 months, and 12 months were significantly higher in laser group when compared with cold-knife group (p values were 0.045, 0.027, and 0.04, respectively. No intra- or postoperative complications were encountered. Use of Ho:YAG laser in the management of urethral stricture disease is a safe and effective method. In addition, it provides shorter operative time and lower recurrence rate when compared with the conventional technique.

  20. Against the motion: Lasers are superfluous for the surgical management of benign prostatic hyperplasia in the developing world

    Directory of Open Access Journals (Sweden)

    Anil Varshney

    2009-01-01

    Full Text Available Lasers have arrived in a big way for the management of benign prostatic hyperplasia. The most common ones in use are holmium, potassium titanyl phosphate (KTP and thulium.They remove the prostatic adenoma either by way of enucleation or ablation. Backed by numerous studies that prove their safety, efficacy and durability, lasers score over TURP in several ways. Their use is associated with less blood loss, shorter catheter time and decreased hospital stay. The fluid absorption during laser prostatectomy is negligible and thus makes it safer for use in cardiac patients. Also there is no chance of a transurethral resection syndrome, the incidence of which is approximately 2% with TURP. Due to superior hemostatic capabilities and non interference lasers can be used in patients on anti coagulants, cardiac pacemaker. Another advantage of laser over TURP is its ability to deal with prostates that are larger in size especially holmium laser which has been used to enucleate glands more than 300 g in size thus completely avoiding the need for open prostatectomy. The amount of tissue removed with enucleation is more thus retreatment rates are less than that of TURP. The initial cost of laser is higher but its capability to treat stones, its use in high risk situations, less morbidity, short hospital stay, and durable results make it an attractive option to treat BPH even in the developing world.

  1. Holmium:YAG Laser Ablation for the Management of Lower Urinary Tract Foreign Bodies Following Incontinence Surgery: A Case Series and Systematic Review.

    Science.gov (United States)

    Chan, Garson; Mamut, Adiel; Martin, Paul; Welk, Blayne

    2016-11-01

    The objective of this study was to determine the outcomes associated with the endoscopic removal of foreign bodies (such as mesh or permanent suture) in the lower urinary tract after female stress incontinence surgery with the Holmium:YAG (Ho:YAG) laser, and to systematically review the literature on this topic. A retrospective chart review of 18 consecutive women found to have mesh or suture exposure was performed. All patients underwent Ho:YAG laser ablation. A systematic review was performed to identify literature addressing the endoscopic management of mesh/suture exposure after stress incontinence surgery. Between November 2011 and February 2016, 18 women underwent Ho:YAG laser ablation of exposed mesh or suture. Presenting symptoms included lower urinary tract symptoms, pelvic pain, incontinence, or recurrent urinary tract infections. Thirteen women had a previous synthetic midurethral sling and five had a prior retropubic suspension. The median age was 58 years (interquartile range [IQR] 50-60) and median follow-up was 2 years (IQR 1-2). Four patients (22%) had residual mesh after the first procedure, requiring a repeat endoscopic procedure. Only one patient had a small amount of asymptomatic residual mesh on cystoscopy after the final procedure. Only minor postoperative complications were observed. Eight patients had stress incontinence and four underwent operative treatment for this. In our systematic review, we identified 16 case series, which described a total of 158 patients. Women most commonly presented with voiding symptoms or incontinence. Based on the synthesis of these data, repeat procedures were necessary in 16% and vesicovaginal fistula occurred in 2%. Recurrent/persistent stress incontinence was present in 20%, and of these patients, 3/4 underwent a new stress incontinence procedure. Both our case series and the systematic review of the literature demonstrated that endoscopic treatment of lower urinary tract foreign bodies after stress

  2. Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction

    Science.gov (United States)

    Barbalat, Yana; Velez, Marissa C.; Sayegh, Christopher I.; Chung, Doreen E.

    2016-01-01

    In 2005, the high power thulium laser was introduced for the surgical treatment of benign prostatic obstruction. It has several properties that confer theoretical advantages over other lasers used for the same indication, such as technical versatility and a relatively small zone of thermal damage. Studies using the 70–150 W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications even in higher risk patients. Different techniques have been employed to treat the prostate with this technology, including enucleation, vapoenucleation, vaporization and resection. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP and holmium laser enucleation of prostate (HoLEP). In this review we discuss the current literature on the safety and efficacy of various thulium techniques for the treatment of benign prostatic hyperplasia and examine comparative studies. PMID:27247628

  3. Postoperative Lower Urinary Tract Storage Symptoms: Does Prostate Enucleation Differ from Prostate Vaporization for Treatment of Symptomatic Benign Prostatic Hyperplasia?

    Science.gov (United States)

    Elkoushy, Mohamed A; Elshal, Ahmed M; Elhilali, Mostafa M

    2015-10-01

    To assess the degree of postoperative storage symptoms after GreenLight™ laser photoselective vaporization of the prostate (PVP) and Holmium laser enucleation of the prostate (HoLEP) for management of benign prostatic hyperplasia (BPH) and its predictors. A retrospective review was performed for patients who underwent HoLEP or PVP for non catheter-dependent patients with BPH. Patients were followed up at 1, 3, 6, and 12 months and then annually by International Prostate Symptoms Score (IPSS), quality of life index, peak flow rate, residual urine volume, and prostate-specific antigen (PSA) level. Moderate or severe storage symptoms were defined as IPSS storage subscore ≥ 9. Of 1673 laser procedures, a total of 1100 procedures met the inclusion criteria including 809 HoLEPs and 291 PVPs. The HoLEP group had significantly larger preoperative prostates and longer operative time. In the HoLEP group, postoperative IPSS was significantly better than in the PVP group at all follow-up points (P100 minutes, and lower percent of postoperative PSA level reduction significantly predicted less improvement of postoperative storage symptoms regardless of the laser procedure. Storage urinary symptoms significantly improved more after HoLEP compared with PVP, irrespective of the generation of GreenLight laser used. Recovery from bothersome storage urinary symptoms after prostate vaporization is time dependent, and baseline degree of storage symptoms, prolonged operative time, and lower percent of postoperative PSA level reduction negatively predicts postoperative improvement of storage symptoms regardless of the laser procedure.

  4. Transurethral enucleation of large benign prostatic hyperplasia in sodium chloride solution

    Directory of Open Access Journals (Sweden)

    I. N. Shvarev

    2016-01-01

    Full Text Available Background. Transurethral resection is a generally recognized treatment for small to medium-sized benign prostatic hyperplasia (BPH. Numerous original tools are proposed for surgery of large BPH. These include laser (holmium laser enucleation of the prostate and transurethral (transurethral enucleation with bipolar (TUEB enucleation in 0.9 % NaCl solution, which are accompanied by removal of the maximum adenoma tissue volume, short-term recovery, and a substantially fewer early and late complications.Objective: to evaluate the safety and efficiency of TUEB in patients with large BPH.Subjects and methods. TUEB was carried out in 58 patients with large BPH. Their mean age was 64 years. The gland size was ≥ 102 сm3. The residual urine volume in all the patients was more than 100 ml. One year later, the results of treatment were analyzed using the International Prostate Symptom Score (IPSS, Quality of Life (QoL Questionnaire, as well as from residual urine volume and remaining prostate tissue.Results. The mean time of surgery and enucleation was 90 and 55 min, respectively. The mean volume of removed adenoma tissue was 99 ml. By the end of month 2 following TUEB, there was a progressive reduction in the total IPSS and QoL scores from 35 to 7 and from 5 to 1, respectively, which preserved this trend by the end of a 1-year follow-up. study. The residual urine amount was less than 30 ml. The mean volume of the prostate tissue left was 8.5 сm3 and less than 11.0 сm3. The ultrasound anatomy of the prostatic urethra (transformation of thin-walled spherical TUR defect that is characteristic slit-like one resembles the inverted letter Y eventually formed by the end of the 1-year follow-up. Stricture of the urethra and contracture of the bladder neck were noted in none of the cases. Conclusion. TUEB is an alternative to open surgery in patients with the enlarged prostate. The use of isotonic NaCl solution as washing fluid allows one to plan

  5. A novel vaporization-enucleation technique for benign prostate hyperplasia using 120-W HPS GreenLight™ laser: Seoul technique II in comparison with vaporization and previously reported modified vaporization-resection technique.

    Science.gov (United States)

    Yoo, Sangjun; Park, Juhyun; Cho, Sung Yong; Cho, Min Chul; Jeong, Hyeon; Son, Hwancheol

    2017-12-01

    We developed a novel vaporization-enucleation technique (Seoul II), which consists of vaporization-enucleation of the prostate using 120-W HPS GreenLight laser, and enucleated prostate resection using bipolar devices for tissue removal. We compared the outcomes of the Seoul II with vaporization and a previously reported modified vaporization-resection technique (Seoul I). Among patients with benign prostate hyperplasia who underwent transurethral surgery using GreenLight laser at our institute, 347 patients with prostate volume ≥ 40 ml were included. The impact of surgical techniques on efficacy and postoperative functional outcomes was compared. No difference was found in baseline characteristics, although the prostate volume was marginally greater in Seoul II (p = 0.051). Prostate volume reduction per operation time (p techniques. In multivariate analysis, postoperative 12-month I-PSS for Seoul II was significantly superior to vaporization (p vaporization (p = 0.014) and Seoul I (p = 0.048). Seoul II showed improved efficacy and voiding functional maintenance over postoperative 12 months in patients with prostate volume ≥ 40 ml compared with vaporization and Seoul I. This technique could be easily accepted by clinicians who are familiar with GreenLight lasers and add flexibility to surgery without additional equipment.

  6. New techniques for laser prostatectomy: an update

    Science.gov (United States)

    Chung, Doreen E.; Te, Alexis E.

    2009-01-01

    Traditionally, the gold standard for treatment of BPH has been the electrocautery-based TransUrethral Resection of the Prostate (TURP). However, the number of laser techniques being performed is rapidly increasing. Potential advantages of laser therapy over traditional TURP include decreased morbidity and shorter hospital stay. There are several techniques for laser prostatectomy that continue to evolve. The main competing techniques are currently the Holmium Laser Enucleation of the Prostate (HoLEP) and the 80W 532nm laser prostatectomy. The HoLEP, using the Holmium:YAG laser, has been shown to have clinical results similar to TURP and is suitable for patients on anticoagulation as well as those with large prostates. Disadvantages of this technique are the high learning curve and requirement of a morcellator. When used to treat BPH, studies have demonstrated that, like the HoLEP, the 80W KTP laser is safe and effective in patients with large prostates and in those taking oral anticoagulation. Several studies have compared these two techniques to TURP. Frequently reported advantages of the HoLEP over the 80W laser prostatectomy are the availability after the procedure of a pathology specimen and ability to remove a higher percentage of prostate tissue during resection. However, the transurethral laser enucleation of the prostate addresses these concerns and has shown to have durable outcomes at 2-year follow-up. Two new laser systems and techniques, the thulium laser and the 980nm laser, have emerged recently. However, clinical data from these procedures are in their infancy and large long-term studies are required. PMID:21789057

  7. Holmium:YAG laser ablation of upper urinary tract transitional cell carcinoma with new Olympus digital flexible ureteroscope.

    Science.gov (United States)

    Abad, Pablo Garrido; Del Peso, Almudena Coloma; Arjona, Manuel Fernández

    2013-07-01

    Upper urinary tract transitional (UUTT) cell carcinoma is a relatively uncommon urologic tumor. The traditional treatment approach for them is radical nephroureterectomy. However, in recent years, less-invasive treatments, including different nephron-sparing procedures, have become increasingly popular. We report a case of laser ablation of UUTT cell carcinoma using new Olympus digital flexible ureteroscope (URF-V).

  8. Holmium Doped Solid State Laser Resonantly Pumped and Q-Switched by Novel GaSb-Based Photonic Devices

    Science.gov (United States)

    2011-08-31

    Schmitz, M. Walther, et al., “Strain adjustment in (GaIn)(AsSb)/( AlGa )(AsSb) QWs for 2.3-2.7 µm laser structures ”, J. Crystal Growth, Vol. 209, p.15...ridge waveguide structure by wet etching of the p-cladding layer outside of the 100 μm wide current stripes. For CW characterization the bars were...somewhat with current. The corresponding near field pattern clearly shows filamentation with an average filament spacing of about 12 µm (Figure 4b

  9. Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes.

    Science.gov (United States)

    Bozzini, G; Seveso, M; Melegari, S; de Francesco, O; Buffi, N M; Guazzoni, G; Provenzano, M; Mandressi, A; Taverna, G

    2017-06-01

    To compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. The study randomized 208 consecutive patients with BPH to ThuLEP (n=102) or TURis (n=106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). The patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70minutes, P=.123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dL, P=.005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P=.011), irrigation volume (29.4 vs 69.2 L, P=.002), and hospital stay (1.7 vs 5.2 days, P=.016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. ThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Holmium thin-disk laser based on Ho:KY(WO4)2/KY(WO4)2 epitaxy with 60% slope efficiency and simplified pump geometry.

    Science.gov (United States)

    Mateos, Xavier; Lamrini, Samir; Scholle, Karsten; Fuhrberg, Peter; Vatnik, Sergei; Loiko, Pavel; Vedin, Ivan; Aguiló, Magdalena; Díaz, Francesc; Griebner, Uwe; Petrov, Valentin

    2017-09-01

    We report on the first holmium (Ho3+) monoclinic double tungstate thin-disk laser. It is based on a 250 μm thick 3 at. % Ho:KY(WO4)2 active layer grown on a (010)-oriented KY(WO4)2 substrate. When pumped by a Tm-fiber laser at 1960 nm with a single-bounce (single double-pass) pump geometry, the CW Ho:KY(WO4)2 thin-disk laser generated 1.01 W at 2057 nm, corresponding to a slope efficiency η of 60% and a laser threshold of only 0.15 W. Implementing a double-bounce (second double-pass) for the pump, the output of this laser was scaled to 1.57 W with η=55%. The maximum stimulated emission cross section σSE of the Ho3+ ions in the epitaxial layer reaches 2.5×10-20  cm2 at 2056.5 nm for E‖Nm. The Ho:KY(WO4)2 epitaxial structures are promising for multi-watt mode-locked thin-disk lasers at ∼2.06  μm.

  11. NON-STENTED HOLMIUM:YAG URETEROSCOPIC ...

    African Journals Online (AJOL)

    Objectif Evaluer les résultats cliniques de la lithotritie par Laser Holmium-YAG sans drainage uré-téral, quant à l'efficacité, la sécurité, la douleur post-opératoire et la durée du séjour hospitalier. Patients and Méthodes Trente cinq patients présentant un calcul du bas uretère ont bénéficié d'une urétéroscopie sans dilatation ...

  12. Microspheres with an ultra high holmium content for brachytherapy of malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Lira, Raphael A.; Myamoto, Douglas M.; Souza, Jaime R.; Nascimento, Nanci; Azevedo, Mariangela de Burgos M. de [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Biotecnologia; Osso Junior, Joao A. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Radiofarmacia; Martinelli, Jose R. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Ciencias e Tecnologia de Materiais

    2011-07-01

    The overall objective of this work is to develop biodegradable microspheres intended for internal radiation therapy which provides an improved treatment for hepatic carcinomas. The most studied brachytherapy system employing microspheres made of holmium-biopolymer system is composed by poly(L-lactic acid) (PLLA) and holmium acetylacetonate (HoAcAc). The importance of the holmium high content in the microspheres can be interpreted as follow from a therapeutic standpoint, to achieve an effective use of microspheres loaded with HoAcAc, a high content of holmium is required to yield enough radioactivity with a relatively low amount of microspheres.The usual amounts of holmium that are incorporated in the microspheres composed by poly(L-lactic acid) and HoAcAc are 17.0 {+-} 0.5% (w/w) of holmium, which corresponds to a loading of about 50% of HoAcAc. Different approaches have been investigated to increase that value. One updated approach towards this direction is the production of microspheres with ultrahigh holmium as matrix using HoAcAc crystals as the sole starting material without the use of biopolymer. Likewise, in the search of microspheres with increased holmium content , it has been demonstrated that by changing the HoAcAc crystal structure by its recrystallization from crystal phase to the amorphous there is lost of acetylacetonate and water molecules causing the increasing of the holmium content. Microspheres were prepared by solvent evaporation, using holmium acetylacetonate (HoAcAc) crystals as the sole ingredient. Microspheres were characterized by using light and scanning electron microscopy, infrared and Raman spectroscopy, differential scanning calorimetry, X-rays diffraction, and confocal laser scanning microscopy. (author)

  13. Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients.

    Science.gov (United States)

    Iacono, Fabrizio; Prezioso, Domenico; Di Lauro, Giovanni; Romeo, Giuseppe; Ruffo, Antonio; Illiano, Ester; Amato, Bruno

    2012-01-01

    Over the past years laser technology has played a predominant role in prostate surgery, for the treatment of benign prostate hypertrophy (BPH). Various laser devices have been introduced in clinical practice, showing good results in terms of complications and urodynamic outcomes efficacy compared with TURP and Open Prostatectomy.In this study we describe the efficacy and the safety profile of a novel laser technique, ThuLEP (Thulium Laser Enucleation of Prostate) that permits a complete anatomical endoscopic enucleation of prostatic adenoma independently to prostate size. 148 patients with a mean age of 68.2 years were enrolled between September 2009 and March 2012 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), International Index of Erectile Function-5 (IIEF-5), Quality of Life (QoL), PSA values, urine analysis and urine culture, uroflowmetry. The same evaluation was conducted after a 12 month follow-up. ThuLEP was performed by 2 expert surgeons. Our data showed a better post-operative outcome in terms of catheter removal, blood loss, TURP syndrome, clot retention and residual tissue compared to large series of TURP and OP. Only 1.3% of patients had bladder wall injury during morcellation. I-PSS, Qmax, Prostate Volume, QoL and PVR showed a highly significant improvement at 12 month follow-up in comparison to preoperative assessment. ThuLEP represent an innovative option in patients with BPH. It is a size independent surgical endoscopic technique and it can be considered the real alternative, at this time, to TURP and even more to Open Prostatectomy for large prostate, with a complete removal of adenoma and with a low complication rate.

  14. Evaluation of a unique cw laser in radial thermokeratoplasty

    Science.gov (United States)

    Smithpeter, Colin L.; Welch, Ashley J.; Rylander, Henry G., III

    1993-06-01

    A unique continuous wave (cw) holmium laser ((lambda) equals 2.09 micrometers , Rare Earth Medical) has been evaluated as a new heating modality for thermokeratoplasty. Thermokeratoplasty is a refractive surgical procedure for the correction of hyperopia which uses selective heating to reshape the cornea. The holmium laser is highly effective in this procedure due to the high absorption coefficient ((mu) a equals 27.55 cm-1) of the cornea at 2.09 micrometers . The depth of corneal photocoagulation has been evaluated with histological studies of enucleated porcine eyes that were irradiated with the cw Ho:YAG laser. Laser power and exposure time ranged from 300 mW to 800 mW and 100 ms to 800 ms, respectively. The laser was delivered to the eyes via a 600 micrometers low-OH optical fiber. Coagulation depth was determined by birefringence microscopy of the corneal sections. Our studies also compared the effects of contact and non-contact irradiation and found significant advantages with the contact mode. The optimal laser parameters determined from the histology studies were used for in vivo rabbit studies to quantify the refractive correction possible. One coagulation was placed on each of sixteen equiangular rays taken from a central, clear, optical zone in the cornea with a diameter of 7 mm. Refractive changes in the central cornea were quantified with a keratoscope. Initial procedures resulted in refractive changes up to five diopters. The keratoscope results showed a significant regression at three weeks post- operatively.

  15. A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up.

    Science.gov (United States)

    Wu, Gang; Hong, Zhe; Li, Chao; Bian, Cuidong; Huang, Shengsong; Wu, Denglong

    2016-05-01

    The objective of this study is to compare the efficacy and safety of diode laser enucleation of the prostate (DiLEP) with plasmakinetic enucleation of the prostate (PKEP) for symptomatic benign prostatic hyperplasia (BPH) patients with large prostate (volume > 80 ml). From January 2013 to June 2014, 80 consecutive patients were randomized treated with DiLEP (n = 40) or PKEP (n = 40). Perioperative and postoperative outcome data were assessed during a 1-year follow-up. There were no significant preoperative differences between the two surgical groups. The mean prostate volumes in the DiLEP and PKEP groups were 98.6 and 93.3 ml, respectively. DiLEP was equivalent to PKEP in improvement in International Prostate Symptom Score (IPSS), quality of life scores, and maximum flow rate. Compared with PKEP, patients treated with DiLEP showed a lower risk of blood loss (P  80 ml). Compared with PKEP, DiLEP provides a decreased risk of hemorrhage, reduced bladder irrigation, and catheterization times, as well as shorter hospital stays.

  16. [Monopolar transurethral enucleation of benign prostatic hyperplasia. Our initial experience].

    Science.gov (United States)

    Tsarichenko, D G; Simberdeev, R R; Glybochko, P V; Alyaev, Y G; Rapoport, L M; Sukhanov, R B; Sorokin, N I; Enikeev, D V; Davydov, D S

    2016-08-01

    The choice of surgical treatment in patients with BPH is one of the most discussed issues in urology. In recent years, the surgical treatment of prostates of medium and large sizes by means of enucleation has become increasingly popular. The emergence of special loops to perform bipolar and monopolar enucleation using standard equipment for TURP has opened up new possibilities for the treatment of patients with BPH-transurethral monopolar enucleation BPH. In the period from December 2014 to the current time 35 monopolar enucleations were performed in the clinic of urology Sechenov FMSMU. The mean age was 70,3+/-3,7 years; Prostate volume was 60,3+/-12,5 cm3; IPSS / Qol 24,6+/-3,3 / 5,1+/-1,1; Qsr 7.7+/-2.1 ml/s. We used resectoscope 26 Ch with constant irrigation, Hook-electrode, pusher-electrode, as well as a standard set of electrodes for mono- and bipolar surgery during the procedure. Enucleated adenomatous nodes were resected either by mono- or bipolar TURP and were laundered by Rene-Alexander syringe, or morcellated. Comparative analysis of different methods of surgical treatment of prostatic hyperplasia (laser and monopolar enucleation) shows the advantages of monopolar enucleation in patients with prostatic hyperplasia. Monopolar enucleation of prostate hyperplasia is a radical, as well as a safe and effective surgical method in the treatment of patients with BPH. Further observation of the operated patients will allow us to make a final conclusion about the place of this technique in the treatment of patients with BPH and adequacy of data.

  17. A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP: First results

    Directory of Open Access Journals (Sweden)

    Christian Tiburtius

    2015-01-01

    Full Text Available Introduction: We report the early postoperative results of the first prospective, randomized comparison of two commercially available thulium lasers with different wavelengths for the treatment of benign prostatic obstruction (BPO. Materials and Methods: From January to June 2013, 80 consecutive patients were randomized for Thulium VapoEnucleation of the prostate (ThuVEP with a 2013 nm (RevoLix ® (n = 39 or a 1940 nm (Vela ® XL (n = 41 thulium laser. Preoperative status, surgical details and the immediate outcome were recorded for each patient. The perioperative complications were assessed and classified according to the modified Clavien classification system. Results: Median operation time, resected tissue, percentage of resected tissue, catheter time, overall operation efficiency and Hb loss differed nonsignificantly between both devices (P > 0.05. At discharge, the median maximum urinary flow rate and postvoiding residual (PVR urine improved significantly in both groups (P < 0.001. The PVR was lower in the 1940 nm ThuVEP group (P ≤ 0.034. Perioperative complications occurred in 18 (22.5% patients (Clavien 1: 12.5%; Clavien 2: 5%, Clavien 3b: 2.5%, Clavien 4a: 2.5%, with no differences between the groups (P = 0.5. Conclusions: The 1940 nm and the 2013 nm thulium lasers are both safe and effective for the treatment of BPO with ThuVEP. Both lasers give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.

  18. Best laser for prostatectomy in the year 2013

    Directory of Open Access Journals (Sweden)

    Pankaj N Maheshwari

    2013-01-01

    Full Text Available Lasers have come a long way in the management of benign prostatic hyperplasia. Over last nearly two decades, various different lasers have been utilized for prostatectomy. Neodymium: yttrium-aluminum-garnet laser that started this journey, is no longer used for prostatectomy. Holmium laser can achieve transurethral enucleation of the prostatic adenoma producing a fossa that can be compared with the fossa after Freyer′s prostatectomy. Green light laser has a short learning curve, is nearly blood-less with good immediate results. Thulium laser is a faster cutting laser while diode laser is a portable laser device. Often laser prostatectomy is considered as a replacement for the standard transurethral resection of prostate (TURP. To be comparable, laser should reduce or avoid the immediate and long-term complications of TURP, especially bleeding and need for blood transfusion. It should also be safe in the ever increasing patient population on antiplatelet and anticoagulant drugs. We need to take stock of the situation and identify, which among the present day lasers has stood the test of time. A review of the literature was performed to see if any of these lasers could be called the "best laser for prostatectomy in 2013."

  19. The role of lasers in modern urology

    Science.gov (United States)

    Dołowy, Łukasz; Dembowski, Janusz; Zdrojowy, Romuald; Kołodziej, Anna

    2015-01-01

    Introduction The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. Material and methods Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. Results Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. Conclusions There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards. PMID:26251737

  20. "Finding the needle in a haystack": oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP).

    Science.gov (United States)

    Herlemann, Annika; Wegner, Kerstin; Roosen, Alexander; Buchner, Alexander; Weinhold, Philipp; Bachmann, Alexander; Stief, Christian G; Gratzke, Christian; Magistro, Giuseppe

    2017-11-01

    To evaluate oncologic parameters of men with bothersome LUTS undergoing surgical treatment with HoLEP or TURP. Five hundred and eighteen patients undergoing HoLEP (n = 289) or TURP (n = 229) were retrospectively analyzed for total PSA, prostate volume, PSA density, history of prostate biopsy, resected prostate weight, and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of incidental PCa (iPCa). Men undergoing HoLEP had a significantly higher total PSA (median 5.5 vs. 2.3 ng/mL) and prostate volume (median 80 vs. 41 cc), and displayed a greater reduction of prostate volume after surgery compared to TURP patients (median 71 vs. 50%; all p < 0.001). With a prevalence of incidental PCa (iPCa) of 15 and 17% for HoLEP and TURP, respectively, the choice of procedure had no influence on the detection of iPCa (p = 0.593). However, a higher rate of false-negative preoperative prostate biopsies was noted among iPCa patients in the HoLEP arm (40 vs. 8%, p = 0.007). In multivariate logistic regression, we identified patient age (OR 1.04; 95% CI 1.01-1.07, p = 0.013) and PSA density (OR 2.13; 95% CI 1.09-4.18, p = 0.028) as independent predictors for the detection of iPCa. Despite differences in oncologic parameters, the choice of technique had no influence on the detection of iPCa. Increased patient age and higher PSA density were associated with iPCa. A higher rate of false-negative preoperative prostate biopsies was noted in HoLEP patients. Therefore, diagnostic assessment of LUTS patients requires a more adapted approach to exclude malignancy, especially in those with larger prostates.

  1. Transpalpebral eye enucleation in the standing horse

    DEFF Research Database (Denmark)

    Christophersen, Mogens Teken

    Transpalpebral eye enucleation in the standing horse. The Nordic Equine Veterinary Conference, Proceedings, Copenhagen. Denmark. Nov. 2011.......Transpalpebral eye enucleation in the standing horse. The Nordic Equine Veterinary Conference, Proceedings, Copenhagen. Denmark. Nov. 2011....

  2. Watt-level short-length holmium-doped ZBLAN fiber lasers at 1.2  μm.

    Science.gov (United States)

    Zhu, Xiushan; Zong, Jie; Wiersma, Kort; Norwood, R A; Prasad, Narasimha S; Obland, Michael D; Chavez-Pirson, Arturo; Peyghambarian, N

    2014-03-15

    In-band core-pumped Ho3+-doped ZBLAN fiber lasers at the 1.2 μm region were investigated with different gain fiber lengths. A 2.4 W 1190 nm all-fiber laser with a slope efficiency of 42% was achieved by using a 10 cm long gain fiber pumped at a maximum available 1150 nm pump power of 5.9 W. A 1178 nm all-fiber laser was demonstrated with an output power of 350 mW and a slope efficiency of 6.5%. High Ho3+ doping in ZBLAN is shown to be effective in producing single-frequency fiber lasers and short-length fiber amplifiers immune from stimulated Brillouin scattering.

  3. Effects of simultaneously fiber transmitted erbium and holmium radiation on the interaction with highly absorbing media

    Science.gov (United States)

    Frenz, Martin; Pratisto, Hans S.; Ith, Michael; Koenz, Flurin; Weber, Heinz P.

    1995-05-01

    Erbium and Holmium lasers have both been shown to be suitable for orthopedic surgery performed under water. Erbium lasers emitting in the 3 micrometers wavelength region corresponding to the maximum water absorption peak effectively ablated biological tissues with high precision and minimal thermal damage. Holmium laser radiation at 2 micrometers , due to a lower absorption coefficient, is characterized by a greater extent of thermal damage leading to hemostasis. To combine the special advantages of each system we simultaneously coupled their radiation into a zirconium fluoride fiber (ZrF4) which was protected with a quartz fiber tip. Pressure measurements performed in the liquid using a piezo electrical transducer, transmission measurements and video flash lamp schlieren imaging of the laser induced vapor bubble were used in order to determine optimum laser parameters. The cutting efficiency of the Erbium laser is drastically improved when a low energy Holmium laser pulse is additionally used which is just able to open a vapor channel through which the Erbium laser pulse can be transmitted. The dynamics of the channel formation, geometry and life time are measured as a function of the delay time between the two different laser pulses and the pulse energy applied. The combination of 2 micrometers and 3 micrometers radiation seems to be an ideal instrument for tissue treatment.

  4. Chitosan microspheres loaded with holmium-165 produced by spray dryer for liver cancer therapy: preliminary experiments

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Douglas Massao; Pires, Geovanna; Lira, Raphael A. de; Melo, Vitor H.S.; Nascimento, Nanci; Azevedo, Mariangela de Burgos M. de, E-mail: douglas.miyamoto@usp.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Osso Junior, Joao Alberto [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Radiofarmacia

    2011-07-01

    Chitosan is a biopolymer of 2-deoxy-2-amino-D-glucose that is obtained by deacetylation of chitin. It's biocompatible, biodegradable, non toxic and has antitumor activity. Chitosan has many applications, such as their microparticles that can be used to treat prostate cancer, rheumatoid arthritis, and for liver tumor brachytherapy treatment. Our group is developing different biodegradable polymer-based microspheres loaded with holmium-165 for this purpose. The Chitosan microspheres were produced loaded with holmium (III) chloride, and not loaded with it, by Mini Spray Dryer procedure. The microspheres were evaluated by scanning electron microscopy, energy dispersive spectroscopy (EDS), confocal laser scanning microscopy, thermogravimetric analysis, particle size, and X-ray diffraction. The EDS analysis confirmed the holmium chloride presence into the prepared chitosan microparticles. (author)

  5. Magnetic structure of holmium-yttrium superlattices

    DEFF Research Database (Denmark)

    Jehan, D.A.; McMorrow, D.F.; Cowley, R.A.

    1993-01-01

    We present the results of a study of the chemical and magnetic structures of a series of holmium-yttrium superlattices and a 5000 angstrom film of holmium, all grown by molecular-beam epitaxy. By combining the results of high-resolution x-ray diffraction with detailed modeling, we show that the s......We present the results of a study of the chemical and magnetic structures of a series of holmium-yttrium superlattices and a 5000 angstrom film of holmium, all grown by molecular-beam epitaxy. By combining the results of high-resolution x-ray diffraction with detailed modeling, we show...... that the superlattices have high crystallographic integrity: the structural coherence length parallel to the growth direction is typically almost-equal-to 2000 angstrom, while the interfaces between the two elements are well defined and extend over approximately four lattice planes. The magnetic structures were...... determined using neutron-scattering techniques. The moments on the Ho3+ ions in the superlattices form a basal-plane helix. From an analysis of the superlattice structure factors of the primary magnetic satellites, we are able to determine separately the contributions made by the holmium and yttrium...

  6. Calcium Signaling Is Required for Erythroid Enucleation.

    Directory of Open Access Journals (Sweden)

    Christina B Wölwer

    Full Text Available Although erythroid enucleation, the property of erythroblasts to expel their nucleus, has been known for 7ore than a century, surprisingly little is known regarding the molecular mechanisms governing this unique developmental process. Here we show that similar to cytokinesis, nuclear extrusion requires intracellular calcium signaling and signal transduction through the calmodulin (CaM pathway. However, in contrast to cytokinesis we found that orthochromatic erythroblasts require uptake of extracellular calcium to enucleate. Together these functional studies highlight a critical role for calcium signaling in the regulation of erythroid enucleation.

  7. Oocytes Polar Body Detection for Automatic Enucleation

    Directory of Open Access Journals (Sweden)

    Di Chen

    2016-02-01

    Full Text Available Enucleation is a crucial step in cloning. In order to achieve automatic blind enucleation, we should detect the polar body of the oocyte automatically. The conventional polar body detection approaches have low success rate or low efficiency. We propose a polar body detection method based on machine learning in this paper. On one hand, the improved Histogram of Oriented Gradient (HOG algorithm is employed to extract features of polar body images, which will increase success rate. On the other hand, a position prediction method is put forward to narrow the search range of polar body, which will improve efficiency. Experiment results show that the success rate is 96% for various types of polar bodies. Furthermore, the method is applied to an enucleation experiment and improves the degree of automatic enucleation.

  8. Effects of holmium laser on dental structure in vivo: thermal evaluation and histological analysis on pulpal tissue; Efeitos in vivo do laser de holmio em estrutura dental: monitoracao termica e analise histologica do tecido pulpar

    Energy Technology Data Exchange (ETDEWEB)

    Strefezza, Claudia

    2001-07-01

    Previous in vitro studies have demonstrated that Ho:YLF laser is capable of inducing physical and chemical changes on dental surfaces treated for caries prevention. The temperature in the pulp chamber was in vitro evaluated to as a function of the power and frequency of the laser irradiation. The purpose of this work is to verify the occurrence of pulp inflammation after Ho:YLF laser irradiation using different parameters in rabbits' teeth. The premolars and molars of ten rabbits (NZB) were divided in two groups according to the irradiation energy values of a Ho:YLF laser prototype operating at 2.065{mu}m wave length, frequency of O,5Hz and pulse length of 250{mu}s. An group A teeth were irradiated with using ten pulses of 334mJ/pulse of a Ho:YLF laser prototype operating at O.5Hz, and group B, with 512mJ/pulse. Animals were killed by transcardiac perfusion and the samples were prepared for histopathological analysis. The in vitro temperature monitoring revealed an increase of 1 deg C for the 334mJ/pulse energy and 4.5 deg C for the 512mJ/pulse energy. SEM observations showed the occurrence of melting and resolidification in dental surface. From the in vivo analysis it can be concluded that both employed laser parameters did not induce to any inflammatory response from the pulp. (author)

  9. In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters.

    Science.gov (United States)

    Kronenberg, Peter; Traxer, Olivier

    2014-08-01

    To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high- with low-frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias. An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2-1.2 J pulse energies, 5-40 Hz frequencies, 4-20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made. Low frequency-high pulse energy (LoFr-HiPE) settings were (up to six times) more ablative than high frequency-low pulse energy (HiFr-LoPE) at the same power levels (P fragmentation volume, fissure width, and fissure depth (all P fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015). At the same total power level, LoFr-HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time-consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability. © 2013 The Authors. BJU International © 2013 BJU International.

  10. Efeito do Hólmio YAG laser (Ho: YAG sobre o tendão patelar de ratos após 12 e 24 semanas de seguimento The effects of Holmium YAG laser (Ho:YAG on the patellar tendon of rats after 12 and 24 weeks of follow up

    Directory of Open Access Journals (Sweden)

    Waldo Lino Júnior

    2005-01-01

    , com neoformação vascular evidente. No grupo de 24 semanas as fibras de colágeno se apresentavam com disposição regular e paralela ao longo eixo do tendão.The authors have studied the effects of the Holmium: Yttrium Aluminum Grenade (Ho:YAG laser on tendon sizes (proximal and distal length and width and on the cellularity and arrangement of collagen fibers in 20 Wistar variety, male, white, adult rats (Rattus Novergicus. The animals have been divided in two groups, according to the follow-up time (12 and 24 weeks and pursuant to the for form of laser application (continuous or two-point. A Holmium laser (pulsed, solid state, 2.1 micron waves, 40 watts, OmniTip 30º tip apparatus was used. After the animals were sacrificed, the proximal and distal length and width of the operated size of such rats were compared to those of the non-operated size be means of non-parametric testing (considering p=0,05. The length in the operated size was significantly bigger for both follow-up groups, when compared to the length of the non-operated size, however there was no significant difference in such measures in function of the type of laser application. In the same manner, the width, both in the proximal and distal regions, was significantly bigger in the operated size in both follow-up groups, without showing any significant difference whatsoever in function of the type of application. When the measures in both follow-up groups were compared, distal length and width showed a trend to become bigger after 24 weeks, while width in the proximal region was significantly bigger in this group. As for the subjective microscopic evaluation, both in longitudinal and cross sections, it was possible to observe and increase in the number of fibroblasts, mainly in the 12-week group. The average fibroblast concentration in the tendon with 24-week follow-up was group deemed to be intermediate between the 12-week group and non-operated tendon. The conjunctive tissue was exuberant in the region

  11. Magnetodielectric coupling in multiferroic holmium iron garnets

    Energy Technology Data Exchange (ETDEWEB)

    Malar Selvi, M.; Chakraborty, Deepannita; Venkateswaran, C., E-mail: cvunom@hotmail.com

    2017-02-01

    Single phase magneto-electric multiferroics require a large magnetic or electric field for producing magneto-electric (ME) and magnetodielectric (MD) effects. For utilizing these effects in devices investigations on the room temperature and low field MD studies are necessary. Recently, efforts have been largely devoted to the investigation of rare earth iron garnets. In the physical method, the preparation of rare earth iron garnet requires high sintering temperature and processing time. To solve these problems, ball milling assisted microwave sintering technique is used to prepare nanocrystalline holmium iron garnets (Ho{sub 3}Fe{sub 5}O{sub 12}). Magnetic and dielectric properties of the prepared sample are investigated. These properties get enhanced in nanocrystalline form when compared to the bulk. The MD coupling of the prepared sample is evident from the anomaly in the temperature dependent dielectric constant plot and the ME coupling susceptibility is derived from the room temperature MD measurements. - Highlights: • Formation of single phase Holmium iron garnet reported. • Ball milling assisted microwave sintering reduces the sintering temperature and time. • Holmium iron garnet shows enhanced magnetic and dielectric properties. • Pyromagnetic and pyroelectric measurements confirm the magnetoelectric coupling. • Room temperature magnetodielectric measurements show the nonlinear behaviour.

  12. [Traumatic enucleation. Accident or self-mutilation?].

    Science.gov (United States)

    Straßburger, P; Váradi, G

    2013-05-01

    A 52-year-old woman was admitted for emergency treatment after traumatic enucleation. Because of the position of the avulsed eye and the acute mental condition of the patient a trauma caused by self-mutilation could not be excluded. There was even the suspicion of self-enucleation in a second case and in both cases a psychiatrist was consulted but ultimately a disastrous accident was clearly verified for both patients. Nevertheless, an interdisciplinary evaluation should be initiated in cases of patients with a suspicious traumatic injury as in cases of self-mutilation the danger of relapse is high in the first hours and weeks after the primary event.

  13. Management of large prostatic adenoma: Lasers versus bipolar transurethral resection of prostate

    Directory of Open Access Journals (Sweden)

    Narmada P Gupta

    2013-01-01

    Full Text Available Transurethral resection of prostate (TURP has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE, but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP, the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP, photo-selective vaporization of prostate (PVP, etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (>60 g. For extremely large glands (>150 g, HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient′s comorbidities and surgeon′s expertise.

  14. Management of large prostatic adenoma: Lasers versus bipolar transurethral resection of prostate

    Science.gov (United States)

    Gupta, Narmada P; Nayyar, Rishi

    2013-01-01

    Transurethral resection of prostate (TURP) has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE), but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP), the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP), photo-selective vaporization of prostate (PVP), etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (<60 g). For extremely large glands (<150 g), HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient's comorbidities and surgeon's expertise. PMID:24082445

  15. [Transurethral enucleation prostate with plasmakinetic energy. A new technique of enucleation].

    Science.gov (United States)

    Ramírez Mendoza, Antonio; Ramírez Zambrana, Antonio; Ramírez Zambrana, María Cristina

    2013-03-01

    We present a new technique of transurethral prostatic enucleation. METHODS. We use an Olympus resectoscope with two electrodes; one has a button or "mushroom" shape to vaporize and enucleate, and the other one the shape of a conventional "cutting loop electrode"to resect. With the button-shaped electrode, we vaporize transversally at the level of the veru montanum, extending the dissection towards the lateroapical lobes, looking for the capsular plane. Once it is found, we ascend vaporizing up to the 3 and 9 in the clock following the capsular plane. Subsequently, we vaporize longitudinally the anterior commissure and keep going down to join the previously vaporizatized area. Then enucleation is achieved by pushing the adenoma with the button-shaped electrode, from distal to proximal, at the capsular plane level. Before the enucleated lobe falls inside the bladder, we can proceed, with the help of the conventional cutting loop electrode, to its resection, which is very fast and bloodless. If there is middle lobe, enucleation is initiated with it, performing two lateral grooves lengthways down to the veru montanum. RESULTS. We have carried out 45 procedures since October 2011, with excellent functional results. Prostate volumes range between 40-120 gr, with an operating time of 30-90 minutes. Hospital stay was 24-48 h. and the catheter is removed in 4-5 days. Blood transfusions were not needed in any case, and we have not recorded complications within this first year of follow-up. CONCLUSIONS. This technique makes possible the enucleation of the adenoma with a good haemostasis control. It also provides a good visualization of the capsular plane. Vaporization of the prostatic tissue is similar to the use of other energy forces. We don't need to use a "morcellator" to extract the enucleated prostatic tissue. It is an economical and easily reproducible procedure, with a short learning curve.

  16. The laser in urology

    Science.gov (United States)

    Hofstetter, Alfons G.

    2002-10-01

    Laser is an acronym for a physical principle and means: Light Amplification by stimulated Emission of Radiation. This principle offers a lot of tissue/light effects caused by the parameters: power density/time and the special qualities of the laser light. Nowadays for diagnosis and therapy following lasers are used in urology: Krypton- and Dye-lasers as well as the Neodymium-YAG- (nd:YAG-), Holmium-YAG (Ho:YAG-), Diode-, Argon- and the CO2-lasers.

  17. Video-thoracoscopic enucleation of esophageal leiomyoma

    Directory of Open Access Journals (Sweden)

    Luh Shi-Ping

    2012-03-01

    Full Text Available Abstract Background Leiomyoma is the most common benign tumor of the esophagus. Surgical enucleation is indicated in case of symptoms or an unclear diagnosis, and open thoracotomy has long been the standard approach for this procedure. However, enucleation through video assisted thoracoscopic surgery (VATS has been developed as a preferred approach for most lesions in recent years. Method Herein we report our twelve patients (seven men and five women, with median age of 42 years from 2001 to 2009, who underwent enucleation through VATS for esophageal leiomyomas, with a size from 1 to 8 cm in diameter (median: 5, and at different locations, from the thoracic outlet to near the diaphragmatic level of the thoracic esophagus. Intraoperative fiberoptic esophagoscopy was performed in two patients for localization by illumination. A right-sided approach was performed in eight cases (upper two thirds of esophagus and the left-sided in another four cases (lower third of esophagus. Result The median operative time was 95 minutes (70 to 230 minutes. Four of them required small utility incisions (4-6 cm for better exploration and manipulation. There were no major complications, such as death or empyema due to leaks from mucosal tears, and the presenting symptoms were improved during the follow-up period, from 12 to 98 months. Conclusion VATS can be considered as an initial approach for most patients with esophageal leiomyomas, even large in size, irregular in shape, or at unfavorable location. It is a safe, minimally invasive, and effective treatment. However, conversion to open thoracotomy should be required for the sake of clinical or technical concern.

  18. ANTIBACTERIAL PROPERTIES OF HOLMIUM TO CAUSATIVE AGENTS OF SUPPURATIVE -INFLAMMATORY COMPLICATIONS IN PATIENTS WITH TRAUMA

    Directory of Open Access Journals (Sweden)

    Poddubnaya H. N.

    2012-06-01

    Full Text Available Article denotes to determination of antibacterial action of polyoxometalate holmium to causative agents of suppurative-inflammatory process in wounds of patients, which were suffered from trauma. Method of serial dilutions was used for determination of minimal inhibiting concentration (MIC of holmium to staphylococci, enterococci and E. coli. Registration of holmium action shows the strong antibacterial influence to staphylococci and enterococci (MIC of holmium action to staphylococcal and enterococcal strains same 1 10 M, to strains of E.coli – 2,5 10 M. Solutions of holmium don’t have antibacterial action to strains of E.coli.

  19. VizieR Online Data Catalog: Spectra of a Holmium in the near-UV. I. Ho I. (Al-Labady+, 2017)

    Science.gov (United States)

    Al-Labady, N.; Ozdalgic, B.; Er, A.; Guzelcimen, F.; Ozturk, I. K.; Kroger, S.; Kruzins, A.; Tamanis, M.; Ferber, R.; Basar, G.

    2017-04-01

    The high-resolution spectra of Holmium (Ho) were recorded with a Fourier Transform spectrometer IFS125 HR at the Laser Centre of the University of Latvia in Riga. Two Ho spectra were recorded, one with argon (Ar) as a buffer gas and one with neon (Ne). The spectra cover the ultraviolet spectral range from 25000 up to 31530cm-1, or 317 to 400nm, respectively. (1 data file).

  20. Formation of mammalian erythrocytes: chromatin condensation and enucleation.

    Science.gov (United States)

    Ji, Peng; Murata-Hori, Maki; Lodish, Harvey F

    2011-07-01

    In all vertebrates, the cell nucleus becomes highly condensed and transcriptionally inactive during the final stages of red cell biogenesis. Enucleation, the process by which the nucleus is extruded by budding off from the erythroblast, is unique to mammals. Enucleation has critical physiological and evolutionary significance in that it allows an elevation of hemoglobin levels in the blood and also gives red cells their flexible biconcave shape. Recent experiments reveal that enucleation involves multiple molecular and cellular pathways that include histone deacetylation, actin polymerization, cytokinesis, cell-matrix interactions, specific microRNAs and vesicle trafficking; many evolutionarily conserved proteins and genes have been recruited to participate in this uniquely mammalian process. In this review, we discuss recent advances in mammalian erythroblast chromatin condensation and enucleation, and conclude with our perspectives on future studies. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Unsuccessful Self-Enucleation in a Schizophrenic Patient

    Directory of Open Access Journals (Sweden)

    Noam Bar-Yaakov

    2014-01-01

    Full Text Available Self-enucleation is a very unusual form of self-mutilation directly linked to mental illness. In this case we present a 26-year-old schizophrenic patient who attempted to enucleate his eye with a rollerball pen. Antipsychotic therapy and emergency surgery saved the patient eye and emphasize the importance of quick response and good collaboration between psychiatric and ophthalmic teams.

  2. A simplified approach for oocyte enucleation in mammalian cloning.

    Science.gov (United States)

    Iuso, Domenico; Czernik, Marta; Zacchini, Federica; Ptak, Grazyna; Loi, Pasqualino

    2013-12-01

    Despite its success in almost all farm and laboratory animals, somatic cell nuclear transfer (SCNT) is still a low-efficiency technique. In this investigation, we determined the impact of each enucleation step on oocyte viability (assessed by parthenogenetic activation): Hoechst (HO) staining, cytochalasin B, ultraviolet (UV) exposure, and demecolcine. Our data showed that of all the factors analyzed, UV exposure impaired oocyte development (cleavage, 59% for untreated oocytes vs. 8% UV exposed; blastocyst stage, 32% untreated vs. 0% UV exposed). A minor toxicity was detected following demecolcine treatment (cleavage, 62%; blastocyst stage, 13%). Next, we compared HO/UV (canonical) and demecolcine-assisted enucleation (DAE), with a straight removal of metaphase chromosomes without any chemical or physical aid (straight enucleation). DAE improved the preimplantation development of sheep cloned embryos compared to HO/UV enucleation (cleavage, 38% vs. 19%; blastocysts, 17% vs. 4%), yet straight enucleation resulted in the highest cleavage and blastocysts rates (61% and 30%, respectively). We concluded that: (1) UV exposure harms sheep oocyte and embryo development; (2) DAE may represent an alternative approach, especially for unskilled operators; and (3) straight enucleation remains, in our estimation, the most reliable and least harmful protocol for SCNT.

  3. Piezosurgery versus conventional surgery in radicular cyst enucleation.

    Science.gov (United States)

    Kocyigit, Ismail Doruk; Atil, Fethi; Alp, Yunus Emre; Tekin, Umut; Tuz, Hakan H

    2012-11-01

    This study compared the use of piezosurgery and conventional surgery in radicular cyst enucleation. The study was conducted with 29 patients who were radiologically and cytologically prediagnosed with radicular cysts in the jaw region. Nineteen patients were treated using piezosurgery, and 10 were treated using conventional surgical procedures. Surgical procedures were evaluated according to the following criteria: hemorrhage, soft-tissue damage, manipulation complexity, major perforation areas on the enucleated cyst tissue, and approximate operation duration. Patients were monitored postoperatively and evaluated for hemorrhaging at 24, 48, and 72 hours following surgery. Follow-up was conducted to check for recurrences and ranged from 5 to 24 months. No complications were observed in any of the 20 patients treated using piezosurgery, although the duration of surgery was longer than expected. Of the 10 patients treated using conventional methods, hemorrhaging that affected the operation occurred in 3 cases, perforation of the cyst epithelium and difficulties in enucleation occurred in 5 cases, postoperative hemorrhage occurred in 2 cases, and recurrence was observed in 2 cases. Piezosurgery may be considered effective in procedures such as enucleation that require sensitive manipulation, despite the increase in the length of the overall surgical procedure. Given the results of the present study and the current lack of information in the literature regarding postoperative pain, infection, and long-term success rates associated with the use of piezosurgery in cyst enucleation, further study in this area is recommended.

  4. NON-STENTED HOLMIUM:YAG URETEROSCOPIC ...

    African Journals Online (AJOL)

    :YAG laser lithotripsy of distal lower ureteral calculi with respect to efficacy, safety, postoperative pain and hospital stay. Patients and Methods Thirty-five patients with distal lower ureteral calculi underwent ureteroscopy without prior ureteral ...

  5. Testing relativity again, laser, laser, laser, laser

    NARCIS (Netherlands)

    Einstein, A.

    2015-01-01

    laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser, laser,

  6. Microspheres of poly({epsilon}-caprolactone) loaded Holmium-165: morphology and thermal degradation behavior

    Energy Technology Data Exchange (ETDEWEB)

    Geraldes, Adriana Napoleao; Miyamoto, Douglas Massao; Lira, Raphael Arivar de; Osso Junior, Joao Alberto; Nascimento, Nanci; Azevedo, Mariangela de Burgos M. de [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2011-07-01

    Polycaprolactone (PCL), being one of the most important biocompatible and biodegradable aliphatic polyester, provides many potential biomedical. The preparation of biodegradable materials, polymer-based microspheres, is being developed by our group and the goal is to prepare and label with Ho-165 different polymer-based microspheres. The use of radionuclide-loaded microspheres is a promising treatment of liver malignancies. PCL microspheres can be loaded with holmium acetylacetonate (HoAcAc). PCL and PCL/HoAcAc microspheres were prepared by an emulsion solvent extraction/evaporation technique. The PCL/ HoAcAc microspheres were irradiated in a nuclear reactor IEA-R1 at IPEN/CNEN-SP to radionuclide activation. Gamma irradiation was performed at 25 and 50 kGy doses. The microspheres were evaluated by differential scanning calorimetry analysis (DSC), thermogravimetric analysis (TG), Fourier transformed infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and con focal laser scanning microscopy (CLSM). In the CLSM images were observed emission in 488 nm characteristic of holmium. The SEM surface image of PCL/HoAcAc microspheres showed more roughness than PCL microspheres. TG of PCL/HoAcAc microspheres showed a substantial weight loss above 200 degree C, indicating decomposition of HoAcAc. The residual weight indicates the presence of Ho{sub 2}O{sub 3}. Gamma irradiation at 25 and 50 kGy doses had no effect on the PCL/HoAcAc microspheres, which indicates that the chemical composition of the microspheres had not change. (author)

  7. Assiut Experience in the Application of Holmium Laser in Treatment ...

    African Journals Online (AJOL)

    Internal Optical Urethrotomy at the National Medical Center of Sanou Souro in Bobo-Dioulasso: Feasibility, Safety and Short-Term Results Objective To analyze the feasibility, safety and short-term results of internal optical urethrotomy in our hospital. Patients and Methods A retrospective study of 70 cases was done ...

  8. Optimal Settings for the Noncontact Holmium:YAG Stone Fragmentation Popcorn Technique.

    Science.gov (United States)

    Emiliani, Esteban; Talso, Michele; Cho, Sung-Yong; Baghdadi, Mohammed; Mahmoud, Sadam; Pinheiro, Hugo; Traxer, Olivier

    2017-09-01

    The purpose of this study was to evaluate the popcorn technique using a wide range of holmium laser settings and fiber sizes in a systematic in vitro assessment. Evaluations were done with 4 artificial stones in a collection tube. A fixed ureteroscope was inserted through a ureteral access sheath to provide constant irrigation flow and the laser was placed 1 mm from the bottom. Combinations of 0.5 to 1.5 J, 10 to 20 and 40 Hz, and long and short pulses were tested for 2 and 4 minutes. We used 273 and 365 μm laser fibers. All tests were repeated 3 times. The stones were weighed before and after the experiments to evaluate the setting efficiency. Significant predictors of a highly efficient technique were assessed. A total of 144 tests were performed. Mean starting weight of the stones was 0.23 gm, which was consistent among the groups. After the experiment the median weight difference was 0.07 gm (range 0.01 to 0.24). When designating a 50% reduction in stone volume as the threshold indicating high efficiency, the significant predictors of an efficient popcorn technique were a long pulse (OR 2.7, 95% CI 1.05-7.15), a longer duration (OR 11.4, 95% CI 3.88-33.29), a small (273 μm) laser fiber (OR 0.23, 95% CI 0.08-0.70) and higher power (W) (OR 1.14, 95% CI 1.09-1.20). Higher energy, a longer pulse, frequencies higher than 10 Hz, a longer duration and a smaller laser fiber predict a popcorn technique that is more efficient at reducing stone volume. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. [Clinical evaluation of transurethral enucleation with bipolar (TUEB)].

    Science.gov (United States)

    Okugi, Hironobu; Makino, Takeaki; Kato, Haruo; Oyam, Yusuke; Okazaki, Hiroshi; Nakamur, Toshiyuki

    2011-01-01

    Transurethral enucleation with bipolar (TUEB) is an established procedure for treating patients with benign prostatic hyperplasia (BPH). In this study, the usefulness of TUEB was evaluated by comparing the preoperative and postoperative results. A total of 45 patients with symptomatic BPH underwent TUEB at our hospital between February 2008 and August 2009. All the patients were assessed using the International prostate symptom score (IPSS), quality of life (QOL) index, overactive bladder symptom score (OABSS), maximum urinary flow rate (Qmax), post void urine residue (PVR), serum prostate specific antigen (PSA) measurement, and estimated prostate weight. Total operative time, enucleation time, enucleated tissue weight, changes in levels of hemoglobin, hematocrit and serum sodium, duration of urethral catheterization, and complications were also investigated. IPSS, QOL index, Qmax, and PVR were reassessed 1, 3, 6 and 12 months after surgery. PSA reduction rate was also assessed 3 months after surgery. The average age was 71.6 years (60-84 years), estimated prostate weight 53.2 g (11.8-105.6 g), total operative time 125.5 minutes (76-212 min.), enucleation time 96.1 min (56-169 min), enucleated tissue weight 32.3 g (6-82 g), and duration of urethral catheterization 2.5 days (2-7 days). Blood transfusion was not required and hyponatremia was not observed in any patients. IPSS, QOL index, OABSS, PVR, and Qmax were significantly improved 1 month after surgery. As complications, re-catheterisation was reported in 2 patients (4.4%), bladder tanponade in 1 (2.2%), and urinary incontinence requiring at least 1 pad 6 months after surgery in 1 (5.9%). Postoperative PSA declined by 89.8% 3 months after surgery. TUEB was a safe and effective treatment procedure for patients with BPH.

  10. [The treatment of bladder lithiasis with laser].

    Science.gov (United States)

    Arrabal Martín, Miguel; Nogueras Ocaña, Mercedes; Arrabal Polo, Miguel Angel; Miján Ortiz, José Luís; Valle Díaz de la Guardia, Francisco; Zuluaga Gómez, Armando

    2008-11-01

    The use of laser for endoscopic lithotripsy started in 1968 when Mulvaney tried a ruby laser without success; Later on, the CO2 laser and the Nd:YAG were tried. With the pulsed dye and alexandrite lasers energetic performances between 30 and 200 mJ are obtained, their capacity of fragmentation is not universal and is limited to small stones, generally ureteral stones, so that it has not been a therapeutic alternative for bladder lithiasis. The holmium laser generates energy pulses of 400-2500 mJ, it is able to fragment every type of stone. The objective of this work is to analyze the results of endoscopic bladder lithotripsy with holmium-YAG laser. In the period between 2006-2008 we treated 21 cases of bladder lithiasis, with a stone size between 1 and 4 cm in patients from 8-76 years, six women and 15 men, which correspond to: four cases of infantile lithiasis, 3 of uric acid, one case of cystine, seven cases of calcium oxalate and/or phosphate, five cases of bladder lithiasis growing around a double J catheter, and one case of lithiasis within on intravesical ureterocele. Treatment was performed with a 20W Dornier Medilas holmium-YAG equipment, applied using children/adult cystoscopes or 7-8.5 Ch ureteroscopes, both semirigid and flexible. Post operative control included KUB x-ray and ultrasound. We performed a study of lithogenic risk factors and stone fragments analysis. The 21 cases described are all secondary or type II bladder lithiasis. In all cases the absence of residual lithiasis was checked with imaging studies and the lithogenic risk factors were corrected with medical or surgical procedures. We consider that today bladder endoscopic lithotripsy with holmium laser is a therapeutic alternative. Despite there are multiple options for endoscopic treatment, transurethral lithotripsy with holmium laser offers good results with a low complication rate.

  11. Synthesis and Characterization of Holmium-Doped Iron Oxide Nanoparticles

    Directory of Open Access Journals (Sweden)

    Maarten Bloemen

    2014-02-01

    Full Text Available Rare earth atoms exhibit several interesting properties, for example, large magnetic moments and luminescence. Introducing these atoms into a different matrix can lead to a material that shows multiple interesting effects. Holmium atoms were incorporated into an iron oxide nanoparticle and the concentration of the dopant atom was changed in order to determine its influence on the host crystal. Its magnetic and magneto-optical properties were investigated by vibrating sample magnetometry and Faraday rotation measurements. The luminescent characteristics of the material, in solution and incorporated in a polymer thin film, were probed by fluorescence experiments.

  12. The studies on the aromaticity of fullerenes and their holmium endohedral compounds.

    Science.gov (United States)

    Tan, Bisheng; Peng, Rufang; Li, Hongbo; Wang, Bing; Jin, Bo; Chu, Shijin; Long, Xinping

    2011-02-01

    Density functional theory BLYP/DNP was employed to optimize a series of fullerenes and their holmium endohedral compounds, including C(20), Ho@C(20), Ho(3+)@C(20), C(60), Ho@C(60), Ho(3+)@C(60),C(70), Ho@C(70), Ho(3+)@C(70) C(78), Ho@C(78), Ho(3+)@C(78), C(82),Ho@C(82) and Ho(3+)@C(82). DFT semi core pseudospot approximation was taken into consideration in the calculations of the element holmium because of its particular electronic structure. Fullerenes and their holmium endohedral compounds' aromaticity were studied in terms of structural criteria, energetic criteria, and reactivity criteria. The results indicate that the aromaticity of fullerenes was reduced when a holmium atom was introduced into the carbon cage, and the endohedral fullerenes' reactive activity enhance; but the aromaticity of the carbon cage increased when a Ho(3+) cation was encapsulated into a fullerene. Calculations of aromaticity and stability indicate that two paths can lead to the similar aim of preparing holmium endohedral fullerenes; that is, they can form from either a holmium atom or a holmium cation (Ho(3+)) reacting with fullerenes, respectively, and the latter is more favorable.

  13. Treatment of a large radicular cyst - enucleation or decompression?

    Directory of Open Access Journals (Sweden)

    Matijević Stevo

    2015-01-01

    Full Text Available Introduction. Radicular cysts treatment involves surgical approach, more or less aggressive. However, treatment of large cystic lesions, including radicular cysts, causes some of dilemmas concerning the choice of the surgical method, especially the degree of radicalism. Case report. We presented a 65-year-old male patient with large radicular cyst in the mandible. A large elliptical multilocular radiolucency, located in the left side of the mandible, being in close vicinity to the mandibular canal, was registered at the orthopantomographic radiography. There was a risk of pathological fracture of the mandible. However, the cyst was completely removed by enucleation without intraoperative and postoperative complications. Conclusion. The presented case support the opinion that careful enucleation of large mandibular cysts may be done without complications, such as damages of surrounding anatomical structures or mandibular fracture. The authors indicate reasons for strong support of the undertaken surgical approach of treating large radicular cysts in the mandible.

  14. Treatment of a large radicular cyst-enucleation or decompression?

    Science.gov (United States)

    Matijević, Stevo; Jovivić, Bojan; Bubalo, Marija; Dukić, Smiljka; Cutović, Tatjana

    2015-04-01

    Radicular cysts treatment involves surgical approach, more or less aggressive. However, treatment of large cystic lesions, including radicular cysts, causes some of dilemmas concerning the choice of the surgical method, especially the degree of radicalism. We presented a 65-year-old male patient with large radicular cyst in the mandible. A large elliptical multilocular radiolucency, located in the left side of the mandible, being in close vicinity to the mandibular canal, was registered at the orthopantomographic radiography. There was a risk of pathological fracture of the mandible. However, the cyst was completely removed by enucleation without intraoperative and postoperative complications. The presented case support the opinion that careful enucleation of large mandibular cysts may be done without complications, such as damages of surrounding anatomical structures or mandibular fracture. The authors indicate reasons for strong support of the undertaken surgical approach of treating large radicular cysts in the mandible.

  15. Monopolar Transurethral Enucleation of Prostatic Adenoma: Preliminary Report.

    Science.gov (United States)

    Pansadoro, Vito; Emiliozzi, Paolo; Del Vecchio, Gianluca; Martini, Marco; Scarpone, Paolo; Del Giudice, Francesco; Veneziano, Domenico; Brassetti, Aldo; Assenmacher, Christophe

    2017-04-01

    To describe preliminary results of our monopolar transurethral enucleation of prostatic adenoma (mTUEPA). A consecutive series of male patients treated with mTUEPA, a retrograde enucleation of the prostatic adenoma performed by means of a standard monopolar resectoscope, were prospectively enrolled. Symptoms, uroflowmetry parameters, and post-voiding residual were assessed at baseline and at 1, 6, and 12 months postoperatively. Prostate volume was evaluated at baseline by means of transrectal ultrasound. Antiplatelet and anticoagulant drugs were stopped at least 1 week before the operation. Forty-seven patients were enrolled. Mean preoperative prostate volume was 64.9 ± 28.5 g. When assessed at baseline, the mean total International Prostatic Symptoms Score was 15.2 ± 3.9, peak flow rate (Qmax) was 8.4 ± 2.9 mL/s and the post-voiding residual was 103.2 ± 90.6 mL. Four weeks after surgery, patients reported a mean International Prostatic Symptoms Score of 5.3 ± 3. This lower urinary tract symptoms relief was further maintained at 6 and 12 months after surgery. A significant postoperative improvement in uroflowmetry parameters was described, being the 6 and 12 months mean Qmax of 23.4 ± 10.6 mL/s and 18.8 ± 9.2 mL/s, respectively (P enucleation and the advantages of mechanical enucleation with standard monopolar transurethral resection of the prostate equipment. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Impaled Orbital TASER Probe Injury Requiring Primary Enucleation.

    Science.gov (United States)

    Rafailov, Leon; Temnogorod, Jenny; Tsai, Frank F; Shinder, Roman

    The Conducted Electrical Weapon is a weapon often used by law enforcement agencies as a method of less lethal means to subdue a suspect. Injuries to the eye with these devices are usually due to the projectile force of the metal probes that are released when these devices are engaged. The authors report what may be the first case of an impaled orbital TASER probe that required primary enucleation for globe perforation.

  17. Sequential transurethral enucleation of the prostate and laparoscopic bladder diverticulectomy.

    Science.gov (United States)

    Yu, Yang; Guan, Sheng; Shen, Chen; Yang, Bo

    2016-08-01

    Transurethral endoscopic technique and standard laparoscopic technique are surgical options for the management of benign prostatic hyperplasia (BPH) associated with urinary bladder diverticuli (UBD). In this article, we report laparoscopic diverticulectomy (LD) and transurethral plasmakinetic enucleation of the prostate (TUEP) in the same patient sequentially. To the best of our knowledge, this is the first case report of LD combined with TUEP. An 82-year-old patient with benign prostatic hyperplasia and two secondary large bladder diverticuli underwent sequential TUEP and LD. After completion of the TUEP procedure, the detached adenoma was pushed into the bladder as a whole. Then laparoscopic transperitoneal extravesical diverticulectomy assisted by cystoscopic transillumination was performed immediately, and the enucleated prostate was removed via the neck of the diverticulum. The enucleation time and diverticulectomy time was 18 minutes and 108 minutes, respectively. The catheter was removed on the tenth postoperative day. Transurethral endoscopic surgery combined with LD is a good choice in treating BPH and UBD in one session. But the combined procedure is time-consuming, especially for fragmentation of the prostate. TUEP can greatly reduce the operative time of the combined procedure.

  18. Microspheres of polyester loaded with Holmium-165: effect of gamma irradiation on the polymeric structure

    Energy Technology Data Exchange (ETDEWEB)

    Azevedo, Mariangela de Burgos M. de; Pires, Geovanna; Lira, Rafael A. de; Geraldes, Adriana N.; Nascimento, Nanci; Melo, Vitor Hugo Soares de, E-mail: mbmazevedo@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Kodama, Yasko [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Biotecnologia

    2011-07-01

    Biodegradable polymers containing radioactive isotopes have potential applications as delivery vehicles of beta radiation to the cancer tumors by brachytherapy. 166-Ho is an example of such radioisotope emitting high-energy beta particles, and also its gamma rays allow nuclear imaging in everywhere is applied. Among the biodegradable polymers, different types of poly(lactide) have been investigated in our laboratory, and poly(L-lactide) (PLLA) was used as substrate to prepare microparticles loaded with holmium acetylacetonate HoAcAc (PLLA-HoAcAc-MP). The aim of this study was to evaluate the stability of these microparticles to gamma radiation. The PLLA-HoAcAc-MP were irradiated in a nuclear reactor IEA-R1 at IPEN/CNEN-SP, and their stability studied out with gamma radiation of 25, 50 and 100 kGy doses. MP were characterized before and after irradiation by differential scanning calorimetry analysis (DSC), thermogravimetric analysis (TGA), scanning electron microscopy (SEM), X-ray diffraction (XRD) and con focal laser scanning microscopy (CLSM). Preliminary results showed that gamma radiation did not damage morphologically the prepared PLLA-HoAcAc-MP in the dose range studied, and this procedure may be an important tool for knowing the stabilities of the polymers studied as MP for possible application in brachytherapy. (author)

  19. The Use of Bipolar Transurethral Enucleation for the Treatment of Large-Sized Benign Prostatic Hyperplasia

    OpenAIRE

    Sevryukov F.A.; Nakagawa Ken

    2012-01-01

    The aim of the investigation is to study the clinical efficiency of the transurethral enucleation of large-sized prostate adenoma based on a comparative analysis with the results of open adenomectomy. Materials and Methods. The research is based on the treatment results of 122 patients treated using the transurethral enucleation method, and 122 patients with open adenomectomy. Conclusion. The advantage of an operative method of bipolar transurethral enucleation of prostate over adenom...

  20. Histone deacetylase 2 is required for chromatin condensation and subsequent enucleation of cultured mouse fetal erythroblasts.

    Science.gov (United States)

    Ji, Peng; Yeh, Victor; Ramirez, Tzutzuy; Murata-Hori, Maki; Lodish, Harvey F

    2010-12-01

    During the final stages of differentiation of mammalian erythroid cells, the chromatin is condensed and enucleated. We previously reported that Rac GTPases and their downstream target, mammalian homolog of Drosophila diaphanous 2 (mDia2), are required for enucleation of in vitro cultured mouse fetal liver erythroblasts. However, it is not clear how chromatin condensation is achieved and whether it is required for enucleation. Mouse fetal liver erythroblasts were purified from embryonic day 14.5 pregnant mice and cultured in erythropoietin-containing medium. Enucleation was determined by flow-cytometry based analysis after treatment with histone deacetylase inhibitors or infection with lentiviral short hairpin RNA. We showed that histone deacetylases play critical roles in chromatin condensation and enucleation in cultured mouse fetal liver erythroblasts. Enzymatic inhibition of histone deacetylases by trichostatin A or valproic acid prior to the start of enucleation blocked chromatin condensation, contractile actin ring formation and enucleation. We further demonstrated that histone deacetylases 1, 2, 3 and 5 are highly expressed in mouse fetal erythroblasts. Short hairpin RNA down-regulation of histone deacetylase 2, but not of the other histone deacetylases, phenotypically mimicked the effect of trichostatin A or valproic acid treatment, causing significant inhibition of chromatin condensation and enucleation. Importantly, knock-down of histone deacetylase 2 did not affect erythroblast proliferation, differentiation, or apoptosis. These results identify histone deacetylase 2 as an important regulator, mediating chromatin condensation and enucleation in the final stages of mammalian erythropoiesis.

  1. Second molar germectomy and third molar eruption. 11 cases of lower second molar enucleation.

    Science.gov (United States)

    Gaumond, G

    1985-01-01

    Eleven cases followed from enucleation of the unerupted lower second molars through third molar eruption. While results were generally good, three presented third molar malpositions requiring further treatment.

  2. Enucleation of cultured mouse fetal erythroblasts requires Rac GTPases and mDia2.

    Science.gov (United States)

    Ji, Peng; Jayapal, Senthil Raja; Lodish, Harvey F

    2008-03-01

    Mammalian erythroid cells undergo enucleation, an asymmetric cell division involving extrusion of a pycnotic nucleus enveloped by the plasma membrane. The mechanisms that power and regulate the enucleation process have remained obscure. Here, we show that deregulation of Rac GTPase during a late stage of erythropoiesis completely blocks enucleation of cultured mouse fetal erythroblasts without affecting their proliferation or differentiation. Formation of the contractile actin ring (CAR) on the plasma membrane of enucleating erythroblasts was disrupted by inhibition of Rac GTPases. Furthermore, we demonstrate that mDia2, a downstream effector of Rho GTPases and a formin protein required for nucleation of unbranched actin filaments, is also required for enucleation of mouse fetal erythroblasts. We show that Rac1 and Rac2 bind to mDia2 in a GTP-dependent manner and that downregulation of mDia2, but not mDia1, by small interfering RNA (siRNA) during the late stages of erythropoiesis blocked both CAR formation and erythroblast enucleation. Additionally, overexpression of a constitutively active mutant of mDia2 rescued the enucleation defects induced by the inhibition of Rac GTPases. These results reveal important roles for Rac GTPases and their effector mDia2 in enucleation of mammalian erythroblasts.

  3. Indications for evisceration and enucleation of the eye at Ilorin, Nigeria

    African Journals Online (AJOL)

    In the period, 1990-1999, 92 eyes that underwent evisceration / enucleation at the University of Ilorin Teaching Hospital, Ilorin, Nigeria were reviewed retrospectively. Males were mostly affected with a male / female ratio of 2.8:1. The most common procedure done was evisceration in 85.9% of the cases. Enucleation was ...

  4. Worldwide enucleation techniques and materials for treatment of retinoblastoma: an international survey

    NARCIS (Netherlands)

    Mourits, Daphne L.; Hartong, Dyonne T.; Bosscha, Machteld I.; Kloos, Roel J. H. M.; Moll, Annette C.

    2015-01-01

    To investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world. A digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma. We received a response of

  5. Indications for Enucleation of the Eyes of Children in Eastern Nigeria ...

    African Journals Online (AJOL)

    Retinoblastoma accounted for 36 (56.1%) enucleations, both sex being equally affected. Avoidable ocular problems resulting in enucleations such as panophthalmitis, endopphthalmitis, some staphyloma and others were noted in as high as 42.7% Trauma, measles and corneal ulcers of unknown aetiology preceded most ...

  6. Irreversible electroporation of human primary uveal melanoma in enucleated eyes.

    Directory of Open Access Journals (Sweden)

    Yossi Mandel

    Full Text Available Uveal melanoma (UM is the most common primary intraocular tumor in adults and is characterized by high rates of metastatic disease. Although brachytherapy is the most common globe-sparing treatment option for small- and medium-sized tumors, the treatment is associated with severe adverse reactions and does not lead to increased survival rates as compared to enucleation. The use of irreversible electroporation (IRE for tumor ablation has potential advantages in the treatment of tumors in complex organs such as the eye. Following previous theoretical work, herein we evaluate the use of IRE for uveal tumor ablation in human ex vivo eye model. Enucleated eyes of patients with uveal melanoma were treated with short electric pulses (50-100 µs, 1000-2000 V/cm using a customized electrode design. Tumor bioimpedance was measured before and after treatment and was followed by histopathological evaluation. We found that IRE caused tumor ablation characterized by cell membrane disruption while sparing the non-cellular sclera. Membrane disruption and loss of cellular capacitance were also associated with significant reduction in total tumor impedance and loss of impedance frequency dependence. The effect was more pronounced near the pulsing electrodes and was dependent on time from treatment to fixation. Future studies should further evaluate the potential of IRE as an alternative method of uveal melanoma treatment.

  7. Carbon nanotubes for ultrafast fibre lasers

    Directory of Open Access Journals (Sweden)

    Chernysheva Maria

    2016-06-01

    Full Text Available Carbon nanotubes (CNTs possess both remarkable optical properties and high potential for integration in various photonic devices. We overview, here, recent progress in CNT applications in fibre optics putting particular emphasis on fibre lasers. We discuss fabrication and characterisation of different CNTs, development of CNT-based saturable absorbers (CNT-SA, their integration and operation in fibre laser cavities putting emphasis on state-of-the-art fibre lasers, mode locked using CNT-SA. We discuss new design concepts of high-performance ultrafast operation fibre lasers covering ytterbium (Yb, bismuth (Bi, erbium (Er, thulium (Tm and holmium (Ho-doped fibre lasers.

  8. Stress relaxation and cartilage shaping under laser radiation

    Science.gov (United States)

    Sobol, Emil N.; Sviridov, Alexander P.; Bagratashvili, Victor N.; Omelchenko, Alexander I.; Ovchinnikov, Yuriy M.; Shekhter, Anatoliy B.; Downes, S.; Howdle, Steven; Jones, Nicholas; Lowe, J.

    1996-05-01

    The problem of a purposeful change of the shape of cartilage is of great importance for otolaryngology, orthopaedics, and plastic surgery. In 1992 we have found a possibility of controlled shaping of cartilage under moderate laser heating. This paper presents new results in studies of that phenomenon. We have measured temperature and stress in a tissue undergoing to irradiation with a Holmium laser. Study of cartilage structure allowed us to find conditions for laser shaping without pronounced alterations in the structure of matrix.

  9. Influence of Magnetic Field on Electric Charge Trasport in Holmium Thin Film at Low Temperature

    Directory of Open Access Journals (Sweden)

    Jan Dudas

    2010-01-01

    Full Text Available High precision electrical resistance measurements were performed in the low  temperature range from 4.2 K up to room temperature on a holmium bulk sample, and on holmium thin films in magnetic field. The X-ray diffraction of Ho films confirmed  their preferential crystal orientation and revealed diffraction peaks originating from the hcp structure of Ho and those from inessential holmium dihydrid content. The TN value of these films decreased with decreasing film thickness. Magnetic field applied parallel to the thin film plane caused an increasing suppression of the TN value up to 5 K  with increasing flux density value up to 5 T.

  10. The eyeball killer: serial killings with postmortem globe enucleation.

    Science.gov (United States)

    Coyle, Julie; Ross, Karen F; Barnard, Jeffrey J; Peacock, Elizabeth; Linch, Charles A; Prahlow, Joseph A

    2015-05-01

    Although serial killings are relatively rare, they can be the cause of a great deal of anxiety while the killer remains at-large. Despite the fact that the motivations for serial killings are typically quite complex, the psychological analysis of a serial killer can provide valuable insight into how and why certain individuals become serial killers. Such knowledge may be instrumental in preventing future serial killings or in solving ongoing cases. In certain serial killings, the various incidents have a variety of similar features. Identification of similarities between separate homicidal incidents is necessary to recognize that a serial killer may be actively killing. In this report, the authors present a group of serial killings involving three prostitutes who were shot to death over a 3-month period. Scene and autopsy findings, including the unusual finding of postmortem enucleation of the eyes, led investigators to recognize the serial nature of the homicides. © 2015 American Academy of Forensic Sciences.

  11. Synthesis, Characterization and Thermal Diffusivity of Holmium and Praseodymium Zirconates

    Directory of Open Access Journals (Sweden)

    Stopyra M.

    2016-06-01

    Full Text Available A2B2O7 oxides with pyrochlore or defected fluorite structure are among the most promising candidates for insulation layer material in thermal barrier coatings. The present paper presents the procedure of synthesis of holmium zirconate Ho2Zr2O7 and praseodymium zirconate Pr2Zr2O7 via Polymerized-Complex Method (PCM. Thermal analysis of precursor revealed that after calcination at relatively low temperature (700°C fine-crystalline, single-phase material is obtained. Thermal diffusivity was measured in temperature range 25-200°C, Ho2Zr2O7 exhibits lower thermal diffusivity than Pr2Zr2O7. Additionally, PrHoZr2O7 was synthesized. The powder in as-calcined condition is single-phase, but during the sintering decomposition of solid solution took place and Ho-rich phase precipitated. This material exhibited the best insulating properties among the tested ones.

  12. [FIRST CASES OF ANTEROPOSTERIOR DISSECTION TUEB (TRANSURETHRAL ENUCLEATION WITH BIPOLAR)].

    Science.gov (United States)

    Hosokawa, Shingo; Matsumoto, Rikiya; Mizuno, Takuji

    2015-01-01

    We examined the efficacy of anteroposterior dissection transurethral enucleation with bipolar (TUEB) for benign prostate hyperplasia (BPH). We performed anteroposterior dissection TUEB on 21 patients with BPH between October 2012 and June 2013. In anteroposterior dissection TUEB, the lateral lobes are anteroposteriorly dissected from the 12 o'clock position to the 6 o'clock position after enucleation of the middle lobe. Mean age was 73 years, mean estimated prostate volume was 62.8 ml, mean estimated transition zone volume was 44.5 ml, mean International Prostate Symptom Score (IPSS) score was 15.5, mean quality of life (QOL) score was 4.1, peak flow rate (Qmax) was 8.6 ml/s, and mean residual urine volume was 42.4 ml. The mean operation time was 69 min, the mean weight of removed prostate tissue was 27.3 g, and the mean decrease in hemoglobin level was 1.8 g/dl. Three months after surgery, mean IPSS score was 5.9, mean QOL score was 1.9, mean Qmax was 28 ml/s, and mean residual urine volume was 1.0 ml, values which were significantly improved over pre-surgery data. No complications such as perforation or bladder injury occurred during surgery, but 1 case (4.7%) of stress urinary incontinence and 1 case (4.7%) of urethral stricture were reported after surgery. Of note, urethral stricture was determined using a flexible cytoscope at 1 week, 1 month, and 3 months post-surgery. Anteroposterior dissection TUEB can be conducted safely and may be useful in reducing frequency of urethral stricture post-surgery.

  13. LAPAROSCOPIC PANCREATIC RESECTION. FROM ENUCLEATION TO PANCREATODUODENECTOMY. 11-YEAR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Marcel Autran Cesar MACHADO

    2013-09-01

    Full Text Available Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6% were performed totally laparoscopic; 4 (4.2% needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%. Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons.

  14. Clinicopathologic correlations in eyes enucleated after uveal melanoma resection with positive surgical margins.

    Science.gov (United States)

    Khalifa, Yousuf; Aaberg, Thomas M; Aaberg, Thomas M; Grossniklaus, Hans E

    2007-01-01

    We identified three eyes that had undergone enucleation after transscleral resection of uveal melanoma. Two enucleated eyes with microscopically positive margins of resection exhibited no evidence of residual melanoma and these patients were alive without metastasis with at least four years' follow-up. One eye with a transected melanoma contained residual melanoma and that patient died with metastatic melanoma to the liver three years after enucleation. There appear to be at least two general types of positive surgical margins of resection of uveal melanoma: microscopically positive margins and macroscopically positive (transected) margins of resection.

  15. Clinicopathologic correlations in eyes enucleated after uveal melanoma resection with positive surgical margins

    Directory of Open Access Journals (Sweden)

    Khalifa Yousuf

    2007-01-01

    Full Text Available We identified three eyes that had undergone enucleation after transscleral resection of uveal melanoma. Two enucleated eyes with microscopically positive margins of resection exhibited no evidence of residual melanoma and these patients were alive without metastasis with at least four years′ follow-up. One eye with a transected melanoma contained residual melanoma and that patient died with metastatic melanoma to the liver three years after enucleation. There appear to be at least two general types of positive surgical margins of resection of uveal melanoma: microscopically positive margins and macroscopically positive (transected margins of resection.

  16. Holmium dodecaiodidoiron-octahedro-hexaholmium, {FeHo6}I12Ho

    Directory of Open Access Journals (Sweden)

    Gerd Meyer

    2009-02-01

    Full Text Available Single crystals of {FeHo6}I12Ho were obtained during the reaction of HoI3 with metallic holmium and iron in a sealed tantalum container. The crystal structure consists of isolated holmium clusters encapsulating a single Fe atom, {FeHo6} (overline{3} symmetry. The rare earth metal atoms are surrounded by 12 edge-capping and six terminal iodide ligands that either connect the clusters to each other directly or via HoI6 octahedra (overline{3} symmetry.

  17. Development of Holmium 166-chitosan complex as a radiopharmaceutical agent for liver cancer therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Jei Man; Nam, Soon Chul; Park, Sun Joo; Moon, Eun Yi; Lee, Won Yong; Shin, Dong Hyuk; Cho, Eun Hee [Korea Atomic Energy Research Instisute, Taejon (Korea, Republic of)

    1997-09-01

    Effective therapeutic methods for cancer disease should be developed because the frequency of cancer disease is being increased rapidly. But there is no effective therapeutic method for treating these disease until now. The purpose of this research is to gain the clinical approval of Holmium{sup 166}-Chitosan complex as a radiopharmaceutical agent for liver cancer. We finished the preclinical test of Holmium{sup 166}-Chitosan complex and got the approval for clinical trial of this agent. 12 refs., 11 tabs., 9 figs. (author)

  18. EXCIMER-LASER ABLATION OF SOFT-TISSUE - A STUDY OF THE CONTENT OF RAPIDLY EXPANDING AND COLLAPSING BUBBLES

    NARCIS (Netherlands)

    van Leeuwen, T. G.; Jansen, E. D.; Motamedi, M.; Welch, A. J.; Borst, C.

    1994-01-01

    Both holmium (lambda = 2.09 mum) and excimer (lambda = 308 nm) lasers are used for ablation of tissue. In a previous study, excimer laser ablation of aorta produced rapidly expanding and collapsing vapor bubbles. To investigate whether the excimer-induced bubble is caused by vaporization of (tissue)

  19. Giant Hepatic Hemangioma With Kasabach–Merritt Syndrome: Is the Appropriate Treatment Enucleation or Liver Transplantation?

    Science.gov (United States)

    Hochwald, Steven N.

    2000-01-01

    We present a case of giant cavernous hemangioma of the liver with disseminated intravascular coagulopathy (Kasabach–Merritt syndrome) which was cured by enucleation. The 51 year old woman presented with increased abdominal girth and easy bruisability. Workup elsewhere revealed a massive hepatic hemangioma and she was started on radiation therapy to the lesion and offered an orthotopic liver transplant. After careful preoperative preparation, we felt that resection was possible and she underwent a successful enucleation. The operation and postoperative course were complicated by bleeding but she recovered and remains well in followup after 6 months. All coagulation parameters have returned to normal. Enucleation should be considered the treatment of choice for hepatic hemangiomas, including those presenting with Kasabach–Merritt syndrome. The benefits of enucleation as compared to liver transplantation for these lesions are discussed. PMID:10977121

  20. Preservation of enucleated porcine eyes for use in a wet laboratory

    NARCIS (Netherlands)

    Nibourg, Lisanne M.; Koopmans, Steven A.

    PURPOSE: To design a method to preserve enucleated porcine eyes for use in a wet laboratory. SETTING: Laboratory of Experimental Ophthalmology, University Medical Center Groningen, the Netherlands. DESIGN: Experimental study. METHODS: Porcine eyes were preserved using 15 methods including salt

  1. Pancreatic enucleation using the da Vinci robotic surgical system: a report of 26 cases.

    Science.gov (United States)

    Shi, Yusheng; Peng, Chenghong; Shen, Baiyong; Deng, Xiaxing; Jin, Jiabin; Wu, Zhichong; Zhan, Qian; Li, Hongwei

    2016-12-01

    As a tissue-sparing procedure, pancreatic enucleation has become an alternative for benign or borderline pancreatic tumours; it has been proved to be safe and feasible. To date, a large sample size of robotic pancreatic enucleation has not been reported. This study aimed to discuss the clinical evaluation and postoperative complications after robotic pancreatic enucleation and compare it with open surgery. Patients who underwent robotic or open pancreatic enucleation during December 2010-December 2014 at Shanghai Ruijin Hospital, affiliated with the Shanghai Jiaotong University School of Medicine in China, were included. Clinical data were collected and analysed. Patients were divided into an open group and a robotic group: 26 patients underwent robotic pancreatic enucleation, of whom 13 patients were female. The mean age was 51.7 years, the operation time was 125.7 ± 58.8 min, blood loss was 49.4 ± 33.4 ml and mean tumour size was 18.8 ± 7.9 mm; 17 patients underwent open pancreatic enucleation, of whom 11 were female. The mean age was 54.6 ± 17.2 min, blood loss was 198.5 ± 70.7 ml and mean tumour size was 3.5 ± 1.9 cm. Pathology included insulinomas, intrapancreatic mucinous neoplasmas (IPMNs), pancreatic neuro-endocrine tumours (PNETs), solid pseudopapillary tumours (SPTs) and serous cystadenomas (SCAs). Robotic pancreatic enucleations were associated with less trauma, shorter operation time, less blood loss and faster wound recovery compared with open pancreatic enucleation. Pancreatic fistulas (PFs) were the main complication that occurred in the robotic group; infection also occurred in the open group. All patients recovered after effective drainage and the use of somatostatin. The mean follow-up time was 25 months. No recurrence was discovered, and one patient in the open group suffered endocrine insufficiency. Robotic pancreatic enucleation is a safe and effective surgical procedure for pancreatic benign and borderline tumours. It produces less

  2. Thulium fiber laser lithotripsy in an in vitro ureter model

    Science.gov (United States)

    Hardy, Luke A.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2014-12-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser (λ=2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. The TFL (λ=1908 nm) was operated with 35 mJ, 500 μs, 150 to 500 Hz, and a 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and 13.7 ml/min for the TFL and holmium laser, respectively. The temperature 3 mm from the tube's center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured 167±41 s (n=12). TFL times measured 111±49, 39±11, and 23±4 s, for pulse rates of 150, 300, and 500 Hz, respectively (n=12 each). Mean peak saline irrigation temperatures reached 24±1°C for holmium, and 33±3°C, 33±7°C, and 39±6°C, for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy.

  3. ENUCLEATION IN A PATIENT WITH NEUROFIBROMATOSIS TYPE 1 WITH BUPHTHALMOS AND OCULAR DEFORMITY

    Directory of Open Access Journals (Sweden)

    F. Asadi-Amoli

    2007-09-01

    Full Text Available To report a case of buphthalmos with neurofibromatosis (NF-1 who suffered with blindness suffered enucleation. Physical examination & histopathology were performed. Physical examination revealed Buphthalmos & vascularized cornea with lower lid ectropion and orbital deformity. Histopathologic findings shows plexiform neurofibroma in orbital tissue with scleral wall involvement. And hamartomatous proliferation in choroid & cilliary bodies with melanocytic elements. Few NF-1 cases with buphthalmos have been reported. But cases with complicationg buphthalmos (retinal Detachment & optic nerve Atrophy suffering enucleation are very rare.

  4. Preparation and complex characterization of silica holmium sol-gel monoliths.

    Science.gov (United States)

    Cacaina, D; Areva, S; Laaksonen, H; Simon, S; Ylänen, H

    2011-01-01

    Amorphous, sol-gel derived SiO(2) are known to biocompatible and bioresorbable materials. Biodegradable and inert materials containing radioactive isotopes have potential application as delivery vehicles of the beta radiation to the cancer tumors inside the body. Incorporation of holmium in the sol-gel derived SiO(2) could lead to the formation of a biodegradable material which could be used as carrier biomaterial for the radiation of radioactive holmium to the various cancer sites. The homogeneity of the prepared sol-gel silica holmium monoliths was investigated by Back Scattered Electron Imaging of Scanning Electron Microscope equipped with Energy Dispersive X-ray Analysis, X-ray Induced Photoelectron Spectroscopy and Nuclear Magnetic Resonance Spectroscopy. The biodegradation of the monoliths was investigated in Simulated Body Fluid and TRIS (Trizma pre-set Crystals) solution. The results show that by suitable tailoring of the sol-gel processing parameters holmium can be homogeneously incorporated in the silica matrix with a controlled biodegradation rate.

  5. New insights into the mechanisms of mammalian erythroid chromatin condensation and enucleation.

    Science.gov (United States)

    Ji, Peng

    2015-01-01

    A unique feature in mammalian erythropoiesis is the dramatic chromatin condensation followed by enucleation. This step-by-step process starts at the beginning of terminal erythropoiesis after the hematopoietic stem cells are committed to erythroid lineage. Although this phenomenon is known for decades, the mechanisms of chromatin condensation and enucleation remain elusive. Recent advances in cell and molecular biology have started to reveal the molecular pathways in the regulation of chromatin condensation, the establishment of nuclear polarity prior enucleation, and the rearrangement of actin cytoskeleton in enucleation. However, many challenging questions, especially whether and how the apoptotic mechanisms are involved in chromatin condensation and how to dissect the functions of many actin cytoskeleton proteins in cytokinesis and enucleation, remain to be answered. Here I review our current understanding of mammalian erythroid chromatin condensation and enucleation during terminal differentiation with a focus on more recent studies. I conclude with my perspective of future works in this rising topic in developmental and cell biology. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Enucleation in Iceland 1992-2004: study in a defined population.

    Science.gov (United States)

    Geirsdottir, Asbjorg; Agnarsson, Bjarni A; Helgadottir, Gudleif; Sigurdsson, Haraldur

    2014-03-01

    To determine the incidence rate as well as causative diagnoses and surgical indications of enucleation in Iceland during the years 1992-2004. A retrospective population-based incidence study involving the entire population of Iceland. Medical records of all patients who underwent enucleation in Iceland from January 1992 through December 2004 were reviewed. The annually updated Icelandic census was used as a denominator data. Fifty-six eyes were enucleated during 1992-2004. No eviscerations were done, and the three exenterations performed were not included in the study. The mean annual age-adjusted incidence rate of enucleation in Iceland was 1.48 enucleations per 100 000 population in comparison with 2.66 enucleations per 100 000 for the time period 1964-1991. With advancing age, a significant increasing linear trend existed (p Iceland is continually decreasing, although the incidence of severe ocular trauma and ocular malignancy is fairly stable. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

  7. Radiological changes post-lymph node enucleation for airway obstruction in children with pulmonary tuberculosis.

    Science.gov (United States)

    Maydell, Arthur; Goussard, Pierre; Andronikou, Savvas; Bezuidenhout, Fourie; Ackermann, Christelle; Gie, Robert

    2010-10-01

    Tuberculous lymphadenopathy causing airway obstruction in children may be life threatening and may require surgical enucleation of the lymph glands. There are no studies investigating the radiological picture post-enucleation. We attempt to explore this area in our study. A retrospective study of the imaging in 21 paediatric cases having undergone tuberculosis (TB) lymph node enucleation. Bronchus intermedius (BI) stenosis was present in 95% of patients undergoing enucleation, followed by left main bronchus (LMB) (81%) and right main bronchus (RMB) (67%) stenosis. Right lung collapse/consolidation occurred more frequently (48-62%) than left-lung collapse/consolidation (10-14%). Resolution of BI stenosis and right lower lobe (RLL) collapse/consolidation is the most consistent postoperative finding. Nine children resolved at an average time of 6.5 months postoperatively, while 10 children were still resolving at an average time of 4.5 months. The resolution of the complications of lymph node enlargement (airway stenosis and lung collapse/consolidation) was seen more frequently than the resolution of the offending lymphadenopathy itself. Right-sided disease was necessary to produce complications severe enough to require enucleation. Subcarinal lymph node enucleation is sufficient for resolution of LMB stenosis and associated left-lung sequelae. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  8. Discharge and infection in retinoblastoma post-enucleation sockets

    Directory of Open Access Journals (Sweden)

    Mourits DL

    2017-03-01

    Full Text Available Daphne L Mourits,1 Dyonne T Hartong,1 Andries E Budding,2 Machteld I Bosscha,1 H Stevie Tan,1 Annette C Moll1 1Department of Ophthalmology, VU University Medical Center, 2Department of Microbiology, Academic Medical Center, Amsterdam, the Netherlands Purpose: To investigate the causes and treatment options for socket discharge and infection in patients enucleated for retinoblastoma (Rb. Methods: A questionnaire was filled out by (parents of ocular prosthesis-wearing patients with a history of enucleation as treatment for Rb. We collected data on patients’ characteristics, cleaning habits of the prosthesis, frequency of socket irritation, discharge, and infection, and use of antibiotics. With ordinal logistic regression analysis, factors related to the outcome parameters (frequency of irritation, mucoid and purulent discharge were identified. In a subset of young asymptomatic and symptomatic patients, a swab culture of the socket was performed to determine the presence of microorganisms. Results: A total of 186 patients or their parents (mean age of the patients: 17.3 years, ranging from 0.8 to 88.3 years filled out the questionnaire. Irritation, mucoid discharge, and purulent discharge were frequently (once a month or more often experienced in 75 (39.5%, 127 (66.8%, and 15 (13.2% sockets, respectively. Younger age was associated with a higher frequency of mucoid and purulent discharge. Radiation therapy, chemotherapy, gender, age at surgery, cleaning frequency, and nocturnal wear were not associated with the outcome parameters. In a subgroup of 26 patients, the sockets were swabbed and cultured. All symptomatic patients had a positive bacterial culture versus 15% (2/13 of the asymptomatic patients (P<0.001. Common cold was correlated with both symptoms and presence of bacteria. Haemophilus influenzae and Staphylococcus aureus were the species most frequently cultured. Conclusion: Ocular prosthesis-wearing patients often experienced mucoid

  9. [Transurethral plasmakinetic enucleation of the prostate for benign prostatic hyperplasia].

    Science.gov (United States)

    Sheng, Xu-jun; Chen, Jian-hua; Wang, Wei-ming; Kong, Liang; Zhang, Liang; Yu, Yong-jiang; Wu, Yu; Qi, Jun

    2011-05-01

    To evaluate clinical application of transurethral plasmakinetic enucleation of the prostate (PKEP) to the treatment of benign prostatic hyperplasia (BPH). A total of 90 BPH patients, aged 59-83 (mean 71) years and with indication of surgery, underwent transurethral resection of the prostate (the TURP group, n=50) and transurethral plasmakinetic enucleation of the prostate (the PKEP group, n=40), respectively. We recorded and analyzed the preoperative prostate volume, IPSS, QOL and Qmax, operation time, intra- and post-operative bleeding and complications, postoperative continuous bladder irrigation, and IPSS, QOL and Qmax at 2 weeks and 6 months after surgery. The preoperative prostate volume and operation time were 58.9 g and 58.8 min in the TURP group versus 58.3 g and 93.0 min in the PKEP group. Mild transurethral resection syndrome (TURS) appeared in 2 TURP receivers, while no abnormality was found in electrocardiogram monitoring in those undergoing PKEP. Continuous bladder irrigation was necessitated in 3 and urgent incontinence of urine occurred in 4 cases of TURP, as compared with 1 and 4 cases in the PKEP group. None of the 90 patients needed blood transfusion. At 2 weeks before and after surgery and 6 months postoperatively, IPSS averaged 19.7, 11.6 and 5.1, QOL 4.6, 3.3 and 1.1, and Qmax 6.3, 13.0 and 18.1 ml/s in the TURP group versus 18.6, 8.4 and 4.9 (IPSS), 4.5, 2.7 and 1.1 (QOL) and 6.9, 14.2 and 19.0 ml/s (Qmax) in the PKEP group. There were significant differences in operation time, IPSS and QOL at 2 weeks postoperatively between the two groups, as well as in IPSS, QOL and Qmax at 6 months before and after surgery (P 0.01). Transurethral PKEP is a safe, effective and thorough surgical method to be chosen for the treatment of BPH.

  10. Thulium fiber laser damage to the ureter

    Science.gov (United States)

    Wilson, Christopher R.; Hardy, Luke A.; Irby, Pierce B.; Fried, Nathaniel M.

    2015-07-01

    Our laboratory is studying experimental thulium fiber laser (TFL) as a potential alternative lithotripter to the clinical gold standard Holmium:YAG laser. Safety studies characterizing undesirable Holmium laser-induced damage to ureter tissue have been previously reported. Similarly, this study characterizes TFL induced ureter and stone basket damage. A TFL beam with pulse energy of 35 mJ, pulse duration of 500 μs, and pulse rates of 150-500 Hz was delivered through a 100-μm-core, low-OH, silica optical fiber to the porcine ureter wall, in vitro. Ureter perforation times were measured and gross, histological, and optical coherence tomography images of the ablation zone were acquired. TFL operation at 150, 300, and 500 Hz produced mean ureter perforation times of 7.9, 3.8, and 1.8 s, respectively. Collateral damage averaged 510, 370, and 310 μm. TFL mean perforation time exceeded 1 s at each setting, which is a greater safety margin than previously reported during Holmium laser ureter perforation studies.

  11. Mouse eye enucleation for remote high-throughput phenotyping.

    Science.gov (United States)

    Mahajan, Vinit B; Skeie, Jessica M; Assefnia, Amir H; Mahajan, Maryann; Tsang, Stephen H

    2011-11-19

    The mouse eye is an important genetic model for the translational study of human ophthalmic disease. Blinding diseases in humans, such as macular degeneration, photoreceptor degeneration, cataract, glaucoma, retinoblastoma, and diabetic retinopathy have been recapitulated in transgenic mice.(1-5) Most transgenic and knockout mice have been generated by laboratories to study non-ophthalmic diseases, but genetic conservation between organ systems suggests that many of the same genes may also play a role in ocular development and disease. Hence, these mice represent an important resource for discovering new genotype-phenotype correlations in the eye. Because these mice are scattered across the globe, it is difficult to acquire, maintain, and phenotype them in an efficient, cost-effective manner. Thus, most high-throughput ophthalmic phenotyping screens are restricted to a few locations that require on-site, ophthalmic expertise to examine eyes in live mice. (6-9) An alternative approach developed by our laboratory is a method for remote tissue-acquisition that can be used in large or small-scale surveys of transgenic mouse eyes. Standardized procedures for video-based surgical skill transfer, tissue fixation, and shipping allow any lab to collect whole eyes from mutant animals and send them for molecular and morphological phenotyping. In this video article, we present techniques to enucleate and transfer both unfixed and perfusion fixed mouse eyes for remote phenotyping analyses.

  12. Enucleation: A treatment alternative for branch duct intraductal papillary mucinous neoplasms.

    Science.gov (United States)

    Kaiser, Joerg; Fritz, Stefan; Klauss, Miriam; Bergmann, Frank; Hinz, Ulf; Strobel, Oliver; Schneider, Lutz; Büchler, Markus W; Hackert, Thilo

    2017-03-01

    Small, asymptomatic, branch-duct intraductal papillary mucinous neoplasms of the pancreas are often kept under surveillance despite their malignant potential. The management of branch-duct intraductal papillary mucinous neoplasm is controversial with regard to indications and extent of any operative intervention. The present study aimed to evaluate enucleation as an alternative operative approach for branch-duct intraductal papillary mucinous neoplasms to exclude and prevent malignancy. For branch-duct intraductal papillary mucinous neoplasms of neoplasm on the basis of these features between January 2004 and September 2014 were analyzed. Among these, patients with successful enucleation were compared with those who were scheduled for enucleation but converted intraoperatively to pancreatic resection (intention-to-treat analysis). End points were hospital morbidity and mortality as well as histopathology and functional outcome at a mean follow-up of 32 months. In the study, 115 patients with presumed branch-duct intraductal papillary mucinous neoplasm and the intention to perform pancreatic enucleation were included; 87 enucleations were performed in 74 patients. In 41 patients, enucleation was converted to a pancreatic resection (procedure-specific success rate 64%); indications for conversion included location or size (46%), presence of multicystic lesions (39%), or involvement of the main pancreatic duct (15%). Of the 74 patients with enucleation, 64 branch-duct intraductal papillary mucinous neoplasms revealed low- (85%), 11% moderate dysplasia-, and 4% high-grade dysplasia on histology. Among converted resections, 6 intraductal papillary mucinous neoplasms revealed high-grade dysplasia or invasive carcinoma (15%). Intention-to-treat analysis with patients converted to pancreatic resection showed that enucleations resulted in less blood loss (100 vs 400 mL) and a shorter operation time (146 vs 255 minutes; P neoplasm-specific recurrence rates (3% vs 6

  13. Intratumoral administration of Holmium-166 Acetylacetonate Microspheres : Antitumor efficacy and feasibility of multimodality imaging in renal cancer

    NARCIS (Netherlands)

    Bult, W.; Kroeze, S.G.C.; Elschot, M.; Seevinck, P.R.; Beekman, F.J.; De Jong, H.W.A.M.; Uges, D.R.A.; Kosterink, J.G.W.; Luijten, P.R.; Hennink, W.E.

    2013-01-01

    The increasing incidence of small renal tumors in an aging population with comorbidities has stimulated the development of minimally invasive treatments. This study aimed to assess the efficacy and demonstrate feasibility of multimodality imaging of intratumoral administration of holmium-166

  14. Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics.

    Science.gov (United States)

    Liu, Chunxiao; Zheng, Shaobo; Li, Hulin; Xu, Kai

    2010-12-01

    We evaluated transurethral enucleation and resection of the prostate in patients with urinary symptoms due to benign prostatic hyperplasia using the Plasmakinetic™ system. We retrospectively analyzed the records of 1,100 patients who underwent transurethral enucleation and resection of the prostate between January 2003 and February 2009 at our institution. We assessed the International Prostate Symptom Score, quality of life score, peak flow rate and post-void residual urine volume preoperatively, 1, 3, 6 and 12 months postoperatively, and yearly thereafter. Enucleation and resection time, enucleated tissue weight, catheterization time, hospital stay and long-term complications were recorded. No patient had significant blood loss or signs of the transurethral resection syndrome. Mean±SD patient age was 66.7±7.3 years and mean followup was 4.3 years. Mean preoperative prostate weight was 67.7±12 gm (range 35 to 256), mean enucleation time was 15.5 minutes (range 10 to 38), mean resection time was 46 minutes (range 20 to 65) and mean resected tissue weight was 42.8±7.7 gm (range 23 to 219). Mean catheter time was 1.8±0.4 days and mean hospital stay was 5.3±2.3 days. Transurethral enucleation and resection of the prostate induced significant, pronounced, immediate and lasting improvement in the International Prostate Symptom Score, quality of life, maximum urinary flow and post-void residual urine volume. Postoperative complications included meatal stenosis in 9 cases, incontinence in 56, urethral stricture in 12 and bladder neck contracture in 10. Transurethral enucleation and resection of the prostate appears to be the modern alternative to transurethral resection of the prostate and open prostatectomy for bladder outlet obstruction due to benign prostatic hyperplasia. It may be done in glands up to 250 gm. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. [Transurethral vapor enucleation and resection of prostate with TURis button electrode].

    Science.gov (United States)

    Xie, Li-ping; Qin, Jie; Zheng, Xiang-yi; Mao, Qi-qi; Zhang, Peng; Huang, Xiao; Tan, Fu-qing; Liu, Ben

    2012-06-12

    To describe an efficient and effective method of using Olympus TURis button plasma vaporization electrode plus loop electrode for transurethral vapor enucleation and resection of prostate. Between July 2011 and October 2011, the investigators performed transurethral vapor enucleation and resection of prostate using Olympus TURis button plasma vaporization electrode plus loop electrode in 16 consecutive patients at our institution. The parameters of prostate weight, International Prostate Symptom Score (IPSS), quality of life (QOL), operative duration, blood loss volume, catheterization period, duration of hospitalization, perioperative complications and the weight of enucleated tissue were evaluated. IPSS and QOL were recorded during the follow-up. No patient had significant blood loss or signs of transurethral resection syndrome. The mean patient age was 67.3 ± 8.1 years. Mean preoperative prostate weight was 49 ± 24 g (range: 19 - 91) and mean resected tissue weight 36 ± 16 g (range: 10 - 50). Serious complications were not observed. Operative duration was 116 ± 31 minutes, mean catheter time 4.9 ± 1.8 days and the duration of hospitalization was 16.6 ± 5.5 days. Transurethral vapor enucleation and resection of prostate induced significant, pronounced, immediate and lasting improvement in IPSS (15.6 ± 6.8 vs 6.7 ± 2.4, P Transurethral vapor enucleation and resection of prostate with Olympus TURis plasma button electrode is a safe, effective and thorough surgical method in the treatment of benign prostatic hyperplasia.

  16. On-Chip Enucleation of Bovine Oocytes using Microrobot-Assisted Flow-Speed Control

    Directory of Open Access Journals (Sweden)

    Akihiko Ichikawa

    2013-06-01

    Full Text Available In this study, we developed a microfluidic chip with a magnetically driven microrobot for oocyte enucleation. A microfluidic system was specially designed for enucleation, and the microrobot actively controls the local flow-speed distribution in the microfluidic chip. The microrobot can adjust fluid resistances in a channel and can open or close the channel to control the flow distribution. Analytical modeling was conducted to control the fluid speed distribution using the microrobot, and the model was experimentally validated. The novelties of the developed microfluidic system are as follows: (1 the cutting speed improved significantly owing to the local fluid flow control; (2 the cutting volume of the oocyte can be adjusted so that the oocyte undergoes less damage; and (3 the nucleus can be removed properly using the combination of a microrobot and hydrodynamic forces. Using this device, we achieved a minimally invasive enucleation process. The average enucleation time was 2.5 s and the average removal volume ratio was 20%. The proposed new system has the advantages of better operation speed, greater cutting precision, and potential for repeatable enucleation.

  17. Interaction of laser radiation with urinary calculi

    OpenAIRE

    Mayo, M E

    2009-01-01

    Urolithias, calculus formation in the urinary system, affects 5 – 10% of the population and is a painful and recurrent medical condition. A common approach in the treatment of calculi is the use of laser radiation, a procedure known as laser lithotripsy, however, the technique has not yet been fully optimised. This research examines the experimental parameters relevant to the interactions of the variable microsecond pulsed holmium laser (λ = 2.12 μm, τp = 120 – 800 μs, I ~ 3 MW...

  18. Calcium phosphate holmium-166 ceramic to addition in bone cement: synthesis and characterization

    Energy Technology Data Exchange (ETDEWEB)

    Donanzam, Blanda A.; Campos, Tarcisio P.R., E-mail: campos@nuclear.ufmg.b [Universidade do Federal de Minas Gerais (DEN/UFMG), Belo Horizonte, MG (Brazil). Escola de Engenharia. Dept. de Engenharia Nuclear; Dalmazio, Ilza; Valente, Eduardo S., E-mail: id@cdtn.b, E-mail: valente@cdtn.b [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

    2011-07-01

    Spine metastases are a common and painful complication of cancer. The treatment often consists of bone cement injection (vertebroplasty or kyphoplasty) within vertebral body for vertebrae stabilization, followed by external beam radiation therapy. Recently, researchers introduced the concept of radioactive bone cement for spine tumors therapy. Then, investigations about bioactive and radioactive materials became interesting. In this study, we present the synthesis of calcium phosphate incorporated holmium (CaP-Ho) via sol-gel technique, and its characterization by XRD, FT-IR, NA and SEM. Results showed a multiphasic bioceramic composed mainly of hydroxyapatite, {beta}-tricalcium phosphate, holmium phosphate and traces of calcium pyrophosphate. Furthermore, the nuclide Ho-166 was the major radioisotope produced. Despite that, the radioactive bioceramic CaP-{sup 166}Ho must be investigated in clinical trials to assure its efficacy and safety on spine tumors treatment (author)

  19. Standard Enucleation with Aluminium Oxide Implant (Bioceramic Covered with Patient's Sclera

    Directory of Open Access Journals (Sweden)

    Gian Luigi Zigiotti

    2012-01-01

    Full Text Available Purpose. We describe in our study a modified standard enucleation, using sclera harvested from the enucleated eye to cover the prosthesis in order to insert a large porous implant and to reduce postoperative complication rates in a phthisis globe. Methods. We perform initially a standard enucleation. The porous implant (Bioceramic is then covered only partially by the patient's sclera. The implant is inserted in the posterior Tenon's space with the scleral covering looking at front. All patients were followed at least for twelve months (average followup 16 months. Results. We performed nineteen primary procedures (19 patients, 19 eyes, M; F and secondary, to fill the orbital cavity in patients already operated by standard evisceration (7 patients, 7 eyes. There were no cases of implant extrusion. The orbital volume was well reintegrated. Conclusion. Our procedure was safe and effective. All patients had a good cosmetic result after final prosthetic fitting and we also achieved good prothesis mobility.

  20. Standard Enucleation with Aluminium Oxide Implant (Bioceramic) Covered with Patient's Sclera

    Science.gov (United States)

    Zigiotti, Gian Luigi; Cavarretta, Sonia; Morara, Mariachiara; Nam, Sang Min; Ranno, Stefano; Pichi, Francesco; Lembo, Andrea; Lupo, Stefano; Nucci, Paolo; Meduri, Alessandro

    2012-01-01

    Purpose. We describe in our study a modified standard enucleation, using sclera harvested from the enucleated eye to cover the prosthesis in order to insert a large porous implant and to reduce postoperative complication rates in a phthisis globe. Methods. We perform initially a standard enucleation. The porous implant (Bioceramic) is then covered only partially by the patient's sclera. The implant is inserted in the posterior Tenon's space with the scleral covering looking at front. All patients were followed at least for twelve months (average followup 16 months). Results. We performed nineteen primary procedures (19 patients, 19 eyes, x M; x F) and secondary, to fill the orbital cavity in patients already operated by standard evisceration (7 patients, 7 eyes). There were no cases of implant extrusion. The orbital volume was well reintegrated. Conclusion. Our procedure was safe and effective. All patients had a good cosmetic result after final prosthetic fitting and we also achieved good prothesis mobility. PMID:22654614

  1. Nanoparticle doping for high power fiber lasers at eye-safer wavelengths.

    Science.gov (United States)

    Baker, Colin C; Friebele, E Joseph; Burdett, Ashley A; Rhonehouse, Daniel L; Fontana, Jake; Kim, Woohong; Bowman, Steven R; Shaw, L Brandon; Sanghera, Jasbinder; Zhang, Jun; Pattnaik, Radha; Dubinskii, Mark; Ballato, John; Kucera, Courtney; Vargas, Amber; Hemming, Alexander; Simakov, Nikita; Haub, John

    2017-06-12

    A nanoparticle (NP) doping technique was developed for fabricating erbium (Er)- and holmium (Ho)-doped silica-based optical fibers for high energy lasers. Slope efficiencies in excess of 74% were realized for Er NP doping in a single mode fiber based master oscillator power amplifier (MOPA) and 53% with multi-Watt-level output in a resonantly cladding-pumped power oscillator laser configuration based on a double-clad fiber. Cores comprising Ho doped LaF3 and Lu2O3 nanoparticles exhibited slope efficiencies as high as 85% at 2.09 µm in a laser configuration. To the best of the authors' knowledge, this is the first report of a holmium nanoparticle doped fiber laser as well as the highest efficiency and power output reported from an erbium nanoparticle doped fiber laser.

  2. A holmium(III)-based single-molecule magnet with pentagonal-bipyramidal geometry

    Energy Technology Data Exchange (ETDEWEB)

    Kajiwara, Takashi [Department of Chemistry, Faculty of Science, Nara Women' s University (Japan)

    2017-09-11

    The right environment: The remarkable properties of a recently reported holmium(III)-based single-ion magnet have been ascribed to the hyperfine interactions with the half-integer nuclear spin in combination with the pentagonal-bipyramidal coordination environment. These results provide insight into the complicated magnetic properties of nanosized magnetic materials. (copyright 2017 Wiley-VCH Verlag GmbH and Co. KGaA, Weinheim)

  3. Early postoperative outcome of bipolar transurethral enucleation and resection of the prostate.

    Science.gov (United States)

    Cho, C L; Leung, Clarence L H; Chan, Wayne K W; Chu, Ringo W H; Law, I C

    2015-12-01

    To report the early postoperative outcome of bipolar transurethral enucleation and resection of the prostate. Our results were compared with those published from various centres. Regional hospital, Hong Kong. A total of 28 consecutive patients who had undergone bipolar transurethral enucleation and resection of the prostate by a single surgeon between January and June 2014. All patients were evaluated preoperatively by physical examination, digital rectal examination, transrectal ultrasonography, and laboratory studies, including measurement of haemoglobin, sodium, and prostate-specific antigen levels. Patients were assessed perioperatively and at 4 weeks and 3 months postoperatively. The mean resected specimen weight of prostatic adenoma in 28 patients was 48.2 g with a mean enucleation and resection time of 13.6 and 47.7 minutes, respectively. There was a mean decrease in serum prostate-specific antigen by 85.9% (from 6.4 ng/mL to 0.9 ng/mL) postoperatively. Prostate volume was decreased by 68.2% (from 71.9 cm(3) to 22.9 cm(3)) at 4 weeks postoperatively. The mean postoperative haemoglobin drop was 11.5 g/L. The rate of transient urinary incontinence at 3 months was 3.6%. Patients who underwent bipolar transurethral enucleation and resection of the prostate had a short catheterisation time and hospital stay, which is comparable to conventional transurethral resection of the prostate. Bipolar transurethral enucleation and resection of the prostate should become the endourological equivalent to open adenomectomy with fewer complications and short convalescence. The technique of bipolar transurethral enucleation and resection of the prostate can be acquired safely with a relatively short learning curve.

  4. Study of the efficiency of chemically assisted enucleation method for handmade cloning in goat (Capra hircus).

    Science.gov (United States)

    Akshey, Y S; Malakar, D; De, A K; Jena, M K; Sahu, S; Dutta, R

    2011-08-01

    The present investigation was carried out to find an efficient chemically assisted procedure for enucleation of goat oocytes related to handmade cloning (HMC) technique. After 22-h in vitro maturation, oocytes were incubated with 0.5 μg/ml demecolcine for 2 h. Cumulus cells were removed by pipetting and vortexing in 0.5 mg/ml hyaluronidase, and zona pellucida were digested with pronase. Oocytes with extrusion cones were subjected to oriented bisection. One-third of the cytoplasm with the extrusion cone was removed with a micro blade. The remaining cytoplasts were used as recipients in HMC. Goat foetal fibroblasts were used as nuclear donors. The overall efficiency measured as the number of cytoplasts obtained per total number of oocytes used was significantly (p < 0.05) higher in chemically assisted handmade enucleation (CAHE) than oriented handmade enucleation without demecolcine (OHE) (80.02 ± 1.292% vs. 72.9 ± 1.00%, respectively, mean ± SEM). The reconstructed and activated embryos were cultured in embryo development medium (EDM) for 7 days. Fusion, cleavage and blastocyst development rate were 71.63 ± 1.95%, 92.94 ± 0.91% and 23.78 ± 3.33% (mean ± SEM), respectively which did not differ significantly from those achieved with random handmade enucleation and OHE. In conclusion, chemically assisted enucleation is a highly efficient and reliable enucleation method for goat HMC which eliminates the need of expensive equipment (inverted fluorescence microscope) and potentially harmful chromatin staining and ultraviolet (UV) irradiation for cytoplast selection. © 2010 Blackwell Verlag GmbH.

  5. Rapid Changes in Cortical and Subcortical Brain Regions after Early Bilateral Enucleation in the Mouse.

    Directory of Open Access Journals (Sweden)

    Olga O Kozanian

    Full Text Available Functional sensory and motor areas in the developing mammalian neocortex are formed through a complex interaction of cortically intrinsic mechanisms, such as gene expression, and cortically extrinsic mechanisms such as those mediated by thalamic input from the senses. Both intrinsic and extrinsic mechanisms are believed to be involved in cortical patterning and the establishment of areal boundaries in early development; however, the nature of the interaction between intrinsic and extrinsic processes is not well understood. In a previous study, we used a perinatal bilateral enucleation mouse model to test some aspects of this interaction by reweighting sensory input to the developing cortex. Visual deprivation at birth resulted in a shift of intraneocortical connections (INCs that aligned with ectopic ephrin A5 expression in the same location ten days later at postnatal day (P 10. A prevailing question remained: Does visual deprivation first induce a change in gene expression, followed by a shift in INCs, or vice versa? In the present study, we address this question by investigating the neuroanatomy and patterns of gene expression in post-natal day (P 1 and 4 mice following bilateral enucleation at birth. Our results demonstrate a rapid reduction in dorsal lateral geniculate nucleus (dLGN size and ephrin A5 gene expression 24-hours post-enucleation, with more profound effects apparent at P4. The reduced nuclear size and diminished gene expression mirrors subtle changes in ephrin A5 expression evident in P1 and P4 enucleated neocortex, 11 and 8 days prior to natural eye opening, respectively. Somatosensory and visual INCs were indistinguishable between P1 and P4 mice bilaterally enucleated at birth, indicating that perinatal bilateral enucleation initiates a rapid change in gene expression (within one day followed by an alteration of sensory INCs later on (second postnatal week. With these results, we gain a deeper understanding of how gene

  6. MR imaging of post transurethral enucleation of the prostate for benign prostatic hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Tajima, Natsuki; Okada, Susumu [Nippon Medical School, Chiba (Japan). Chiba Hokusoh Hospital; Hiraoka, Yasunori; Tajima, Hiroyuki; Iida, Eiji; Kobayashi, Yuko; Sugizaki, Kenichi; Yamamoto, Kanae; Kumazaki, Tatsuo

    1995-11-01

    Magnetic resonance imaging of post transurethral enucleation of the prostate for benign prostatic hypertrophy was evaluated in 11 patients. Both pre- and post-enucleation images were evaluated in 6 patients. Decrease in maximum diameter of prostatic glands after this method had a good correlation with the resected volume, uroflowmetry analysis and clinical symptoms. Intensity decrease of peripheral zone on T2-weighted image was detected in 3 of 6 patients, while size increase of peripheral zone was seen in 1 of 6 patients. Low intensity band around the resected urethra was demonstrated in all patients after surgical intervention. (author).

  7. Efficiency of two enucleation methods connected to handmade cloning to produce transgenic porcine embryos

    DEFF Research Database (Denmark)

    Li, J; Villemoes, K; Zhang, Y

    2009-01-01

    The purpose of our work was to establish an efficient-oriented enucleation method to produce transgenic embryos with handmade cloning (HMC). After 41â€"42 h oocytes maturation, the oocytes were further cultured with or without 0.4 μg/ml demecolcine for 45 min [chemically assisted handmade......%) of cloned embryos with GFP transgenic fibroblast cells after CAHE vs OHE. With adjusted time-lapse for zonae-free cloned embryos cultured in WOWs with PZM-3, it was obvious that in vitro developmental competence after CAHE was compromised when compared with the OHE method. OHE enucleation method seems...

  8. Effects of ocular enucleation on the oxidative metabolism of CNS structures and ovarium in female rats.

    Science.gov (United States)

    López, B D; Menéndez-Patterson, A; Marín, B

    1980-01-01

    In this paper we have studied oxygen uptake of the amygdala, hypothalamus, septal area, anterior cortex (latero-frontal), posterior cortex (latero-occipital) and ovarium in female rats in the oestrous and dioestrous phases with occular enculeation. Our results point to a statistically significant difference in the oestrous phase of the posterior cortex and ovarium levels, comparing control rats with the enucleated ones. In the dioestrous phase, the modifications that we have encountered are at the amygdala and ovarium. We point out the possible participation of the pineal gland in the control of the sexual cycle in in enucleated rats.

  9. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement.

    Science.gov (United States)

    Kyriazis, Iason; Świniarski, Piotr P; Jutzi, Stephan; Wolters, Mathias; Netsch, Christopher; Burchardt, Martin; Liatsikos, Evangelos; Xia, Shujie; Bach, Thorsten; Gross, Andreas J; Herrmann, Thomas R W

    2015-04-01

    Retrograde transurethral anatomical enucleation of the prostate is gaining momentum as a new concept in transurethral surgery of benign prostatic hyperplasia. Its adaptation is boosted by the familiarity of urologists with the finger-assisted anatomical enucleation of the adenoma during open prostatectomy and the combination of this well-established concept with the minimal invasive characteristics of transurethral surgery. The thulium laser appears as an ideal energy source for such operation. In this work, current evidence on thulium laser-assisted anatomical enucleation of the prostate (ThuLEP) is being reviewed. A comprehensive literature review was performed on Medline, PubMed, and Cochrane databases retrieving all literature on thulium laser-assisted prostatectomy between 2006 and 2015. Experimental studies, review articles and editorial comments as well as studies on thulium laser-assisted approaches other than ThuLEP (i.e., ThuVEP, ThuVAP or ThuVARP) were excluded from the analysis. In total, six original articles on either surgical technique or clinical outcomes were retrieved. With regard to functional results, ThuLEP presented no significant differences toward the standard treatment (TURP/HoLEP) arm in two randomized controlled trials and favorable outcomes in available prospective cohorts. Observed morbidity was minimum and comparable with the rest of transurethral literature. ThuLEP literature is still very limited. Based on the available data, the approach is safe and effective, demonstrating favorable outcomes, comparable with the current standard treatment options. Further documentation of ThuLEP outcomes is necessary to define the optimum indications of this novel technique.

  10. Highly efficient and reliable chemically assisted enucleation method for handmade cloning in cattle

    DEFF Research Database (Denmark)

    Vajta, Gábor; Maddox-Hyttel, Poul; Skou, Christina T.

    2005-01-01

    The purpose of the present study was to find an efficient and reliable assisted procedure for enucleation related to the handmade cloning (HMC) technique. After in vitro maturation oocytes were incubated in 0.5 µgmL-¹ demecolcine for 2 h. Subsequently, zonae pellucidae were digested with pronase...

  11. JAW CYSTS AND GUIDED BONE REGENERATION (a late complication after enucleation

    Directory of Open Access Journals (Sweden)

    Hristina Lalabonova

    2013-10-01

    Full Text Available Maxillary jaw bone possesses a high regenerative capacity. Yet sometimes the defects enucleation of jaw cysts leaves may regenerate only partially or not at all. For this reason some researchers advise treatment of the residual cavities after cystectomy using bone regeneration stimulation methods. We report a case of an atypical complication after enucleation of a maxillary cyst manifesting itself eight years after the initial treatment. The symptoms the patient reported were at first periodic sweating on the left sides of face and head. This was followed by a piercing pain in the left palpebral fissure radiating to the middle of the palate and felt in the left cheekbone, left eye and left supraorbital ridge. The patient has a history of maxillary cysts recurring three times and of three operations she had 20, 12 and 8 years previously. The multiple recurrences of the cysts after their enucleation indicates poor regenerative capacity of the body which resulted in the formation of cicatricial tissue. It is most probably this tissue that was responsible for the disruption of the nerve conduction capacity which can account for the reported symptoms. We filled the cavity with bone graft material which boosted the bone structure regeneration. Although maxillary jaws possess high regenerative capacity we advise the use of guided bone regeneration in cases of large bone defects that usually occur after enucleation of jaw cysts.

  12. Prevention of Evisceration or Enucleation in Endogenous Bacterial Panophthalmitis with No Light Perception and Scleral Abscess.

    Science.gov (United States)

    Chen, Kuan-Jen; Chen, Yen-Po; Chao, An-Ning; Wang, Nan-Kai; Wu, Wei-Chi; Lai, Chi-Chun; Chen, Tun-Lu

    2017-01-01

    Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Severe inflammation of the anterior and posterior segments is frequently accompanied by corneal opacity, scleral abscess, and perforation or rupture. Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. The purpose of this retrospective study is to examine the outcomes of patients with endogenous bacterial panophthalmitis, no light perception and scleral abscess who were treated with multiple intravitreal and periocular injections of antibiotics and dexamethasone. Evaluation included spreading of infection to contiguous or remote sites, following evisceration or enucleation, and sympathetic ophthalmia. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. in three, Pseudomonas aeruginosa in one, Escherichia coli in one, and Staphylococcus aureus in one. The average number of periocular injections was 2.2, and the average number of intravitreal injections was 5.8. No eye required evisceration or enucleation and developed the spreading of infection to contiguous or remote sites during the follow-up. No sympathetic ophthalmia was observed in the fellow eye of all patients. Prevention of evisceration or enucleation in patients with EBP, NLP and scleral abscess can be achieved by multiple intravitreal and periocular injections of antibiotics and dexamethasone.

  13. Psychosocial factors influencing parental decision to allow or refuse potentially lifesaving enucleation in children with retinoblastoma

    Directory of Open Access Journals (Sweden)

    Rolando Enrique D. Domingo

    2017-01-01

    Full Text Available Objective: Retinoblastoma is the most common malignancy of the eye and ocular adnexa in the Philippines. It is curable when treated early, but delay in enucleation is common due to the parental refusal of surgery for varied reasons. The aim of this study is to identify the psychosocial barriers and facilitating factors for accepting versus refusing enucleation as treatment for retinoblastoma. Methods: This is a cross-sectional descriptive study utilizing structured interviews and a questionnaire. It was conducted at the Retinoblastoma Clinic of the Philippine General Hospital. A questionnaire using the Likert scale was constructed after performing key informant interviews and focus group discussions. It was pretested and revised before parents of patients with retinoblastoma were invited to participate in the study. Descriptive statistics, quantitative item analyses using inter-item correlations and item-total correlations was performed. Results: Factors that correlate with refusal to enucleate are the beliefs that cancer is a fatal illness, the fear of unacceptable esthetic outcome of the surgery, and the cost of treatment. Favorable factors include value of life, high regard for the opinion of medical practitioners, and appreciation of the efficacy of treatment. Conclusions: There are several favorable factors and barriers that health practitioners must consider in facilitating parental decision-making toward enucleation for retinoblastoma.

  14. Dermal-fat graft for anophthalmic socket in children enucleated for retinoblastoma.

    Science.gov (United States)

    Bosch-Canto, V; Cruz, C; Ordaz-Favila, J C

    2018-01-01

    Retinoblastoma is the most frequent intraocular tumour in childhood. The definitive treatment is enucleation. The management of the anophthalmic socket consists in the use of a plastic implant. The problem is that they are expensive and they usually extrude. The use of dermal-fat grafts minimises the hemi-facial hypoplasia. They usually grow with the face, and help to expand the orbital bones, thus avoiding the psychological and physical consequences. To determine if there is hemi-facial hypoplasia, using MRI images after the use of a dermal-fat implant in patients enucleated for RB. The study included patients enucleated for RB in which a dermal-fat implant was used and MRI images were taken in the period between June 2010 and December 2012. Facial growth and cosmesis was measured. The study included 12 patients, aged between 6 to 41 months. After 24 months of follow up, none of them developed hemifacial hypoplasia. All had a good cosmesis with the prosthesis. There were no complications after the surgery. The use of dermal-fat implant is a good option for the anophthalmic socket in patients with RB after enucleation. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Orbital Implants in Enucleation Surgery: A Report by the American Academy of Ophthalmology.

    Science.gov (United States)

    Wladis, Edward J; Aakalu, Vinay K; Sobel, Rachel K; Yen, Michael T; Bilyk, Jurij R; Mawn, Louise A

    2018-02-01

    To compare the motility and complication rates of porous and nonporous implants after enucleation surgery. Literature searches of the PubMed and Cochrane Library databases were last performed in February 2017 to identify studies published between 2003 and 2017 on outcomes after enucleation surgeries in which a variety implants were used. The searches were limited to the English language with abstracts and yielded 43 articles, which the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel reviewed for relevancy. Twenty-five articles were considered to have met the search strategy, and the panel methodologist assigned ratings to them according to the level of evidence. Only 2 of the 25 articles identified met the criteria for level I evidence. Eighteen of the studies did not assess motility after enucleation surgery, and the 7 that did evaluate this metric involved porous implants. The studies that analyzed this outcome reported favorable results, but the results were not uniformly based on objective analysis. Both porous and nonporous implants were well tolerated, and complication rates were generally low for both types. In keeping with increasing surgeon preference for porous implants, most studies identified in this literature search involved the use of this type of implant. These implants resulted in excellent motility after enucleation surgery, although many studies did not assess this outcome. Regardless of implant type, major complications were rare, and infection was exceptionally uncommon after enucleation. Given the paucity of data on motility and the absence of direct, objective comparisons of porous and nonporous implants, definitive conclusions about the impact of implant material on motility cannot be made. Since few studies evaluated nonporous implants, direct comparisons cannot be made definitively between implant types, and future investigations are needed to enable a critical assessment. Copyright © 2017 American Academy of

  16. Enucleation versus Anatomic Resection for Giant Hepatic Hemangioma: A Meta-Analysis.

    Science.gov (United States)

    Liu, Yuhui; Wei, Xuyong; Wang, Kun; Shan, Qiaonan; Dai, Haojiang; Xie, Haiyang; Zhou, Lin; Xu, Xiao; Zheng, Shusen

    2017-03-01

    Hepatic hemangiomas are the most common benign liver tumors, and the management of giant hepatic hemangioma (GHH) is still in controversial. The aim of this meta-analysis was to compare the postoperative outcomes of enucleation versus anatomic resection for GHH. PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 1988 to December 2015 to identify studies comparing the outcomes of enucleation versus anatomic resection for GHH. Finally, we performed this meta-analysis using the Review Manager 5.3 software, and the results were presented as risk ratio (RR) or mean difference (MD) with corresponding 95% confidence interval (CI). The major limitation is that all data were derived from nonrandomized studies, and we cannot exclude potential selection bias. Nine studies involving 1,185 patients were included. The results showed that there was a lower incidence of complications (RR = 0.66, 95% CI 0.52 to 0.84, I(2) = 0%, p = 0.0007); no incidents of death occurred among the 9 included trials. Blood loss (MD = -419.07 mL, 95% CI -575.04 to -263.09, I(2) = 83%, p < 0.00001), duration of surgery (MD = -23.5 min, 95% CI -45.28 to -1.74, I(2) = 0%, p = 0.03), and length of hospital stay (MD = -1.59 days, 95% CI -3.06 to -0.13, I(2) = 0%, p = 0.03) were much lower in the enucleation group. GHH can be removed safely by either enucleation or anatomic resection. Enucleation can preserve more hepatic parenchyma and reduce postoperative complications, which is why it should be the preferred surgical procedure for suitable lesions.

  17. Novel methylene blue staining technique for localizing small esophageal leiomyomas during thoracoscopic enucleation.

    Science.gov (United States)

    Zhang, Z; Ai, B; Liao, Y; Liu, L; Liu, M

    2016-11-01

    The treatment of choice for leiomyoma, the most common benign esophageal tumor, is thoracoscopic enucleation. One of the most difficult aspects of thoracoscopic enucleation is the precise localization of small tumors (≤1.5 cm) and tumors without external protrusion. No simple, feasible solutions to this problem are available. We developed a novel methylene blue staining technique to localize small esophageal leiomyomas and evaluated the feasibility of our technique. Between January 2013 and July 2014, eight patients with small esophageal leiomyomas (≤1.5 cm) underwent thoracoscopic enucleation in Tongji Hospital. Preoperative endoscopic ultrasonography was performed in all patients. The leiomyomas were located in the middle (n = 5) and lower (n = 3) thirds of the esophagus. We preoperatively injected 0.5-1.0 mL methylene blue in the submucosa adjacent to the tumors under standard gastroscope guidance. The entire staining process took about 10 minutes. Staining was successful in all patients. The unstained tumor was exposed after the blue-stained mediastinal pleura, and overlying muscle were incised longitudinally. All procedures were successfully completed without conversion to open surgery. No abnormalities were detected in the esophageal mucosa. The median operating time was 60 minutes (range, 40-90 minutes). Postoperative histopathology confirmed leiomyoma in all patients. The median postoperative hospital stay was 6 days (range, 5-7 days). No major complications, such as esophageal leakage or esophageal diverticulum, occurred. Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during thoracoscopic enucleation. This method will enable precise and easy enucleation. © 2015 International Society for Diseases of the Esophagus.

  18. Lasers.

    Science.gov (United States)

    Passeron, T

    2012-12-01

    Lasers are a very effective approach for treating many hyperpigmented lesions. They are the gold standard treatment for actinic lentigos and dermal hypermelanocytosis, such as Ota nevus. Becker nevus, hyperpigmented mosaicisms, and lentigines can also be successfully treated with lasers, but they could be less effective and relapses can be observed. However, lasers cannot be proposed for all types of hyperpigmentation. Thus, freckles and café-au-lait macules should not be treated as the relapses are nearly constant. Due to its complex pathophysiology, melasma has a special place in hyperpigmented dermatoses. Q-switched lasers (using standard parameters or low fluency) should not be used because of consistent relapses and the high risk of post-inflammatory hyperpigmentation. Paradoxically, targeting the vascular component of the melasma lesion with lasers could have a beneficial effect. However, these results have yet to be confirmed. In all cases, a precise diagnosis of the type of hyperpigmentation is mandatory before any laser treatment, and the limits and the potential side effects of the treatment must be clearly explained to patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  19. [Lasers].

    Science.gov (United States)

    Passeron, T

    2012-11-01

    Lasers are a very effective approach for treating many hyperpigmented lesions. They are the gold standard treatment for actinic lentigos and dermal hypermelanocytosis, such as Ota nevus. Becker nevus, hyperpigmented mosaicisms, and lentigines can also be successfully treated with lasers, but they could be less effective and relapses can be observed. However, lasers cannot be proposed for all types of hyperpigmentation. Thus, freckles and café-au-lait macules should not be treated as the relapses are nearly constant. Due to its complex pathophysiology, melasma has a special place in hyperpigmented dermatoses. Q-switched lasers (using standard parameters or low fluency) should not be used because of consistent relapses and the high risk of post-inflammatory hyperpigmentation. Paradoxically, targeting the vascular component of the melasma lesion with lasers could have a beneficial effect. However, these results have yet to be confirmed. In all cases, a precise diagnosis of the type of hyperpigmentation is mandatory before any laser treatment, and the limits and the potential side effects of the treatment must be clearly explained to patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  20. Age and prostate volume are risk factors for transient urinary incontinence after transurethral enucleation with bipolar for benign prostatic hyperplasia.

    Science.gov (United States)

    Hirasawa, Yosuke; Kato, Yuji; Fujita, Kiichiro

    2017-10-03

    To investigate the predictive factors for transient urinary incontinence after transurethral enucleation with bipolar. We retrospectively analyzed the data of 584 patients who underwent transurethral enucleation with bipolar between December 2011 and September 2016 operated by a single surgeon. Urinary incontinence after transurethral enucleation with bipolar was defined as involuntary leakage of urine that required the use of pads. It was evaluated at 1 week, and 1, 3, 6, 12 and 24 months after transurethral enucleation with bipolar. We defined transient urinary incontinence as urinary incontinence persisting up to 1 month after transurethral enucleation with bipolar. Based on independent risk factors identified by a multivariate stepwise logistic regression analysis, a nomogram to predict transient urinary incontinence was developed. Of the 584 patients, 17.3%, 13.5%, 3.1%, 0.41%, and 0% patients had urinary incontinence at 1 week, 1, 3, 6 and 12 months after transurethral enucleation with bipolar, respectively. The mean (±standard error) age was 69.6 ± 0.26 years, estimated prostate volume was 54.7 ± 0.91 cm3 , operative time was 58.0 ± 1.1 min and the prostate specimen weight was 30.6 ± 0.69 g. On univariate analysis, age, prostate volume estimated by transrectal ultrasonography, prostate-specific antigen, prostate specimen weight, operative time, prostate specimen weight/prostate volume and prostate specimen weight/operative time were significant predictive factors for transient urinary incontinence after transurethral enucleation with bipolar. On multivariate analysis, age (hazard ratio 1.07, P-value = 0.0034) and prostate volume (hazard ratio 1.03, P-value transurethral enucleation with bipolar. Age and prostate volume estimated by transrectal ultrasonography seem to represent significant independent risk factors for transient urinary incontinence after transurethral enucleation with bipolar. This should be well discussed with the patient before surgery

  1. 28 W CW linearly polarized single mode all-fiber thulium-doped fiber laser operating at 1.95 μm

    Science.gov (United States)

    Wang, Jiachen; Yeom, Dong-il; Lee, Sang Bae; Lee, Kwanil

    2017-04-01

    An all-fiber type, CW, linearly polarized thulium-doped fiber laser is reported. Highly linear polarization was achieved by a special management of fiber Bragg gratings, which performs as the laser cavity reflectors. The laser generated 28 W signal output at 1949 nm with a slope efficiency of 47.3%. The polarization extinction ratio of the laser was measured to be around 20 dB. The beam quality of the laser was near diffraction-limited, with M2 of 1.1. The laser's output features make it to be a potential light source for some important applications such as for pumping holmium-doped solid state lasers.

  2. Lesion-specific laser catheters for angioplasty

    Science.gov (United States)

    Murphy-Chutorian, Douglas

    1991-07-01

    Since no one laser catheter can treat all types of disease, a new family of 'lesion-specific' devices was evaluated with a holmium laser source. Fifty patients (avg. 69 yrs) with lifestyle-limiting peripheral vascular disease and 29 patients (avg. 58 yrs) with symptomatic coronary disease were studied. Average lesion length was 5.3 cm in legs and 1.5 cm in hearts. A 1.5, 2.0, or 2.8 mm, tapered-tip or non-tapered, multifiber catheter (Eclipse, Palo Alto, CA) was advanced over the wire while emitting 300-1200 mj/pulse at 5 Hz. Mean percent stenosis decreased from 89% to 45% after lasing with a mean of 411 pulses in legs and from 86% to 46% with a mean of 158 pulses in hearts. Complications were infrequent. Laser technical success was 80% and overall procedural success was 97%. Conclusion: 1) Specialized laser catheters delivering holmium laser energy are capable of reducing the severity of peripheral and coronary stenoses including balloon angioplasty failures and bypass graft failures; 2) Follow-up studies are in progress to assess long term efficacy.

  3. Risk of metastasis and orbital recurrence in advanced retinoblastoma eyes treated with systemic chemoreduction versus primary enucleation.

    Science.gov (United States)

    Berry, Jesse L; Kogachi, Kaitlin; Aziz, Hassan A; McGovern, Kathleen; Zolfaghari, Emily; Murphree, A Linn; Jubran, Rima; Kim, Jonathan W

    2017-04-01

    The purpose of this study was to evaluate the risk of metastatic disease and orbital recurrence in advanced retinoblastoma treated with systemic chemoreduction versus primary enucleation. A retrospective review of patients with Group D/E retinoblastoma was conducted with data collection from 1995 to 2015. Overall, 345 eyes (294 patients) were included (165 Group D and 180 Group E). Primary outcome measures were orbital recurrence and metastatic disease. Of the 345 eyes, 139 were treated with systemic chemoreduction (102 Group D, 37 Group E) and 206 with primary enucleation (63 Group D, 143 Group E). In the chemoreduction group, one patient developed metastasis (0.7%) and one an orbital recurrence (0.7%). In the primary enucleation group, two patients developed metastases (0.9%) and one an orbital recurrence (0.5%). After systemic chemoreduction, 58 of the 139 eyes (30 Group D, 28 Group E) were secondarily enucleated for treatment failure (41.7%). The median time to secondary enucleation from diagnosis was 8.1 months. None of the eyes in the systemic chemoreduction group had high-risk pathologic features. In the primary enucleation group, 56 eyes had high-risk pathology. Over a 20-year period, 345 eyes were treated for advanced retinoblastoma at Children's Hospital Los Angeles. Incidence of orbital recurrence and metastatic disease was <1% and did not vary by treatment modality or group classification. None of the eyes enucleated for treatment failure had high-risk pathology, and none of these patients developed metastatic disease. Globe salvage therapy with systemic chemoreduction and subsequent enucleation for poor response does not increase the risk of metastatic disease or orbital recurrence. © 2016 Wiley Periodicals, Inc.

  4. Enucleation after Embolization of Liver Failure-Causing Giant Liver Hemangioma

    Science.gov (United States)

    Sharma, Amit; Kaspar, Matthew; Siddiqui, Mohammad; Kim, Joohyun

    2015-01-01

    Patient: Female, 73 Final Diagnosis: Giant liver hemangioma Symptoms: Abdominal discomfort • abdominal enlargement • Icterus Medication: — Clinical Procedure: Enucleation after embolization of liver failure-causing giant liver Specialty: Surgery Objective: Unusual clinical course Background: Hepatic hemangioma is a congenital tumor of the mesenchymal tissues of the liver. While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy. In such instances, surgical treatment may be warranted. Case Report: We present a case of a symptomatic giant hepatic hemangioma in an elderly patient who presented with impending liver failure. She was successfully treated with a combination of surgical enucleation and liver resection after preoperative arterial embolization. We also provide a brief discussion of current treatment options for giant hepatic hemangiomas. Conclusions: Early referral to experienced surgical centers before the onset of dire complications such as severe hepatic dysfunction and liver failure is recommended. PMID:26301888

  5. Use of a hydroxyapatite orbital implant in a cosmetic corneoscleral prosthesis after enucleation in a horse.

    Science.gov (United States)

    Gilger, Brian C; Pizzirani, Stefano; Johnston, Lisa C; Urdiales, Nicholas R

    2003-02-01

    A hydroxyapatite orbital implant was used after enucleation of an eye from a 5-year-old performance horse. A custom-made corneoscleral prosthesis was made and fitted over the hydroxyapatite implant. The implant and surgery were well tolerated. Placement of a cosmetic prosthesis is desired after enucleation of equine eyes to allow horses to return to competition. Synthetic spheres consisting of methylmethacrylate or silicone have been used, although reported complications have included extrusion, infection, and poor cosmetic results. Hydroxyapatite orbital implants made from marine coral allow vascular and fibrous tissue growth from the host orbit into the implant, which decreases the possibility of implant extrusion or infection and allows enhanced healing of defects in the overlying conjunctiva. Extraocular muscle fixation onto the implant permits motility and assists in the prevention of implant extrusion.

  6. Giant Hepatic Hemangioma With Kasabach–Merritt Syndrome: Is the Appropriate Treatment Enucleation or Liver Transplantation?

    OpenAIRE

    Hochwald, Steven N.; Blumgart, Leslie H

    2000-01-01

    We present a case of giant cavernous hemangioma of the liver with disseminated intravascular coagulopathy (Kasabach–Merritt syndrome) which was cured by enucleation. The 51 year old woman presented with increased abdominal girth and easy bruisability. Workup elsewhere revealed a massive hepatic hemangioma and she was started on radiation therapy to the lesion and offered an orthotopic liver transplant. After careful preoperative preparation, we felt that resection w...

  7. The role of intraoperative ultrasound in small renal mass robotic enucleation

    Directory of Open Access Journals (Sweden)

    Roberta Gunelli

    2016-12-01

    Full Text Available Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8 using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826. Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2, the exact position of the lesion could be easily identified in all cases (22/22, even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13 and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22. No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during

  8. Spontaneous alignment of permanent successors after enucleation of odontogenic cysts associated with primary teeth.

    Science.gov (United States)

    Chiu, W K; Sham, A S K; Hung, J N M

    2008-01-01

    Pulpotomy and pulpectomy occasionally lead to cyst formation in the primary dentition. They show specific clinical features of large size, rapid growth, buccal expansion and displacement of permanent teeth. Complete enucleation of the cyst with extraction of the associated primary teeth and preservation of the permanent teeth appeared to be the most suitable treatment option. Normal alignment of the permanent teeth occurred spontaneously even their initial positions were highly unfavourable.

  9. Microstructure and hysteresis curves of samarium-holmium-iron garnet synthesized by coprecipitation

    Directory of Open Access Journals (Sweden)

    Caffarena Valeska da Rocha

    2003-01-01

    Full Text Available An investigation was made into the synthesis and magnetic properties of Sm(3-xHo xFe5O12 (samarium-holmium-iron garnet ferrite, as yet absent from the literature. The material in question was synthesized by co-precipitation, starting from hydrated chlorides of rare-earth elements and ferrous sulfate, and the mixed hydroxide co-precipitate was calcined at 1000 °C. Using PVA as a binder, rectangular cross section-shaped compacts were produced by means of steel-die pressing, drying and sintering from 1200 to 1450 °C. The main conclusions of this study were that the coercive force decreases as the sintering temperature increases, and that the effect of substituting holmium for samarium in SmIG is entirely different from that provided by replacing yttrium by gadolinium in YIG, which is the most important result of this work. An in-depth investigation will be necessary to determine the correlation between microstructure/magnetic properties and ceramic processing variables.

  10. Le Fort I osteotomy to enucleation of grand proportions fissural cyst-presentation of case report.

    Science.gov (United States)

    Cavalcante, Rafael Correia; Durski, Fernanda; Deliberador, Tatiana Miranda; Giovanini, Allan Fernando; Rebellato, Nelson Luís Barbosa; da Costa, Delson João; Klüppel, Leandro Eduardo; Scariot, Rafaela

    2016-01-01

    Fissural cysts (FC) are caused by entraped epithelium between nasal and maxilar processes. They are commonly treated with surgical enucleation precedded or not by marsupialization depending on the cyst size. Biopsy of lesion is recommended due to confirm radiographic evaluation. It is rare to observe Le Fort I surgical approach to this type of injury. This study reports the case of an uncommon grand proportions fissural cyst in a female patient, 53, that was referred to the Oral and Maxillofacial Surgery Departament of Hospital XV presenting volume increase in maxilla associated with numbness of palate. Radiograph examination showed an intimate relationship between incisors apexes and FC. Expansion of both buccal and palate cortical was then confirmed as well as its unusual size, approximately 25 millimeters. Due to the abnormal size of lesion and possible impairment of upper incisors, LeFort I osteotomy associated with downfracture to cystic enucleation was the chosen treatment. After enucleation, the remaining space was filled with BIOSs and bioguide (lyophilized bone and collagen membrane). Patients' twelve months follow-up demonstrate no relapses and maintenance of teeth involved. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. A Case of Attempted Bilateral Self-Enucleation in a Patient with Bipolar Disorder.

    Science.gov (United States)

    Castro, Hannah Muniz; Alvarez, John; Bota, Robert G; Yonkers, Marc; Tao, Jeremiah

    2017-03-22

    Attempted and completed self-enucleation, or removal of one's own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.

  12. Technical aspects of transurethral plasmakinetic enucleation and resection of the prostate for benign prostatic hyperplasia.

    Science.gov (United States)

    Yu, Yang; Lou, Guantao; Shen, Chen; Guan, Sheng; Wang, Wei; Yang, Bo

    2017-02-01

    TUERP, which is based on TURP, technically has been proven to be safe and effective with reduced complication rates. Due to the lack of systematic pre-clinical training, the surgery is learnt only inside the operative theatre in the majority of the Chinese medical centers. It is also known to have a steep learning curve, and very few articles have addressed the technical aspects of TUERP. The videos of 91 cases of bipolar transurethral enucleation and resection of the prostate, which were performed by one urological surgeon in our department from August 2013 to January 2016, were retrospectively analyzed. With an extensive review of the literature and based on the summary of our experience, detailed techniques and tips for TUERP are described. The procedure is initiated from the enucleation of mid-lobe and progressed in a retrograde mode with the guide of the capsular plane. Along with the experience accumulated, the capability of landmark identifying and the surgical skills were improved. A steep operative learning curve may be the main obstacle to the widespread use of TUERP. Accurate identification and orientation of the landmark with good understanding of the three-dimensional structure of the prostatic fossa and the detailed technical issues of enucleating along the right capsule plane will be helpful for beginners to overcome the learning curve and gain confidence with this procedure and for experienced surgeons to further improve their surgical technique.

  13. Clinical Outcomes of Transurethral Enucleation with Bipolar for Benign Prostatic Hypertrophy.

    Science.gov (United States)

    Kawamura, Yoshiaki; Tokunaga, Masatoshi; Hoshino, Hideaki; Matsushita, Kazuo; Terachi, Toshiro

    2015-12-20

    This study compared outcomes of transurethral enucleation with bipolar (TUEB) with transurethral resection in saline (TURis). Thirty patients who underwent TURis were compared with 30 who underwent TUEB. Perioperative treatment outcomes, preoperative and 1-month postoperative International Prostrate Symptom Scores (IPSS), quality of life (QOL) index, maximum flow rate, average urinary flow, post- void residual urinary volume, and complications were compared. There were no significant differences in IPSS, measurements of urinary flow, or duration of catheterization. However, the improvement of QOL index after surgery was significantly greater in the TUEB group than the TURis group. The TUEB group had significantly longer surgical time, but tended to have greater enucleated tissue weight than the TURis group. There was no significant difference in enucleated tissue weight per unit time between the groups. The TUEB group also tended to have less hemoglobin decrease at postoperative day 1; this tendency was more prominent in patients with an estimated prostate volume of ≥ 50 ml. No significant differences in postoperative complications were observed. This study confirmed that the previously reported safety and efficacy of TUEB are comparable to those of TURis. TUEB appears especially safe for those with a large benign hypertrophic prostate.

  14. Transurethral enucleation of prostate with button electrode plasmakinetic vaporization for the treatment of Benign Prostatic Hyperplasia.

    Science.gov (United States)

    Peng, Bo; Huang, Jianhua; Wang, Guangchun; Zhang, Haimin; Liu, Min

    2016-12-23

    Benign prostatic hyperplasia (BPH) is a common disease in aged men. In this study, we investigated the efficacy and safety of transurethral enucleation of prostate with button electrode plasmakinetic vaporization for the treatment of BPH. 60 patients diagnosed with BPH who were treated in our hospital from August to December, 2014 by enucleation with button electrode were retrospectively reviewed, and operation time, urinary catheter indwelling time, continuous bladder irrigation time, operation related complications, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), International Prostate Symptom Score (IPSS), quality of life assessment (QOL), perioperative hemoglobin and electrolytes were recorded. All the operations were completed successfully. The operation time and urinary catheter indwelling time were 45.3 ± 16.2 min and 1.72 ± 0.32 d, respectively. During the follow-up, urethral stricture (n = 1), and urinary incontinence (n = 2) were found with recovery after 1-month training. Postoperative PVR at 1, 3 and 6 months significantly decreased compared with preoperative ones (P enucleation of prostate with button electrode was efficient and safe, which was worth being recommended.

  15. A case of attempted bilateral self-enucleation in a patient with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Hannah Muniz Castro

    2017-06-01

    Full Text Available Attempted and completed self-enucleation, or removal of one’s own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.

  16. Clinical comparison of ultrasonic surgery and conventional surgical techniques for enucleating jaw cysts.

    Science.gov (United States)

    Yaman, Z; Suer, B T

    2013-11-01

    The conventional treatment of odontogenic cysts usually involves enucleation of the cyst using rotary and manual instruments; such procedures can cause trauma to the cystic epithelium or soft tissues in the region, such as sinus membrane perforation or nerve damage. The use of ultrasonic surgery may reduce the risk of damage to soft tissues. The objective of this study was to evaluate the performance of ultrasonic surgery in removing odontogenic cysts. Eighty-two cysts were removed from 68 patients over a period of 45 months. Ultrasonic surgery was used for 34 patients and conventional surgical procedures were used for 34 control patients. Two surgeons rated the cutting efficiency, visibility of the surgical field, ease of operation, and ease of cyst epithelium removal on a 100-mm visual analogue scale. The operation time was also recorded. No major intraoperative or postoperative complications were observed, and there was no cyst recurrence. Ultrasonic surgery for enucleating jaw cysts was found to increase the operation time, but also markedly increased the visibility of the operation field. In cases where cyst enucleation is performed in difficult areas that require delicate manipulation, there is less risk of damage to vital structures such as neurovascular tissues with ultrasonic surgery. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

    National Research Council Canada - National Science Library

    Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter; Ogan, Kenneth

    2009-01-01

    ...). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts...

  18. GaSe Parametric Oscillator Pumped by Powerful Holmium Laser Near 3 Microns

    Science.gov (United States)

    2001-05-31

    0.027 cm-1 . We get fit-function (solid line) with help of MATHCAD 6 PLUS program, which is shown on Fig.10. This function approximate our...40 50 Input energy, mJ O ut pu t e ne rg y, m J Fig.10. MATHCAD 6 PLUS gives a curve of a gain factor G in dependence on input energy Ein at...shows as MATHCAD 6 PLUS gives a good approximation of our experimental points except the first two points (nearest to zero) on the Fig.13 at the

  19. Laser enucleation of the prostate: Overview of our results after the ...

    African Journals Online (AJOL)

    Y. Kharbach

    2017-08-01

    Aug 1, 2017 ... Ischemic or valvular heart disease. 28. Diabetes. 36. Chronic renal failure. 8. Bronchopulmonary pathology. 12. Rheumatic disease. 16. Prostate volume (ml). 59.61 ± 18.86. Qmax. 9.50 ± 5.88. IPSS. 22.64 ± 6.42. Surgical indication. Recurrent acute urinary retention. 40 (28.9%). Medical treatment failure.

  20. Comparative study of different laser systems.

    Science.gov (United States)

    Bhatta, N; Isaacson, K; Bhatta, K M; Anderson, R R; Schiff, I

    1994-04-01

    To review lasers, laser physics, laser-tissue interaction, delivery systems, and their clinical applications relevant to gynecology. Gynecological Service at Massachusetts General Hospital (MGH) and MGH Laser Center. None. Laser literature review and personal experiences of the authors were used to prepare this manuscript. Lasers have been used in gynecologic practice for cutting and coagulating purposes. Photodynamic therapy has been used clinically for malignant conditions and is being investigated for dysplastic lesions of the lower genital tract and for endometrial ablation. Laser welding has potential, but further work is required in this field before it finds a clinical application. The main lasers used in gynecology are CO2, neodymium-yttrium aluminum garnet (Nd:YAG), and potassium tatanyl-phosphate-doubled Nd:YAG. Pulsed Ho:YAG laser looks promising, as does diode lasers. Holmium-yttrium aluminum garnet and diode lasers will be soon available commercially. Improvements in delivery systems have increased user friendliness, and more developments in this area are anticipated, for example, a fiber-optic delivery system for CO2 lasers. We believe that enhanced understanding of laser technology will provide unique applications for development in gynecology.

  1. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup.

    Science.gov (United States)

    Zhu, Lingfeng; Chen, Shushang; Yang, Shunliang; Wu, Meijing; Ge, Rong; Wu, Weizhen; Liao, Lianming; Tan, Jianming

    2013-04-01

    We compared the perioperative and postoperative characteristics of prostate PlasmaKinetic™ enucleation and bipolar transurethral resection for large volume benign prostatic hyperplasia. In this prospective, randomized, controlled trial 80 patients with benign prostatic hyperplasia and a prostate of larger than 70 ml were randomly assigned to prostate bipolar transurethral resection or PlasmaKinetic enucleation. Operative time, resected adenoma weight, changes in hemoglobin, catheterization time and postoperative hospital stay were recorded and compared. Patients were followed 1, 6, 12, 24, 36, 48 and 60 months after surgery. Greater resected prostate weight (mean ± SD 64.2 ± 19.0 vs 50.6 ± 20.0 gm, p = 0.03), less blood loss (mean 0.87 ± 0.42 vs 1.74 ± 0.63 gm, p enucleation group than in the resection group. The postoperative improvement in International Prostate Symptom Score, quality of life, maximal flow rate and post-void residual urine volume was similar in the 2 groups at 1, 6, 12 and 24 months but significantly better in the enucleation group at 36, 48 and 60 months. During the 5-year followup no patient in the enucleation group but 2 in the resection group experienced recurrence. For large volume benign prostatic hyperplasia PlasmaKinetic enucleation of the prostate is associated with less blood loss, shorter hospital stay and catheterization time than bipolar transurethral resection of the prostate. Moreover, PlasmaKinetic enucleation seems to be superior at long-term followup with fewer reoperations necessary. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. Strain differences of the effect of enucleation and anophthalmia on the size and growth of sensory cortices in mice.

    Science.gov (United States)

    Massé, Ian O; Guillemette, Sonia; Laramée, Marie-Eve; Bronchti, Gilles; Boire, Denis

    2014-11-07

    Anophthalmia is a condition in which the eye does not develop from the early embryonic period. Early blindness induces cross-modal plastic modifications in the brain such as auditory and haptic activations of the visual cortex and also leads to a greater solicitation of the somatosensory and auditory cortices. The visual cortex is activated by auditory stimuli in anophthalmic mice and activity is known to alter the growth pattern of the cerebral cortex. The size of the primary visual, auditory and somatosensory cortices and of the corresponding specific sensory thalamic nuclei were measured in intact and enucleated C57Bl/6J mice and in ZRDCT anophthalmic mice (ZRDCT/An) to evaluate the contribution of cross-modal activity on the growth of the cerebral cortex. In addition, the size of these structures were compared in intact, enucleated and anophthalmic fourth generation backcrossed hybrid C57Bl/6J×ZRDCT/An mice to parse out the effects of mouse strains and of the different visual deprivations. The visual cortex was smaller in the anophthalmic ZRDCT/An than in the intact and enucleated C57Bl/6J mice. Also the auditory cortex was larger and the somatosensory cortex smaller in the ZRDCT/An than in the intact and enucleated C57Bl/6J mice. The size differences of sensory cortices between the enucleated and anophthalmic mice were no longer present in the hybrid mice, showing specific genetic differences between C57Bl/6J and ZRDCT mice. The post natal size increase of the visual cortex was less in the enucleated than in the anophthalmic and intact hybrid mice. This suggests differences in the activity of the visual cortex between enucleated and anophthalmic mice and that early in-utero spontaneous neural activity in the visual system contributes to the shaping of functional properties of cortical networks. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Advanced Unilateral Retinoblastoma: The Impact of Ophthalmic Artery Chemosurgery on Enucleation Rate and Patient Survival at MSKCC.

    Directory of Open Access Journals (Sweden)

    David H Abramson

    Full Text Available To report on the influence of ophthalmic artery chemosurgery (OAC on enucleation rates, ocular and patient survival from metastasis and impact on practice patterns at Memorial Sloan Kettering for children with advanced intraocular unilateral retinoblastoma.Single-center retrospective review of all unilateral retinoblastoma patients with advanced intraocular retinoblastoma treated at MSKCC between our introduction of OAC (May 2006 and December 2014. End points were ocular survival, patient survival from metastases and enucleation rates.156 eyes of 156 retinoblastoma patients were included. Primary enucleation rates have progressively decreased from a rate of >95% before OAC to 66.7% in the first year of OAC use to the present rate of 7.4%. The percent of patients receiving OAC has progressively increased from 33.3% in 2006 to 92.6% in 2014. Overall, ocular survival was significantly better in eyes treated with OAC in the years 2010-2014 compared to 2006-2009 (p = 0.023, 92.7% vs 68.0% ocular survival at 48 months. There have been no metastatic deaths in the OAC group but two patients treated with primary enucleation have died of metastatic disease.OAC was introduced in 2006 and its impact on patient management is profound. Enucleation rates have decreased from over 95% to less than 10%. Our ocular survival rate has also significantly and progressively improved since May 2006. Despite treating more advanced eyes rather then enucleating them patient survival has not been compromised (there have been no metastatic deaths in the OAC group. In our institution, enucleation is no longer the most common treatment for advanced unilateral retinoblastoma.

  4. Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy.

    Science.gov (United States)

    Wilson, Christopher R; Hardy, Luke A; Irby, Pierce B; Fried, Nathaniel M

    2015-07-01

    The experimental Thulium fiber laser (TFL) is currently being studied as a potential alternative lithotripter to the clinical gold standard Holmium:YAG laser. Safety studies characterizing undesirable Holmium:YAG laser-induced damage to ureter tissue and stone baskets have been previously reported. Similarly, this study characterizes TFL induced ureter and stone basket damage. A TFL beam with energy of 35 mJ per pulse, pulse duration of 500 µs, and variable pulse rates of 50-500 Hz, was delivered through 100-µm-core optical fibers, to either porcine ureter wall, in vitro, or a standard 1.9-Fr Nitinol stone basket wire. Ureter perforation times were measured and gross, histological, and optical coherence tomography images of the ablation area were acquired. Stone basket damage was graded as a function of pulse rate, number of pulses, and working distance. TFL operation at 150, 300, and 500 Hz produced mean ureter perforation times of 7.9, 3.8, and 1.8 seconds, respectively. Collateral damage widths averaged 510, 370, and 310 µm. Nitinol wire damage decreased with working distance and was non-existent at distances greater than 1.0 mm. In contact mode, 500 pulses delivered at pulse rates ≥300 Hz (≤1.5 seconds) were sufficient to cut Nitinol wires. The TFL, operated in low pulse energy and high pulse rate mode, may provide a greater safety margin than the standard Holmium:YAG laser for lithotripsy, as evidenced by longer TFL ureter perforation times and shorter non-contact working distances for stone basket damage than previously reported with Holmium:YAG laser. © 2015 Wiley Periodicals, Inc.

  5. [Effect of surgical laser on collagen-rich tissue].

    Science.gov (United States)

    Gebauer, D; Constantinescu, M A

    2000-01-01

    The goal of this ex-vivo study was a controlled macroscopical and microscopical comparison of the immediate effects of surgical lasers on dense collagenous tissues. The investigation of the exact denaturizing effects following tissue interaction between lasers and collagenous fibers are of importance for a better understanding of the observed and described healing process. Partial tenotomies were performed ex vivo on sixty tendons of the flexor digitorum profundus muscle of New Zealand White Rabbits using four surgical lasers (Holmium:YAG-, Erbium:YAG-, Neodym:YAG-, and CO2-Laser). The tendons were evaluated macroscopically, histologically and observations were made on the surgical handling of the lasers during the procedure. The choice of lasers allowed the comparison of a wide spectrum of wavelengths (gamma = 1.0 to 10.6 microns). In addition, beam delivery modalities were compared to each other (focus vs. contact). The pulse (frequency and power) was varied within each laser. Other parameters including focus size, absorption, dispersion, and thermal tissue conductivity were maintained constant in this test arrangement in order to allow a later comparison between the observed areas of denaturated collagen. The macroscopical and histological results showed great differences in the effects of the four lasers. Even within each single laser group, the results varied greatly with the choice of variable parameters. Holmium:YAG- and CO2-Laser can produce similar areas of collagen denaturation. When comparing specimens with similar areas of collagen denaturation induced by different laser types, different amounts of charring were observed. Erbium:YAG-Laser tenotomies showed generally inhomogeneous denaturation areas, while tenotomies with Neodym: YAG-Laser used in continuous mode resulted in significant charring and tissue retraction in the area of interaction. These observations help in defining the combination of parameters with which Holmium:YAG-, Erbium:YAG-, and CO2

  6. Synthesis and optical properties of antimony oxide glasses doped with holmium trioxide

    Energy Technology Data Exchange (ETDEWEB)

    Raghunatha, S.; Eraiah, B., E-mail: eraiah@rediffmail.com [Department of physics, Bangalore University, Bengaluru – 560 056. India (India)

    2016-05-06

    Holmium doped lithium-antimony-lead borate glasses having 1 mol% AgNO{sub 3} with composition 50B{sub 2}O{sub 3}-20PbO-25Sb{sub 2}O{sub 3}-5Li{sub 2}O have been prepared using single step melt quenching technique. The XRD spectrum confirms amorphous nature of glasses. The optical absorbance studies were carried out on these glasses. The optical direct band gap energies were found to be in the range of 3.10 eV to 3.31 eV and indirect band gap energies were found to be in the range of 2.28 eV to 3.00 eV. The refractive indexes have been calculated by using Lorentz-Lorenz formula and the calculated values in the range of 2.31 to 2.37.

  7. Magnetic Phase Transition in Rare Earth Metal Holmium at Low Temperatures and High Pressures

    Science.gov (United States)

    Thomas, Sarah; Uhoya, Walter; Wenger, Lowell; Vohra, Yogesh

    2012-02-01

    The heavy rare earth metal Holmium has been studied under high pressures and low temperatures using a designer diamond anvil cell and neutron diffraction using a Paris-Edinburgh Cell at the Spallation Neutrons and Pressure (SNAP) Diffractometer. The electrical resistance measurement using designer diamond shows a change in slope at the Neel temperature as the temperature is lowered at high pressures. At atmospheric pressure TN=120 K and decreases with a slope of -4.7 K/GPa as pressure is increased, until reaching 9 GPa, at which pressure the magnetic ordering is lost. This correlates to the pressure at which there is a structural change from an hcp phase to an α-Sm structure. Neutron diffraction measurements made above and below the Neel temperature at increasing pressures show the reversibility of the change between the paramagnetic and antiferromagnetic states. The parameters of the low temperature incommensurate magnetic phase will be reported at various pressures.

  8. Worldwide enucleation techniques and materials for treatment of retinoblastoma: an international survey.

    Science.gov (United States)

    Mourits, Daphne L; Hartong, Dyonne T; Bosscha, Machteld I; Kloos, Roel J H M; Moll, Annette C

    2015-01-01

    To investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world. A digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma. We received a response of 58 surgeons in 32 different countries. A primary artificial implant is routinely inserted by 42 (72.4%) surgeons. Ten (17.2%) surgeons leave the socket empty, three (5.2%) decide per case. Other surgeons insert a dermis fat graft as a standard primary implant (n=1), or fill the socket in a standard secondary procedure (n=2; one uses dermis fat grafts and one artificial implants). The choice for porous implants was more frequent than for non-porous implants: 27 (58.7%) and 15 (32.6%), respectively. Both porous and non-porous implant types are used by 4 (8.7%) surgeons. Twenty-five surgeons (54.3%) insert bare implants, 11 (23.9%) use separate wrappings, eight (17.4%) use implants with prefab wrapping and two insert implants with and without wrapping depending on type of implant. Attachment of the muscles to the wrapping or implant (at various locations) is done by 31 (53.4%) surgeons. Eleven (19.0%) use a myoconjunctival technique, nine (15.5%) suture the muscles to each other and seven (12.1%) do not reattach the muscles. Measures to improve volume are implant exchange at an older age (n=4), the use of Restylane SQ (n=1) and osmotic expanders (n=1). Pegging is done by two surgeons. No (worldwide) consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma. Considerations for the use of different techniques are discussed.

  9. Worldwide enucleation techniques and materials for treatment of retinoblastoma: an international survey.

    Directory of Open Access Journals (Sweden)

    Daphne L Mourits

    Full Text Available To investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world.A digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma.We received a response of 58 surgeons in 32 different countries. A primary artificial implant is routinely inserted by 42 (72.4% surgeons. Ten (17.2% surgeons leave the socket empty, three (5.2% decide per case. Other surgeons insert a dermis fat graft as a standard primary implant (n=1, or fill the socket in a standard secondary procedure (n=2; one uses dermis fat grafts and one artificial implants. The choice for porous implants was more frequent than for non-porous implants: 27 (58.7% and 15 (32.6%, respectively. Both porous and non-porous implant types are used by 4 (8.7% surgeons. Twenty-five surgeons (54.3% insert bare implants, 11 (23.9% use separate wrappings, eight (17.4% use implants with prefab wrapping and two insert implants with and without wrapping depending on type of implant. Attachment of the muscles to the wrapping or implant (at various locations is done by 31 (53.4% surgeons. Eleven (19.0% use a myoconjunctival technique, nine (15.5% suture the muscles to each other and seven (12.1% do not reattach the muscles. Measures to improve volume are implant exchange at an older age (n=4, the use of Restylane SQ (n=1 and osmotic expanders (n=1. Pegging is done by two surgeons.No (worldwide consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma. Considerations for the use of different techniques are discussed.

  10. miR-191 regulates mouse erythroblast enucleation by down-regulating Riok3 and Mxi1.

    Science.gov (United States)

    Zhang, Lingbo; Flygare, Johan; Wong, Piu; Lim, Bing; Lodish, Harvey F

    2011-01-15

    Using RNA-seq technology, we found that the majority of microRNAs (miRNAs) present in CFU-E erythroid progenitors are down-regulated during terminal erythroid differentiation. Of the developmentally down-regulated miRNAs, ectopic overexpression of miR-191 blocks erythroid enucleation but has minor effects on proliferation and differentiation. We identified two erythroid-enriched and developmentally up-regulated genes, Riok3 and Mxi1, as direct targets of miR-191. Knockdown of either Riok3 or Mxi1 blocks enucleation, and either physiological overexpression of miR-191 or knockdown of Riok3 or Mxi1 blocks chromatin condensation. Thus, down-regulation of miR-191 is essential for erythroid chromatin condensation and enucleation by allowing up-regulation of Riok3 and Mxi1.

  11. Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

  12. The Asymmetric Cell Division Regulators Par3, Scribble and Pins/Gpsm2 Are Not Essential for Erythroid Development or Enucleation.

    Directory of Open Access Journals (Sweden)

    Christina B Wölwer

    Full Text Available Erythroid enucleation is the process by which the future red blood cell disposes of its nucleus prior to entering the blood stream. This key event during red blood cell development has been likened to an asymmetric cell division (ACD, by which the enucleating erythroblast divides into two very different daughter cells of alternate molecular composition, a nucleated cell that will be removed by associated macrophages, and the reticulocyte that will mature to the definitive erythrocyte. Here we investigated gene expression of members of the Par, Scribble and Pins/Gpsm2 asymmetric cell division complexes in erythroid cells, and functionally tested their role in erythroid enucleation in vivo and ex vivo. Despite their roles in regulating ACD in other contexts, we found that these polarity regulators are not essential for erythroid enucleation, nor for erythroid development in vivo. Together our results put into question a role for cell polarity and asymmetric cell division in erythroid enucleation.

  13. Hereditary Spherocytosis and Hereditary Elliptocytosis: Aberrant Protein Sorting during Erythroblast Enucleation

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    Salomao, Marcela; Chen, Ke; Villalobos, Jonathan; Mohandas, Narla; An, Xiuli; Chasis, Joel Anne

    2010-02-08

    During erythroblast enucleation, membrane proteins distribute between extruded nuclei and reticulocytes. In hereditary spherocytosis (HS) and hereditary elliptocytosis (HE), deficiencies of membrane proteins, in addition to those encoded by the mutant gene, occur. Elliptocytes, resulting from protein 4.1R gene mutations, lack not only 4.1R but also glycophorin C, which links the cytoskeleton and bilayer. In HS resulting from ankyrin-1 mutations, band 3, Rh-associated antigen, and glycophorin A are deficient. The current study was undertaken to explore whether aberrant protein sorting, during enucleation, creates these membrane-spanning protein deficiencies. We found that although glycophorin C sorts to reticulocytes normally, it distributes to nuclei in 4.1R-deficient HE cells. Further, glycophorin A and Rh-associated antigen, which normally partition predominantly to reticulocytes, distribute to both nuclei and reticulocytes in an ankyrin-1-deficient murine model of HS. We conclude that aberrant protein sorting is one mechanistic basis for protein deficiencies in HE and HS.

  14. [Transurethral enucleation plus pneumo-cystostomy rotary cut for large benign prostatic hyperplasia].

    Science.gov (United States)

    Dong, Yan-Xin; Wu, Yang; Zeng, Rui; Yang, Jun-Chang; Gao, Xiao-Kang; Zhu, Ming-De; Huo, Shuang-Jin; Li, Dong; Niguti

    2014-06-01

    To investigate the feasibility, effectiveness and practicability of transurethral enucleation plus pneumocystostomy rotary cut (TUE + PCRC) for large benign prostatic hyperplasia (BPH). We performed TUE + PCRC for 26 BPH patients aged 62 - 85 years with the prostate volume of 80 - 165 ml. We conducted transurethral enucleation of the hyperplastic prostate glands and pushed them into the bladder, followed by bladder puncture for pneumo-cystostomy rotary cut. All the surgical procedures were successfully accomplished, with the mean surgical time of 41 (32 - 54) minutes and intraoperative blood loss < 60 ml in all the cases. Twenty-three of the patients were followed up for 2 - 8 months, which revealed no stricture of the urethra or any other severe complications. Compared with the preoperative baseline, significant improvement was achieved in the IPSS (6.5 +/- 2.2 vs 26.2 +/- 2.4), QOL (1.4 +/- 0.9 vs 4.6 +/- 1.2) and Qmax ([5.8 +/- 1.0 ] vs [19.6 +/- 2.8] ml/s) of the patients after surgery (P < 0.01). TUE + PCRC, with its advantages of short operation time and less severe complications, is a safe and effective approach to the management of large BPH.

  15. Bipolar Button Transurethral Enucleation of Prostate in Benign Prostate Hypertrophy Treatment: A New Surgical Technique.

    Science.gov (United States)

    Giulianelli, Roberto; Gentile, Barbara; Albanesi, Luca; Tariciotti, Paola; Mirabile, Gabriella

    2015-08-01

    To evaluate the safety and efficacy of transurethral bipolar enucleation with a button electrode (B-TUEP) for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia. Between July 2011 and March 2012, a single surgeon performed 50 B-TUEP. Preoperative and postoperative assessments included prostate-specific antigen, International Prostate Symptoms Score (IPSS), International Index of Erectile Function-5 (IIEF-5), quality of life (QoL) index, uroflowmetry with postvoiding residual (PVR) urinary volume, and prostate volume measured by transrectal ultrasonography. Intraoperatively, we evaluated B-TUEP time (enucleation and resection time). Perioperatively, we evaluated hemoglobin dosage, bladder irrigation time, catheterization time, acute urinary retention events, length of stay, patient readmission, and any endoscopic retreatments. Three months after surgery, 82% of the patients presented a significant improvement in maximum urine flow (Qmax; P transurethral incision of the prostate. B-TUEP using the Gyrus PK system is a rapid and safety technique with optimal outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. [Application of morcellator in transurethral bipolar plasmakinetic anatomical enucleation of the prostate].

    Science.gov (United States)

    Xu, A-Bai; Luo, Fu; Zou, Zhi-Hui; DU, Wei; Zhao, Peng-Peng; Liu, Chun-Xiao

    2016-08-20

    To assess the safety and therapeutic effect of morcellator in transurethral bipolar plasmakinetic anatomical enucleation (TUPKAEP) of benign prostate hyperplasia (BPH). The clinical data of 47 patients with BPH receiving TUPKAEP between January and July, 2015 were analyzed. During the operation, morcellator was used to smash the enucleated BPH which was aspirated with subatmospheric pressure in 29 cases, and the tissue was smashed with bipolar electrosurgical loop slicing from top to bottom and aspirated by ellic suction in 18 cases. s The procedures were completed successfully in all the 47 cases. The time used for adenoma dissociation was 2.24∓1.09 with morcellator at the speed of 18.43∓6.01 g/min, and was 17.19∓11.74 min with bipolar electrosurgical loop at the speed of 1.91∓0.65 g/min; the mean total operation time was significantly shorter in morcellator group (28.13∓14.71 vs 43.22∓25.39 min). The 2 groups showed no significant difference in postoperative continuous bladder irrigation time, postoperative indwelling time of urinary catheter or postoperative hospital stay. s Morcellator is safe and feasible for application in TUPKAEP and helps to shorten the operation time.

  17. Marsupialization and enucleation of keratocystic odontogenic tumor with the use of Carnoy's solution

    Directory of Open Access Journals (Sweden)

    Jovanović Goran

    2010-01-01

    Full Text Available Introduction. Keratocystic odontogenic tumors (KCOT or odontogenic keratocysts are aggressive and expansive odontogenic neoplasms with high recurrence rate (25%- 60%. There are a small number of publications about the combination of marsupialization and enucleation with the use of Carnoy's solution for the treatment of KCOT. Case report. In a female patient, aged 24, marsupialization KCOT was done in the first stage, and enucleation with the use of Carnoy's solution in the second stage, six months later. Lost sensibility of the lower lip was reestablished after three months. A postoperation defect was completely filled in seven months. One year later orthopantomographic x-ray showed the presence of a newly formed bone tissue, whereas in 7 years a completely preserved new mandibular bone and recanalisation of mandibular canal were observed. Conclusion. We consider that our method was successful in the treatment of KCOT, with no occurrence of recidives seven years later. However, it is necessary to follow the patient periodically because of a possible late recidive.

  18. A technique for evisceration as an alternative to enucleation in birds of prey: 19 cases.

    Science.gov (United States)

    Murray, Maureen; Pizzirani, Stefano; Tseng, Florina

    2013-06-01

    Ocular trauma is common in birds of prey presented to wildlife clinics and rehabilitation centers. Enucleation is the procedure most commonly described for treatment of end-stage ocular disease or chronically painful eyes in birds; however, there are several disadvantages and risks to this procedure. While evisceration has been suggested as an alternative, it has not been described for multiple cases or with long-term follow-up data in birds of prey. This report details an evisceration technique performed in 5 captive birds of prey of 4 different species (1 eastern screech owl [Megascops asio], 1 great horned owl [Bubo virginianus], 2 red-tailed hawks [Buteo jamaicensis], and 1 bald eagle [Haliaeetus leucocephalus]) with long-term follow-up information. In addition, this report describes 14 cases of free-living owls of 3 different species (1 great horned owl, 4 barred owls [Strix varia], and 9 eastern screech owls) on which this technique was performed from 2004 to 2011 and which were subsequently released to the wild. Because of the limited risk of complications and the less-severe disruption of facial symmetry, which may be particularly important in owls that are candidates for release to the wild, evisceration should be considered over enucleation in birds of prey that require surgical intervention for the management of severe sequelae to ocular trauma.

  19. Enucleated cells reveal differential roles of the nucleus in cell migration, polarity, and mechanotransduction.

    Science.gov (United States)

    Graham, David M; Andersen, Tomas; Sharek, Lisa; Uzer, Gunes; Rothenberg, Katheryn; Hoffman, Brenton D; Rubin, Janet; Balland, Martial; Bear, James E; Burridge, Keith

    2018-01-19

    The nucleus has long been postulated to play a critical physical role during cell polarization and migration, but that role has not been defined or rigorously tested. Here, we enucleated cells to test the physical necessity of the nucleus during cell polarization and directed migration. Using enucleated mammalian cells (cytoplasts), we found that polarity establishment and cell migration in one dimension (1D) and two dimensions (2D) occur without the nucleus. Cytoplasts directionally migrate toward soluble (chemotaxis) and surface-bound (haptotaxis) extracellular cues and migrate collectively in scratch-wound assays. Consistent with previous studies, migration in 3D environments was dependent on the nucleus. In part, this likely reflects the decreased force exerted by cytoplasts on mechanically compliant substrates. This response is mimicked both in cells with nucleocytoskeletal defects and upon inhibition of actomyosin-based contractility. Together, our observations reveal that the nucleus is dispensable for polarization and migration in 1D and 2D but critical for proper cell mechanical responses. © 2018 Graham et al.

  20. [Transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients less than 50 years old].

    Science.gov (United States)

    Xu, Ya-wen; Liu, Chun-xiao; Zheng, Shao-bo; Li, Hu-ling; Fang, Ping; Chen, Bin-shen; Xu, Kai; Shen, Hai-yan

    2010-12-01

    To evaluate the therapeutic effect of transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients below 50 years of age. Twelve patients with benign prostatic hyperplasia patients (mean age 48.2 years, range 46-49 years) underwent transurethral enucleation of the prostate. The middle lobe and two lateral lobes were enucleated with the preprosthetic sphincter and anterior fibromuscular stroma preserved during the operation. The patients were followed up to evaluate the lower urinary tract symptoms and sexual activity after the surgery. The 12 patients were followed up for 3 to 6 months. The symptoms of lower urinary tract obstruction were improved obviously after the surgery, and the International Prostate Symptom Score (IPSS) decreased from 24±5.1 to 8.8±1.4 and peak urine flow rate (Qmax) increased from 8.1±4.2 ml/s to 20.1±4.2 ml/s at 3 months postoperatively. All the 12 cases had residual urine (12-44 ml) preoperatively, but after the surgery, only 4 still had residual urine of less than 30 ml. All the patients had normal erection function postoperatively, and 10 had normal ejaculation; the other 2 patients recovered normal ejaculation 3 and 5 months after the operation, respectively. Transurethral enucleation can alleviate the low urinary tract obstruction symptom and improve the sexual function by avoiding preprosthetic sphincter injury in relatively young patients with benign prostatic hyperplasia.

  1. Room temperature CW and QCW operation of Ho:CaF2 laser pumped by Tm:fiber laser

    Science.gov (United States)

    Jelínek, Michal; Cvrček, Jan; Kubeček, Václav; Zhao, Beibei; Ma, Weiwei; Jiang, Dapeng; Su, Liangbi

    2017-05-01

    Laser radiation in the wavelength range around 2 μm is required for its specific properties - it is very suitable for medical applications, remote sensing, or pumping of optical parametric oscillators to generate ultrafast pulses in the mid-IR region further exploited in nonlinear optics. Crystals as YLF, YAG, LLF, and GdVO4 doped by holmium were already investigated and found suitable for the tunable laser generation around 2.1 mμ. Only a few works are devoted to the laser operation of holmium-doped fluorides as CaF2. In this work, pulsed and continuous-wave laser operation of a modified- Bridgman-grown Ho:CaF2 active crystal at room temperature is reported. A commercial 50 W 1940 nm Tm-fiber laser was used to pump a laser oscillator based on a novel 10 mm long 0.5 at.% Ho:CaF2 active crystal placed in the Peltiercooled holder. In the pulsed regime (10 ms, 10 Hz), the laser slope efficiency of 53 % with respect to the absorbed pump power was achieved. The laser generated at the central wavelength of 2085 nm with the maximum mean output power of 365 mW corresponding to the power amplitude of 3.65 W. In the continuous wave regime, the maximum output power was 1.11 W with the slope efficiency of 41 % with respect to the absorbed pump power. To our best knowledge this is the first demonstration of this laser active material operating in the CW regime at room temperature. The tuning range over 60 nm from 2034 to 2094 nm was achieved using a birefringent filter showing the possibility to develop a mode-locked laser system generating pulses in the sub-picosecond range.

  2. Late effects of orbital enucleation and radiation on maxillofacial prosthetic rehabilitation: A clinical report.

    Science.gov (United States)

    Tummawanit, Supanut; Shrestha, Binit; Thaworanunta, Sita; Srithavaj, Theerathavaj

    2013-05-01

    The retinoblastoma is one of the most common tumors of the eye diagnosed in childhood. The treatment for patients with retinoblastoma includes surgical removal of the lesion along with adjunctive chemotherapy and radiotherapy. If the tumor is controlled, these treatments can have secondary adverse effects pertaining to the growth and development of orofacial structures in young patients. This clinical report describes the prosthetic rehabilitation of a patient who underwent enucleation followed by radiation therapy and adjunctive chemotherapy to treat the primary diagnosis of retinoblastoma. This therapy resulted in a combination of dental and facial growth and developmental abnormalities. Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

  3. [Initial results of transurethral enucleation with bipolar system for benign prostate hypertrophy patients].

    Science.gov (United States)

    Nakao, Atsushi; Fukui, Koji; Togo, Yoshikazu; Kokura, Koji

    2010-07-01

    We have performed transurethral enucleation with bipolar system (TUEB) on 60 patients since April 2008. The patients were 61 to 81 years old (average 71.7 years old), and estimated prostate volumes were 25 cm3 to 80.43 cm3 (average 51.1 cm3). The weight of prostate removed was 8 g to 56 g (average 27.4 g) during the operations which lasted between 40 min to 200 min (average 117.5 min). The International Prostate Symptom Score (IPSS), quality of life index (QOL) maximum flow rate (Q max) and average flow rate (Qave) were recorded before operation, and at 1 and at 3 months after operation. The results indicated a high safety with TUEB compared to TUR-P even for beginners. In conclusion, TUEB may become the most common approach in the treatment of BPH.

  4. Prosthetic rehabilitation of surgically treated orbital defects - evisceration, enucleation, and exenteration: A case series

    Directory of Open Access Journals (Sweden)

    Anna Serene Babu

    2016-01-01

    Full Text Available The rehabilitation of a patient who has suffered the psychological trauma due to loss of an eye requires a prosthesis that will provide the optimum cosmetic and functional result. The mode of rehabilitation varies based on the type of defect and surgical approach being adopted. A case series of prosthetic rehabilitation of three types of orbital defects - evisceration, enucleation and exenteration have been reported in this article. The clinical relevance of surgical approaches highlights the preservation of remaining anatomic structures creating a negative space or concavity to aid in future prosthetic rehabilitation. A multidisciplinary management and team approach is essential in providing esthetics and to regain the confidence. Follow-up care for the patient is mandatory.

  5. Analysis of thulium fiber laser induced bubble dynamics for ablation of kidney stones.

    Science.gov (United States)

    Hardy, Luke A; Kennedy, Joshua D; Wilson, Christopher R; Irby, Pierce B; Fried, Nathaniel M

    2017-10-01

    The Thulium fiber laser (TFL) is being explored as an alternative to the Holmium : YAG laser for lithotripsy. TFL parameters differ in several fundamental ways from Holmium laser, including smaller fiber delivery, more strongly absorbed wavelength, low pulse energy/high pulse rate operation, and more uniform temporal pulse structure. High speed imaging of laser induced bubbles was performed at 105,000 frames per second and 10 μm spatial resolution to determine influence of these laser parameters on bubble formation and needle hydrophone data was also used to measure pressure transients. The TFL was operated at 1908 nm with pulse energies of 5-65 mJ, and pulse durations of 200-1000 μs, delivered through 105-μm-core and 270-μm-core silica optical fibers. Bubble dynamics using Holmium laser at a wavelength of 2100 nm with pulse energies of 200-1000 mJ and pulse duration of 350 μs was studied, for comparison. A single, 500 μs TFL pulse produced a bubble stream extending 1200 ± 90 μm and 1070 ± 50 μm from fiber tip, with maximum bubble widths averaging 650 ± 20 μm and 870 ± 40 μm (n = 4), for 105 μm and 270 μm fibers, respectively. These observations are consistent with previous studies which reported TFL ablation stallout at working distances beyond 1.0 mm. TFL bubble dimensions were four times smaller than for Holmium laser due to lower peak power and smaller fiber diameter used. The maximum pressure transients measured 0.6 bars at 35 mJ pulse energy for TFL and 7.5 bars at 600 mJ pulse energy for Holmium laser. These fundamental studies of bubble dynamics as a function of specific laser and fiber parameters may assist with optimization of the TFL parameters for safe and efficient lithotripsy in the clinic. Image of bubble formation during fiber optic delivery of Thulium fiber laser energy in saline (35 mJ, 500 μs). © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  6. Radiation synovectomy with holmium-166 ferric hydroxide macroaggregate in equine metacarpophalangeal and metatarsophalangeal joints.

    Science.gov (United States)

    Mäkelä, Olli; Sukura, Antti; Penttilä, Pirkko; Hiltunen, Jukka; Tulamo, Riitta-Mari

    2003-01-01

    To evaluate the effects of radiation synovectomy (RSYN) with holmium-166 ferric hydroxide macroaggregate (Ho-166 FHMA) on synovium and synovial fluid in normal metacarpo- and metatarsophalangeal joints of horses and to determine intraarticular distribution of radioactivity after Ho-166 FHMA treatment. Either Ho-166 FHMA or nonradioactive Ho-165 FHMA was injected into metacarpo- or metatarsophalangeal joints. Six adult mixed-breed horses without any clinical evidence of metacarpo- or metatarsophalangeal joint disease. Joints were injected with a single high dose of Ho-166 FHMA (mean, 1,000 MBq/joint) or a nonradioactive Ho-165 FHMA preparation (controls). Clinical examination, arthroscopy, synovial fluid analyses, and histologic studies were performed to detect effects of RSYN. Scintigraphy was used to localize intraarticular distribution of Ho-166 FHMA. Ho-166 FHMA treatment induced joint inflammation leading to regional edema, effusion, and scar tissue formation. Scintigraphy revealed the highest intensity of radioactivity in the proximal plantar joint pouch, at which the Ho-166 FHMA treatment caused multifocal necrosis. In the dorsal joint pouch, however, arthroscopic study and histologic analysis showed very little effect of RSYN. There was no regeneration of synovium evident within 2 months. Synovial fluid protein concentration was significantly (P equine fetlock joints. Inflamed equine joints with synovial lining hyperplasia could benefit from Ho-166 FHMA-induced radiation synovectomy if excessive scar tissue formation can be avoided. Copyright 2003 by The American College of Veterinary Surgeons

  7. Development and evaluation of holmium doped phosphate glass microspheres for selective internal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Barros Filho, Eraldo C.; Martinelli, Jose Roberto; Squair, Peterson L; Osso Junior, Joao A., E-mail: eraldo.barros@gmail.com, E-mail: jaosso@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Sene, Frank Ferrer, E-mail: ffsene@hotmail.com [Centro Tecnologico da Marinha em Sao Paulo (CTMSP), Sao Paulo, SP (Brazil)

    2013-07-01

    Selective Internal Radiotherapy is used to treat hepatocellular carcinoma. In this treatment {sup 90}Y -doped aluminosilicate glass microspheres are introduced in the hepatic artery and they migrate to the liver near to the tumor where they are trapped in the arterioles. The radiation β- emitted by the decay of {sup 90}Y annihilates the cancer cells. A macroaggregate of albumin containing technetium is previously used to monitor the lung shunt and to prevent the spreading of {sup 90}Y during the treatment. In the present work, {sup 165}Ho- doped phosphate glass microspheres were developed aiming that application. {sup 165}Ho has high cross section for neutron capture (64 bars) and {sup 166}Ho decays emitting β- radiation with appropriate energy for killing cancer cells, and gamma rays with low energy which can be used to obtain images of the microspheres location and to check possible occurrence of lung shunt. Holmium also is highly paramagnetic and can be used to obtain images whereby NMR. The glass matrix consists of (P{sub 2}O{sub 5}) tetrahedrons and can be produced by a relatively lower melting temperature of chemical compounds. The {sup 31}P decays by emitting β- radiation and contributes to the absorbed dose, helping to annihilate the cancer cells. The microspheres were produced by using two methods: the flame and the gravitation falling methods to obtain microspheres with appropriate properties. (author)

  8. Temperature dependence of resonant x-ray magnetic scattering in holmium

    Science.gov (United States)

    Helgesen, G.; Hill, J. P.; Thurston, T. R.; Gibbs, Doon; Kwo, J.; Hong, M.

    1994-08-01

    We report the results of resonant x-ray magnetic scattering experiments on bulk and thin-film single crystals of holmium. The scattering at the principal magnetic reflection has been characterized as a function of the temperature in the spiral phases near and below their respective Néel temperatures. The integrated intensity of the principal magnetic peak in both samples shows power-law behavior versus reduced temperature with nearly equal exponents. The exponents for the scattering at the resonant second and third harmonics in the bulk sample are not simple integer multiples of the first, and motivate the consideration of simple scaling corrections to mean-field theory. We also present and compare the results of high-resolution measurements of the temperature dependence of the magnetic wave vectors, c-axis lattice constants, and correlation lengths of the magnetic scattering of the two samples in their spiral phases. Although the qualitative behavior is similar, systematic differences are found, including uniformly larger magnetic wave vectors and the suppression of the 1/6 phase in the film. The spiral magnetic structure of the film forms a domain state at all temperatures in the ordered phase. The magnetic correlation lengths of both samples are greatest near the Néel temperature, where that of the film appears to exceed the translational correlation lengths of the lattice. As the temperature decreases, the magnetic correlation lengths also decrease. These results are discussed in terms of the strain present in the samples.

  9. Visual system plasticity in mammals: the story of monocular enucleation-induced vision loss

    Science.gov (United States)

    Nys, Julie; Scheyltjens, Isabelle; Arckens, Lutgarde

    2015-01-01

    The groundbreaking work of Hubel and Wiesel in the 1960’s on ocular dominance plasticity instigated many studies of the visual system of mammals, enriching our understanding of how the development of its structure and function depends on high quality visual input through both eyes. These studies have mainly employed lid suturing, dark rearing and eye patching applied to different species to reduce or impair visual input, and have created extensive knowledge on binocular vision. However, not all aspects and types of plasticity in the visual cortex have been covered in full detail. In that regard, a more drastic deprivation method like enucleation, leading to complete vision loss appears useful as it has more widespread effects on the afferent visual pathway and even on non-visual brain regions. One-eyed vision due to monocular enucleation (ME) profoundly affects the contralateral retinorecipient subcortical and cortical structures thereby creating a powerful means to investigate cortical plasticity phenomena in which binocular competition has no vote.In this review, we will present current knowledge about the specific application of ME as an experimental tool to study visual and cross-modal brain plasticity and compare early postnatal stages up into adulthood. The structural and physiological consequences of this type of extensive sensory loss as documented and studied in several animal species and human patients will be discussed. We will summarize how ME studies have been instrumental to our current understanding of the differentiation of sensory systems and how the structure and function of cortical circuits in mammals are shaped in response to such an extensive alteration in experience. In conclusion, we will highlight future perspectives and the clinical relevance of adding ME to the list of more longstanding deprivation models in visual system research. PMID:25972788

  10. Ultrastructure of basal vitreo-retina interface in enucleated pig eyes

    Directory of Open Access Journals (Sweden)

    Yi-Bin Xiong

    2013-04-01

    Full Text Available AIM: To investigate the ultrastructure of the basal vitreo- retina interface in enucleated pig eyes after vitreous injection of enzymes. METHODS:Totally 130 eyes were obtained from freshly slaughter pigs and divided into 5 groups. Each group was sub-divided into the 15 minutes group and the 30 minutes group, with 13 eyes in each group. The control group were performed middle vitreous injection of 0.1mL PBS, 200U/mL and 800U/mL hyaluronidase(HAwere injected in groups A and B, 10U/mL and 50U/mL chondroitinase(CAin groups C and D. After incubation for 15 minutes and 30 minutes, the eye balls were fixed with 4% glutaraldehyde and retina fixative solution. Pathological examination, eosin-hematoxylin staining, scan electron microscopy were taken to evaluate the remaining vitreous on vitreous base, transmission electron microscopy to evaluate retina toxicity. RESULTS:Both of gross appearance and hematoxylin+eosine slice all revealed basal vitreous partially liquefied and degradation. Remarkably decrease was found in basal vitreous than the control group both in the HA 800U/mL group and the CA 50U/mL group when using electron microscopy scanning. Transmission electron microscopy in group B, C and D revealed the remaining vitreous were less than the control group. CONCLUSION: Both CA and HA can cause basal vitreoretinal detachment in enucleated pig eyes. But the HA may cause less damage to the retina.

  11. Cortical potentials after electrical intraneural stimulation of the optic nerve during orbital enucleation.

    Science.gov (United States)

    Benedičič, Mitja; Beltram, Matej; Olup, Brigita Drnovšek; Bošnjak, Roman

    2012-12-01

    The aim of this study was to present cortical potentials after electrical intraneural stimulation of the optic nerve during orbital enucleation due to malignant melanoma of the choroid or the ciliary body. These cortical potentials were related to cortical potentials after electrical epidural stimulation of the optic nerve, recorded during non-manipulative phases of neurosurgery for central skull base tumors. Cortical potentials were recorded with surface occipital electrode (Oz) in six patients undergoing orbital enucleation under total intravenous anesthesia. Two thin needle stimulating electrodes were inserted inside the intraorbital part of the optic nerve. The electrical stimulus consisted of a rectangular current pulse of varying intensity (0.2-10.0 mA) and duration (0.1-0.3 ms); the stimulation rate was 2 Hz; the bandpass filter was 1-1,000 Hz; the analysis time was 50-300 ms. Cortical potentials could not be obtained or were inconsistently elicitable in three patients with longstanding history (>3 months) of severe visual deterioration, while they consisted of several positive and negative deflections in a patient with a short history of mild visual impairment. In two other patients, cortical potentials consisted of N20, P30 and N40 waves. Cortical potentials after electrical intraneural stimulation of the optic nerve could be recorded in patients with a short history of visual deterioration and without optic nerve atrophy and appear more heterogeneous than cortical potentials after electrical epidural stimulation of the optic nerve, recorded during non-manipulative phases of neurosurgery for central skull base tumors.

  12. The effect of frequency doubled double pulse Nd:YAG laser fiber proximity to the target stone on transient cavitation and acoustic emission.

    Science.gov (United States)

    Fuh, Eric; Haleblian, George E; Norris, Regina D; Albala, W David M; Simmons, Neal; Zhong, Pei; Preminger, Glenn M

    2007-04-01

    Scant information has been published describing the effect of laser fiber distance from the stone target on the mechanism of calculus fragmentation. Using high speed photography and acoustic emission measurements we characterized the impact of laser fiber proximity on stone comminution. We evaluated the effect of laser fiber distance from the stone target on resultant cavitation bubble formation and shock wave generation. Stone fragmentation was assessed using a FREDDY (frequency doubled double pulse Nd:YAG) (World of Medicine, Orlando, Florida) laser and a holmium laser. The FREDDY laser was operated using a 420 microm fiber at an output energy of 120 and 160 mJ in single and double pulse settings, and a pulse repetition rate of 1 Hz. The holmium laser was operated using a 200 microm fiber at an output energy of 1 to 3 J and a pulse repetition rate of 1 Hz. The surface of a 1 cm square BegoStone (Bego, Bremen, Germany) attached to an X-Y-Z translational stage was aligned perpendicular to the laser fiber, which was immersed in a Lucite tank filled with water at room temperature. An Imacon 200 high speed camera was used to capture transient cavitation bubbles at a framing rate of up to 1,000,000 frames per second. Acoustic emission signals associated with shock waves generated during the rapid expansion and collapse of the cavitation bubble were measured using a 1 MHz focused ultrasound transducer. At laser fiber distances of 3.0 mm or less cavitation bubbles and shock waves were observed with the FREDDY laser. In contrast to the holmium laser, the bubble size and shock wave intensity of the FREDDY laser was inversely related to the fiber-to-stone distance over the range tested (0.5 to 3.0 mm). While bubble size was noted to increase with a larger stone-to-fiber distance using the holmium laser, to consistently generate cavitation bubbles and shock waves using the FREDDY laser the laser fiber should be operated within 3.0 mm of the target stone. These findings have

  13. Electron transfer behavior and water photodecomposition ability of calcined material from a cerium-S-phenylene-O-holmium-O-phenylene-S hybrid copolymer.

    Science.gov (United States)

    Matsui, Hideo; Otsuki, Keigo; Yamada, Hiroyoshi; Kawahara, Tetsuro; Yoshihara, Masakuni

    2006-05-15

    Calcination of a cerium-S-phenylene-O-holmium-O-phenylene-S hybrid copolymer under a vacuum gave cerium oxide-carbon cluster-holmium oxide composite material. The material calcined at 600 degrees C loaded with Pt particles could decompose water to H2 and O2 with a H2/O2 ratio of 2 under visible light irradiation. ESR spectral examinations of the calcined materials revealed the possibility of a two-step electron transfer in the process of CeO2 --> carbon cluster --> Ho2O3 --> Pt with an oxidation site at CeO2 particles and a reduction site at Pt particles.

  14. Intratumoral administration of holmium-166 acetylacetonate microspheres: antitumor efficacy and feasibility of multimodality imaging in renal cancer.

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    Wouter Bult

    Full Text Available PURPOSE: The increasing incidence of small renal tumors in an aging population with comorbidities has stimulated the development of minimally invasive treatments. This study aimed to assess the efficacy and demonstrate feasibility of multimodality imaging of intratumoral administration of holmium-166 microspheres ((166HoAcAcMS. This new technique locally ablates renal tumors through high-energy beta particles, while the gamma rays allow for nuclear imaging and the paramagnetism of holmium allows for MRI. METHODS: (166HoAcAcMS were administered intratumorally in orthotopic renal tumors (Balb/C mice. Post administration CT, SPECT and MRI was performed. At several time points (2 h, 1, 2, 3, 7 and 14 days after MS administration, tumors were measured and histologically analyzed. Holmium accumulation in organs was measured using inductively coupled plasma mass spectrometry. RESULTS: (166HoAcAcMS were successfully administered to tumor bearing mice. A striking near-complete tumor-control was observed in (166HoAcAcMS treated mice (0.10±0.01 cm(3 vs. 4.15±0.3 cm(3 for control tumors. Focal necrosis and inflammation was present from 24 h following treatment. Renal parenchyma outside the radiated region showed no histological alterations. Post administration CT, MRI and SPECT imaging revealed clear deposits of (166HoAcAcMS in the kidney. CONCLUSIONS: Intratumorally administered (166HoAcAcMS has great potential as a new local treatment of renal tumors for surgically unfit patients. In addition to strong cancer control, it provides powerful multimodality imaging opportunities.

  15. Specific heat of holmium and YNi{sub 2}B{sub 2}C. Criticalbehaviour and superconducting properties; Spezifische Waerme von Holmium und YNi{sub 2}B{sub 2}C. Kritisches Verhalten und supraleitende Eigenschaften

    Energy Technology Data Exchange (ETDEWEB)

    Bekkali, Abdelhakim

    2010-01-04

    Object of the thesis is the study of the specific heat of holmium and YNi{sub 2}B{sub 2}C in the temperature ranges from 50 to 200 KI respectively from 380 mK to 20 K in magnetic fields up to 9 T. In the present thesis the criticalbehaviour of YNi{sub 2}B{sub 2}C and properties of the superconducting state of tne non-magnetic rare-earth nickel borocarbide YNi{sub 2}B{sub 2}C are studied by means of a self-developed measurement apparatur of the specific heat using the quasi-adiabatic heating-pulse method as well as of holmium by means of the relaxation method. In this thesis reliable statements about the critical exponents on monocrystalline holmium could be made. The study on holmium proves that the critical behaviour of the specific heats cannot be described in the framework of the predictions of the chiral universality classes. By means of measurements of the specific heat in this thesis could be confirmed that YNi{sub 2}B{sub 2}C is a multiband superconductor. The positive curvature of the boundary line below T{sub c} in the phase diagram yields a first hint to the many-band character of YNI{sub 2}B{sub 2}C. In the zero-field the electronic specific heat in the superconducting state c{sub es}(T) can be not explained in the framework of the pure BCS theory. At low temperatures a residual contribution by normally conducting electrons could be detected, which hints to a not completely opened energy gap. A possible explanation would be that a band (or several bands) with low charge-carrier concentration not contribute to the superconductivity. This result agrees with de Haas-van Alphen measurements on isostructural superconducting LuNi{sub 2}B{sub 2}C monocrystals, which suggest the many-band character of the superconductivity as well as a vanishing energy gap in one band. The fluctuation behaviour of the specific heat of YNi{sub 2}B{sub 2}C in the neighbourhood of the superconducting-normally conducting transition agrees well with that of the 3D-XY model. [German

  16. Shifts in developmental timing, and not increased levels of experience-dependent neuronal activity, promote barrel expansion in the primary somatosensory cortex of rats enucleated at birth.

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    Ingrid Fetter-Pruneda

    Full Text Available Birth-enucleated rodents display enlarged representations of whiskers (i.e., barrels of the posteromedial subfield in the primary somatosensory cortex. Although the historical view maintains that barrel expansion is due to incremental increases in neuronal activity along the trigeminal pathway during postnatal development, recent evidence obtained in experimental models of intramodal plasticity challenges this view. Here, we re-evaluate the role of experience-dependent neuronal activity on barrel expansion in birth-enucleated rats by combining various anatomical methods and sensory deprivation paradigms. We show that barrels in birth-enucleated rats were already enlarged by the end of the first week of life and had levels of metabolic activity comparable to those in control rats at different ages. Dewhiskering after the postnatal period of barrel formation did not prevent barrel expansion in adult, birth-enucleated rats. Further, dark rearing and enucleation after barrel formation did not lead to expanded barrels in adult brains. Because incremental increases of somatosensory experience did not promote barrel expansion in birth-enucleated rats, we explored whether shifts of the developmental timing could better explain barrel expansion during the first week of life. Accordingly, birth-enucleated rats show earlier formation of barrels, accelerated growth of somatosensory thalamocortical afferents, and an earlier H4 deacetylation. Interestingly, when H4 deacetylation was prevented with a histone deacetylases inhibitor (valproic acid, barrel specification timing returned to normal and barrel expansion did not occur. Thus, we provide evidence supporting that shifts in developmental timing modulated through epigenetic mechanisms, and not increased levels of experience dependent neuronal activity, promote barrel expansion in the primary somatosensory cortex of rats enucleated at birth.

  17. Studies on therapeutic method of liver cancer(hapatocellular carcinome)by Holmium-166 radionuclide

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Yoo, H. S.; Kim, M. J.; Han, K. H.; Park, C. I. [Yonsei University Medical College, Seoul (Korea, Republic of)

    1997-07-01

    As the study of radioactive nuclide, Holmium-166 in the treatment of liver cancer(hepatocellular carcinoma), this study was performed under the base of animal experimental. Using dog liver, percutaneous injection of Ho-166 MAA or chitosan with premade dose was done under the ultrasound guidance. Continuously the same procedure as previous one was performed in the skin hapatoma, which was developed by the injection of hepatocellular carcinoma cell in the nude mouse, In case of injected normal liver of dog, imaging study including ultrasound, CT and MRI was done in order to evaluate effect of Ho-166 and pathologic reaction. The result showed well defined nectosis of normal liver as well as skin hepatoma. The area of nectosis is dependent on the dose of injected Ho-166. Generally, pathologic reaction is tissue coagulation nectosis, Ho-166 particles, fibrosis and hemorrhage. In the clinical study, 50 patients with hapatoma was selected for this study under the agreement of patient. Under ultrasound guidance percutaneous injection of Ho-166 Maa or chitosan to tumor was performed and follow-up study was extended from 6 to 12 month. The result showed that 64% of patient were completely treated. Overall, the effect of treatment could be obtained in 41 patient (82%) among 50 hepatoma patient. Conclusively Ho-166 is thought to be a compromising agent in the treatment of hepatocellular carcinoma and one of therapeutic modality, if it is established internally and world-wide. In the future, the popular percutaneous ethanol injection method will be replaced to this method. 19 refs., 1 tabs., 14 figs. (author)

  18. A comparative assessment of prosthetic outcome on enucleation and evisceration in three different etiological eye defects: A case series.

    Science.gov (United States)

    Jamayet, Nafij Bin; Kirangi, John Kariuki; Husein, Adam; Alam, Mohammad Khursheed

    2017-01-01

    Enucleation and evisceration are the most common surgical procedures that are performed to manage tumor, trauma, and infection. Given the consequences of surgical intervention, the conditions of the remaining eye socket may affect future prosthetic rehabilitation. A custom-made ocular prosthesis can be used to help restore the esthetics and functional defects and to improve the quality of life of patients with such conditions. An assessment must be performed on the prosthetic outcome before rehabilitation. The etiology of defect, type of surgery, condition of the remaining socket, and patient's age should all be considered. This report discusses three different etiological eye defects that have undergone enucleation and evisceration and describes the factors that have a significant role in the esthetic and functional outcome of the prosthesis. This report should serve as a helpful aid for maxillofacial prosthodontists to understand the primary objective of rehabilitating each eye defect and to meet patient expectations.

  19. Ankyrin and band 3 differentially affect expression of membrane glycoproteins but are not required for erythroblast enucleation.

    Science.gov (United States)

    Ji, Peng; Lodish, Harvey F

    2012-01-27

    During late stages of mammalian erythropoiesis the nucleus undergoes chromatin condensation, migration to the plasma membrane, and extrusion from the cytoplasm surrounded by a segment of plasma membrane. Since nuclear condensation occurs in all vertebrates, mammalian erythroid membrane and cytoskeleton proteins were implicated as playing important roles in mediating the movement and extrusion of the nucleus. Here we use erythroid ankyrin deficient and band 3 knockout mouse models to show that band 3, but not ankyrin, plays an important role in regulating the level of erythroid cell membrane proteins, as evidenced by decreased cell surface expression of glycophorin A in band 3 knockout mice. However, neither band 3 nor ankyrin are required for enucleation. These results demonstrate that mammalian erythroblast enucleation does not depend on the membrane integrity generated by the ankyrin-band 3 complex. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Learning curve for bipolar transurethral enucleation and resection of the prostate in saline for symptomatic benign prostatic hyperplasia: experience in the first 100 consecutive patients.

    Science.gov (United States)

    Xiong, Wei; Sun, Minghan; Ran, Qing; Chen, Fang; Du, Yangchun; Dou, Ke

    2013-01-01

    Bipolar transurethral enucleation and resection of the prostate in saline has recently been considered as a safe and technically feasible endoscopic procedure for symptomatic benign prostatic hyperplasia. However, it has not been accepted widely because of the perception of technical difficulty. A retrospective data review was performed of the first consecutive 100 patients who had undergone bipolar transurethral enucleation and resection of prostatic adenoma. Operative outcome, complications, ratio of conversion to conventional transurethral resection of the prostate and efficiency of tissue enucleation and resection were used to assess the learning curve. Bipolar transurethral enucleation and resection of the prostate was successfully performed in 83 patients. The mean operative time was 117.5 min, and the mean indwelling catheterization was 3.3 ± 1.9 days. After 6 months, maximum urinary flow was 21.34 ± 4.09 ml/s, IPSS was 9.66 ± 2.64, and quality of life was 2.31 ± 0.92 with a residual prostate volume of 35.29 ± 17.57 ml. Regarding the learning curve, the ratio of conversion to conventional bipolar transurethral resection of the prostate decreased after 30 cases, and the efficiency of enucleation and resection increased significantly with accumulative experience after 50 cases. The current results established that bipolar transurethral enucleation and resection of the prostate in saline is a safe and reproducible procedure. Copyright © 2012 S. Karger AG, Basel.

  1. Comparison of transurethral enucleation with bipolar and transurethral resection in saline for managing benign prostatic hyperplasia.

    Science.gov (United States)

    Hirasawa, Yosuke; Ide, Hiroki; Yasumizu, Yota; Hoshino, Katsura; Ito, Yujiro; Masuda, Takeshi

    2012-12-01

    Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Transurethral enucleation with bipolar (TUEB) has been widely adopted as an alternative to standard TURP, although the surgical technique, efficacy and safety of TUEB have not been described so far. The present study provides illustrations of the TUEB technique, as well as peri-operative, 6-month and 12-month follow-up results of TUEB from a retrospective review of a single-institution experience comparing the efficacy and safety of TUEB and transurethral resection in saline for managing BPH. • To illustrate the transurethral enucleation with bipolar (TUEB) technique and compare the efficacy and safety of TUEB and transurethral resection in saline (TURis) for managing benign prostatic hyperplasia (BPH). • A retrospective review of a single-institution experience of 110 consecutive TUEB or TURis between 2008 and 2011 at our hospital was performed aiming to compare the efficacy and safety of TUEB and TURis for managing BPH (55 patients in each group). • Peri-operative data included operating time, resected tissue weight, changes in haemoglobin, duration of catheterization, hospital stay and early complications. • Postoperative outcomes included 6- and 12-month postoperative International Prostate Symptom Score (IPSS), and Quality of Life (QoL) score, uroflowmetry findings, change in serum prostate-specific antigen level and all late complications in the two groups. • Both groups were well matched for age, preoperative prostate volume, IPSS, QoL and uroflowmetry findings. • The change in haemoglobin at postoperative day 1 in the TUEB group was significantly less than in the TURis group (1.08 vs 1.60 g/dL; P < 0.001). • Catheterization time and hospital stay were significantly shorter in the TUEB group than in the TURis group and the mean retrieved tissue weight in the TUEB group was larger than that in the TURis group (41.3 vs 31.7 g; P = 0

  2. Superiority of resection over enucleation for schwannomas of the cervical vagus nerve: A retrospective cohort study of 22 consecutive patients.

    Science.gov (United States)

    Illuminati, Giulio; Pizzardi, Giulia; Minni, Antonio; Masci, Federica; Ciamberlano, Bernardo; Pasqua, Rocco; Calio, Francesco G; Vietri, Francesco

    2016-05-01

    Schwannoma of the cervical vagus nerve is rare. Treatment options include intracapsular enucleation and en bloc resection. The purpose of this study was to compare the outcomes of enucleation and resection in terms of postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence, quality-adjusted life-year (QALY) and vocal handicap index (VHI). Twentytwo consecutive patients were divided into two groups. Patients in group A (n = 9) underwent intracapsular enucleation, whereas patients in Group B (n = 13) underwent en bloc resection. Main endpoints of the study were postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence and quality of life. The quality of life after surgery was assessed according to the quality-adjusted life-year (QALY) EQ-5D-5L methodology, and calculation of the voice handicap index (VHI). Postoperative mortality was nil. Morbidity included 1 wound dehiscence in group A and 2 transitory dysphagias in group B. Freedom from vocal cord palsy was 22% in group A and zero in group B (p = 0.15). Operation-specific local recurrence rate was 33% (3/9 patients) in group A and nil in group B (0/23 patients) (p = 0.05). QALYs was 0.55 in group A and 0.54 in group B (p = 1.0). VHI was 23.77 in group A and 26.15 in group B (p = 1.00). Resection is superior to enucleation in terms of freedom from local recurrence. Functional results are comparable for both techniques. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Evaluation of the learning curve for transurethral plasmakinetic enucleation and resection of prostate using a mentor-based approach

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    Lang Feng

    Full Text Available ABSTRACT Objective To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP prospectively. Materials and Methods Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA. Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist. Results The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002. The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01. The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001. Conclusions PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.

  4. Determination of some trace elements in food and soil samples by atomic absorption spectrometry after coprecipitation with holmium hydroxide.

    Science.gov (United States)

    Saracoglu, Sibel; Soylak, Mustafa; Cabuk, Dilek; Topalak, Zeynep; Karagozlu, Yasemin

    2012-01-01

    The determination of trace elements in food and soil samples by atomic absorption spectrometry was investigated. A coprecipitation procedure with holmium hydroxide was used for separation-preconcentration of trace elements. Trace amounts of copper(II), manganese(II), cobalt(II), nickel(ll), chromium(lll), iron(Ill), cadmium(ll), and lead(ll) ions were coprecipitated with holmium hydroxide in 2.0 M NaOH medium. The optimum conditions for the coprecipitation process were investigated for several commonly tested experimental parameters, such as amount of coprecipitant, effect of standing time, centrifugation rate and time, and sample volume. The precision, based on replicate analysis, was lower than 10% for the analytes. In order to verify the accuracy of the method, the certified reference materials BCR 141 R calcareous loam soil and CRM 025-050 soil were analyzed. The procedure was successfully applied for separation and preconcentration of the investigated ions in various food and soil samples. An amount of the solid samples was decomposed with 15 mL concentrated hydrochloric acid-concentrated nitric acid (3 + 1). The preconcentration procedure was then applied to the final solutions. The concentration of trace elements in samples was determined by atomic absorption spectrometry.

  5. Ankyrin and band 3 differentially affect expression of membrane glycoproteins but are not required for erythroblast enucleation

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Peng, E-mail: peng-ji@fsm.northwestern.edu [Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 (United States); Whitehead Institute for Biomedical Research, Cambridge, MA 02142 (United States); Lodish, Harvey F. [Whitehead Institute for Biomedical Research, Cambridge, MA 02142 (United States); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States)

    2012-01-27

    Highlights: Black-Right-Pointing-Pointer Ankyrin and band 3 are not required for erythroblasts enucleation. Black-Right-Pointing-Pointer Loss of ankyrin does not affect erythroid membrane glycoprotein expression. Black-Right-Pointing-Pointer Loss of band 3 influences erythroid membrane glycoprotein expression. -- Abstract: During late stages of mammalian erythropoiesis the nucleus undergoes chromatin condensation, migration to the plasma membrane, and extrusion from the cytoplasm surrounded by a segment of plasma membrane. Since nuclear condensation occurs in all vertebrates, mammalian erythroid membrane and cytoskeleton proteins were implicated as playing important roles in mediating the movement and extrusion of the nucleus. Here we use erythroid ankyrin deficient and band 3 knockout mouse models to show that band 3, but not ankyrin, plays an important role in regulating the level of erythroid cell membrane proteins, as evidenced by decreased cell surface expression of glycophorin A in band 3 knockout mice. However, neither band 3 nor ankyrin are required for enucleation. These results demonstrate that mammalian erythroblast enucleation does not depend on the membrane integrity generated by the ankyrin-band 3 complex.

  6. Melanocortins contribute to sequential differentiation and enucleation of human erythroblasts via melanocortin receptors 1, 2 and 5.

    Directory of Open Access Journals (Sweden)

    Eriko Simamura

    Full Text Available In this study, we showed that adrenocorticotropic hormone (ACTH promoted erythroblast differentiation and increased the enucleation ratio of erythroblasts. Because ACTH was contained in hematopoietic medium as contamination, the ratio decreased by the addition of anti-ACTH antibody (Ab. Addition of neutralizing Abs (nAbs for melanocortin receptors (MCRs caused erythroblast accumulation at specific stages, i.e., the addition of anti-MC2R nAb led to erythroblast accumulation at the basophilic stage (baso-E, the addition of anti-MC1R nAb caused accumulation at the polychromatic stage (poly-E, and the addition of anti-MC5R nAb caused accumulation at the orthochromatic stage (ortho-E. During erythroblast differentiation, ERK, STAT5, and AKT were consecutively phosphorylated by erythropoietin (EPO. ERK, STAT5, and AKT phosphorylation was inhibited by blocking MC2R, MC1R, and MC5R, respectively. Finally, the phosphorylation of myosin light chain 2, which is essential for the formation of contractile actomyosin rings, was inhibited by anti-MC5R nAb. Taken together, our study suggests that MC2R and MC1R signals are consecutively required for the regulation of EPO signal transduction in erythroblast differentiation, and that MC5R signal transduction is required to induce enucleation. Thus, melanocortin induces proliferation and differentiation at baso-E, and polarization and formation of an actomyosin contractile ring at ortho-E are required for enucleation.

  7. Direct fixation of extraocular muscles to a silicone sphere: a cost-sensitive, low-risk enucleation procedure.

    Science.gov (United States)

    Wells, Timothy S; Harris, Gerald J

    2011-01-01

    To describe a simple, cost-sensitive enucleation technique and to evaluate it in the context of intended benefits and long-term outcomes of alternate methods. A retrospective record review of patients who underwent enucleation using the described technique at a single institution by 2 surgeons. Surgery involved direct fixation of extraocular muscles to a solid silicone sphere, using nonabsorbable braided sutures with knots tied beneath the muscle insertions. Outcome measures included implant-related complications. Seventy-five patients meeting inclusion criteria ranged in age from 3 to 94 years (mean, 54 years; median, 56 years). Surgical indications included a blind painful or disrupted eye in 56 cases; uveal melanoma in 15 cases; retinoblastoma in 2 cases; and endophthalmitis in 2 cases. Follow-up intervals ranged from 3 to 57 months (mean, 27 months; median, 22 months). Complications requiring surgical revision of the implant occurred in 2 of the 75 cases (one luxation; one exposure). There were no instances of chronic socket discharge or implant infection. Nonabsorbable-suture attachment of muscles to a solid silicone implant offers an inexpensive enucleation option, with minimal risk of implant migration, exposure, or infection. In light of widespread disaffection with pegging of porous implants, and with no motility advantage of unpegged porous over nonporous implants, consideration should be given to techniques that are equally effective, less costly, and perhaps more reliable.

  8. A case of lipoma of lateral anterior neck treated with surgical enucleation

    Directory of Open Access Journals (Sweden)

    Francesco Grecchi

    2012-01-01

    Full Text Available Lipoma arise in almost 50% of all soft tumours. The neck lipomas are rare tumours that may present as painless masses with slow growth, in the lateral portions of the neck. Some lipomas, such as the one studied in our case, grow deep in the subcutaneous tissue, in close contact with muscles. Here, we report a case of lipoma extending from pre-tragal region up to the ascending branch of the mandible in a 62 year old man, treated with enucleation. The inferior margin of lipoma involved the pharyngeal and the superior margin was achieved by the top of the skull base. The mass of lipoma caused breathing difficulties in the patient, preventing regular sleep. No complication was recorded in the post-operative period and no further surgery was performed. The complete resolution after one year′s follow-up, together with the rarity of the anatomical site, makes this case worthy of description. A correct diagnosis facilitated removal of this lesion with a surgical method.

  9. Orbital and Subcutaneous Emphysema Following Enucleation and Respiratory Distress in a Japanese Chin.

    Science.gov (United States)

    Gornik, Kara R; Pirie, Christopher G; Alario, Anthony F

    2015-01-01

    A 7 yr old, neutered male Japanese chin presented to the Cummings School of Veterinary Medicine at Tufts University (CSVMTU) for evaluation of chronic unilateral orbital swelling that worsened following an episode of respiratory distress. The left eye had been enucleated 5 yr previously. Intermittent mild-to-moderate left orbital swelling had been noted by the owner since the initial surgery. Examination demonstrated a moderate-to-severe, soft, fluctuant swelling involving the left orbit with erythema of the overlying skin. Crepitus was noted over the occipital tuberosity. Computed tomography revealed a large volume of gas involving the left orbit. The gas extended caudally within the subcutaneous tissues to both hemimandibles, dorsal to the cranium, and partially surrounded the cranial neck. The presence of a mucosa-lined, air-filled space with a patent nasolacrimal duct was noted on orbital exploration. The lining was removed and the duct closed. Histopathology confirmed the presence of an epithelial lining. No recurrence of the swelling was observed on examination 8 wk after surgery. This is the first report documenting acute worsening of orbital swelling following an episode of respiratory distress. This case highlights the importance of addressing the nasolacrimal duct while performing an enculeation in a brachycephalic dog.

  10. Comparison of fluid absorption between transurethral enucleation and transurethral resection for benign prostate hyperplasia.

    Science.gov (United States)

    Ran, Longfei; He, Weiyang; Zhu, Xin; Zhou, Qingsong; Gou, Xin

    2013-01-01

    Although transurethral resection of prostate (TURP) remains the reference standard for benign prostate hyperplasia (BPH), the concern about complications promotes researchers to develop alternative surgical methods with fewer complications. In this study, we compared the safety and efficacy between the transurethral plasma kinetic enucleation of prostate (TUPKEP) and transurethral plasma kinetic resection of prostate (TUPKRP), mainly including absorption of irrigation fluid, the operation time, the weight of prostate tissue removed and severe complications. Sixty BPH patients were randomly and evenly assigned to the TUPKEP or TUPKRP group. The irrigation fluid used in both groups was 1% ethanol-containing saline solution. The ethanol concentrations in the subjects' end expiration were measured during operation. The volume of irrigation fluid absorbed was calculated accordingly. No significant difference was found in operation time between two groups, whereas the weight of prostate tissue resection was significantly higher in the TUPKEP than that in the TUPKRP group. The study provides evidence for the safety, feasibility and effectiveness of both bipolar transurethral techniques. Further, compared to the TUPKRP group, the TUPKEP group has more efficient for resection of prostatic hyperplasia tissue, even though in terms of fluid absorption, no difference has been found in both groups. Ethanol monitoring is simple, safe and effective, which is beneficial for enhancing safety procedures. Copyright © 2013 S. Karger AG, Basel.

  11. Autogenous Partial Bone Chip Grafting on the Exposed Inferior Alveolar Nerve After Cystic Enucleation.

    Science.gov (United States)

    Seo, Mi Hyun; Eo, Mi Young; Cho, Yun Ju; Kim, Soung Min; Lee, Suk Keun

    2017-10-26

    This prospective study evaluated the clinical effectiveness of the new approach of partial autogenous bone chip grafts for the treatment of mandibular cystic lesions related to the inferior alveolar nerve (IAN). A total of 38 patients treated for mandibular cysts or benign tumors were included in this prospective study and subsequently divided into 3 groups depending on the bone grafting method used: cystic enucleation without a bone graft (group 1), partial bone chip graft covering the exposed IAN (group 2), and autogenous bone graft covering the entire defect (group 3). We evaluated the symptoms, clinical signs, and radiographic changes using dental panorama preoperatively, immediate postoperatively, and at 1, 3, 6, and 12 months postoperatively. Radiographic densities were compared using Adobe Photoshop CS5 (Adobe Systems Inc., San Jose, CA). Repeated measures analysis of variance was used for statistical evaluation with SPSS 22.0 (SPSS Inc, Chicago, IL), and P < 0.05 was considered statistically significant.Radiopacities were the most increased at 1 year postoperative in group 3; groups 2 and 3 did not show statistically significant differences, whereas groups 1 and 3 were statistically significant. In terms of radiographic bone healing with clinical regeneration of the exposed IAN, healing occurred in all patients, although the best healing was achieved in group 2.This autogenous partial bone chip grafting procedure to cover the exposed IAN is suggested as a new surgical protocol for the treatment of cystic lesions associated with the IAN.

  12. Histopathology of enucleated intraocular melanomas irradiated with cobalt and ruthenium plaques

    Energy Technology Data Exchange (ETDEWEB)

    Fuchs, U.; Kivelae, T.; Tarkkanen, A.; Laatikainen, L.

    1988-01-01

    Eight malignant uveal melanomas irradiated with Stallard's /sup 60/Co applicator or Lommatzsch's /sup 106/Ru//sup 10/ /sup 6/Rh applicator were studied by light microscopy and immunohistochemistry to analyse tumour cell morphology, antigenic expression and inflammatory cell infiltration in relation to radiation dose. The tumours were enucleated 1 to 24 months after irradiation because they did not regress or continued to grow. One patient has later died of metastatic disease. Eight uveal melanomas that were not irradiated were studied for comparative purposes. Radiation necrosis was found only in two cases. In four irradiated and in one control melanoma conspicuous collagen fibres were present in the basal part of the tumour. No difference was noted between the two groups in the number of mitotic figures or in the morphology of tumour cells. In all cases but one, more than half of the tumour cells were variably positive for S-100 protein. Neutron-specific enolase-positive melanoma cells were few in number and occurred in small clusters, and were somewhat more common in irradiated cases. A few lymphocytes and macrophages, which were preferentially found near the choroid, infiltrated every melanoma, but only single cells were associated with radiation necrosis. A mild scleritis near the tumour was present irrespective of irradiation. Although the melanomas were quite large for irradiation, the lack of necrosis in optimally irradiated basal parts of the tumour additionally indicates substantial radioresistance.

  13. Preparation, Irradiation and Clinical Use of Holmium Containing Microspheres Obtained by Neutron Irradition in TRIGA Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Sedda, A.F.; Rossi, G. [UTTMAT-IRR, ENEA Casaccia, Rome (Italy)

    2011-07-01

    A radioactive composition for use in therapy, containing radioisotopes immobilized on biocompatible and bioabsorbable poly(lactic acid)-based microspheres was prepared, and internationally patented. A 10% of an holmium organic complex was previously embedded within the matrix of the microspheres, that were successively irradiated in a TRIGA reactor for 1- to 3 hours 2 hours at a flux of 1,25.10{sup 13} n cm{sup -2} s{sup -1}, obtaining a total activity of 5-200 mCi of {sup 166}Ho per irradiation. The irradiated microspheres were certified sterile at the end of the irradiation, due to the gamma and neutron flux of the reactor. The radioactive microsphere were dispersed in a biocompatible and bioabsorbable matrix consisting of a hypotonic gel, and were used in the therapy of neoplastic diseases, by application of radioactive sources in direct contact with the tumor tissues or within the same (brachytherapy). Patients with II and III grade glioblastoma multiforme were treated, by hypodermic injection in the Ommaya reservoir placed under the patient's scalp, visualising the introduction of the microparticle-containing gel in the brain cavity by computed tomography (CT) and gamma scintigraphy. It has thus been ascertained that the introduced substance forms, at the outset, an approximately spherical deposit, and that the gel is later gradually absorbed in the surrounding tissue, thus leaving the dispersed radioactive particles in contact with all of the interstices of the brain cavity. Patients with solid hepatic or splenic tumours, that were considered untreatable by surgery due to bad general conditions or advanced age, have been treated by injecting intratissue the microspheres in the tumour lesions, under stereotaxy and ultrasound or radiographic visualisation. Patients with solid hepatic, adrenal or renal tumours, that were considered untreatable by surgery due to bad general conditions or advanced age, have been treated by injecting intra-arterially the

  14. Carbon Nanotube Mode-Locked Thulium Fiber Laser With 200 nm Tuning Range.

    Science.gov (United States)

    Meng, Yafei; Li, Yao; Xu, Yongbing; Wang, Fengqiu

    2017-03-21

    We demonstrated a mode-locked thulium/holmium (Tm/Ho) fiber laser continuously tunable across 200 nm (from 1860 nm to 2060 nm), which to the best of our knowledge represents the widest tuning range ever achieved for a passively mode-locked fiber laser oscillator. The combined use of a broadband carbon nanotube (CNT) saturable absorber and a diffraction grating mirror ensures ultra-broad tuning range, superb stability and repeatability, and makes the demonstrated laser a highly practical source for spectroscopy, imaging and optical communications. The laser emits <5 ps pulses with an optical spectral bandwidth of ∼3 nm across the full tuning range. Our results indicate that carbon nanotubes can be an excellent saturable absorber for achieving gain-bandwidth-limited tunable operation for 2 μm thulium fiber lasers.

  15. Carbon Nanotube Mode-Locked Thulium Fiber Laser With 200 nm Tuning Range

    Science.gov (United States)

    Meng, Yafei; Li, Yao; Xu, Yongbing; Wang, Fengqiu

    2017-03-01

    We demonstrated a mode-locked thulium/holmium (Tm/Ho) fiber laser continuously tunable across 200 nm (from 1860 nm to 2060 nm), which to the best of our knowledge represents the widest tuning range ever achieved for a passively mode-locked fiber laser oscillator. The combined use of a broadband carbon nanotube (CNT) saturable absorber and a diffraction grating mirror ensures ultra-broad tuning range, superb stability and repeatability, and makes the demonstrated laser a highly practical source for spectroscopy, imaging and optical communications. The laser emits indicate that carbon nanotubes can be an excellent saturable absorber for achieving gain-bandwidth-limited tunable operation for 2 μm thulium fiber lasers.

  16. Transurethral Bipolar Enucleation of the Prostate Is an Effective Treatment Option for Men With Urinary Retention.

    Science.gov (United States)

    Tracey, James M; Warner, Jonathan N

    2016-01-01

    To evaluate outcomes of transurethral bipolar enucleation (TuBE) of the prostate in patients with refractory lower urinary tract symptoms. A retrospective analysis was performed on patients who underwent TuBE from July 2014 to March 2015. Perioperative factors evaluated included International Prostate Symptom Score, Sexual Health Inventory for Men score, prostate-specific antigen, postvoid residual volume, transrectal ultrasound volume measurement, estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 6 weeks and 3 months. Forty-nine patients were identified. Mean age was 67 years and mean follow-up was 4.4 months. Twenty-eight patients (57%) were in retention. Preoperative, 6-week, and 3-month mean postvoid residual volumes were 278 mL, 66 mL, and 87 mL (P < .01); mean International Prostate Symptom Scores were 22, 9, and 8 (P  <  .01); mean quality of life scores were 5.0, 1.9, and 1.9; and Sexual Health Inventory for Men scores were 7.1, 8.4, and 7.0 (P = .35), respectively. Twenty-eight patients (57%) were able to have erections preoperatively and were still able to postoperatively. All (100%) of the patients in retention were able to void postoperatively. Mean operative time was 93 minutes, estimated blood loss was 49 mL, and pathologic weight was 18 g. Urinary tract infection occurred in 3 patients (6%), urethral stricture in 1 (2%), and bladder neck contracture in 2 (4%). Mean prostate-specific antigen decreased from 3.2 ng/dL to 0.9 ng/dL at 3 months (P < .01). TuBE is an effective operation for refractory urinary tract symptoms including those who are in urinary retention. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Early outcome of transurethral enucleation and resection of the prostate versus transurethral resection of the prostate.

    Science.gov (United States)

    Palaniappan, Sundaram; Kuo, Tricia Li Chuen; Cheng, Christopher Wai Sam; Foo, Keong Tatt

    2016-12-01

    Recurrent prostate adenoma is a long-term complication following transurethral resection of the prostate (TURP). Transurethral enucleation and resection of the prostate (TUERP) is more appealing, since the nodular adenoma can be completely removed through endoscopy. TUERP is also hypothesised to result in a lower frequency of recurrent adenoma. This study aimed to compare the early outcomes of TUERP and TURP, and assess the feasibility and safety of TUERP. We compared the outcome of 81 patients who underwent TUERP with that of 85 patients who underwent TURP. International prostate symptom score, quality of life score, prostate volume, degree of intravesical prostatic protrusion, maximum flow rate, post-void residual volume and prostate-specific antigen (PSA) level were obtained pre- and postoperatively. Complications (e.g. transfusion rate, incontinence, infection and urethral stricture) were analysed. Operative time was significantly longer in the TUERP group compared to the TURP group (85.3 minutes vs. 51.6 minutes). After TUERP, the maximum flow rate was significantly higher (21.1 mL/s vs. 17.1 mL/s) and PSA level was significantly lower (1.2 ng/mL vs. 1.9 ng/mL) than after TURP. The rates of infection, transfusion and urethral stricture were similar for both groups, but the TUERP group had a higher rate of temporary incontinence (13.6% vs. 4.7%). The lower PSA level and better maximum flow rate achieved following TUERP suggest that prostate adenoma removal was more complete with TUERP. Long-term follow-up is required to establish whether TUERP results in fewer resections for recurrent adenoma.

  18. Factors involved in the occurrence of bleeding complications after enucleation for cornea donation.

    Science.gov (United States)

    van Wijk, Marja J; Nijenhuis, Matthijs V; Dorrepaal, Caroline A; Bokhorst, Arlinke G

    2009-10-01

    To identify risk factors for the occurrence of bleeding complications after enucleation for cornea donation, in order to develop preventive activities to reduce the occurrence of bleeding complications and especially the development of ocular hematomas. From all Dutch cornea donors deceased in the year 2006, donor characteristics, retrieval characteristics, and bleeding complication data were collected. First, univariate relations between donor and retrieval factors and bleeding complications were determined. Then, multivariate logistic regression analysis was used to identify factors significantly associated with bleeding complications. In 114 of the 1173 cornea donors (9.7%), bleeding complications occurred, with ocular hematomas developing in 39 (3.3% of all cornea donors). Donor factors significantly associated with bleeding complications were age [odds ratio (OR) 0.96 (95% CI 0.94-0.97)], weight [OR 1.03 (1.02-1.04)], heart failure [OR 2.10 (1.12-3.94)], thrombocyte aggregation inhibitor use [OR 1.64 (1.02-2.64)], and chronic alcoholic liver disease [OR 2.85 (1.11-7.31)]. The most significant factor associated with bleeding complications was the retrieval sequence. If cornea donation was followed by any other tissue retrieval, the risk of bleeding complications was strongly increased. : This study shows that the tissue retrieval sequence in multitissue donors is the most important factor associated with the occurrence of bleeding complications. The risk of bleeding and ocular hematoma is lower if cornea donation is performed after all other retrievals. However, if the tissue retrieval sequence is altered, the effect of prolonged postmortem time on corneal quality must be taken into account.

  19. Intraoperative arrhythmias and tissue damage during transmyocardial laser revascularization.

    Science.gov (United States)

    Kadipaşaoglu, K A; Sartori, M; Masai, T; Cihan, H B; Clubb, F J; Conger, J L; Frazier, O H

    1999-02-01

    Transmyocardial laser revascularization creates transmural channels to improve myocardial perfusion. Different laser sources and ablation modalities have been proposed for transmyocardial laser revascularization. We investigated the incidence of cardiac arrhythmias and laser-tissue interactions during transmyocardial laser revascularization of normal porcine myocardium with three different lasers. We used a continuous-wave, chopped CO2 laser (20 J/pulse, 15 ms/pulse) synchronized with the R wave; a holmium:yttrium aluminum garnet (Ho:YAG) laser (2 J/pulse, 250 micros/pulse, 5 Hz); and a xenon-chloride (excimer, Xe:Cl) laser (35 mJ/pulse, 20 ns/pulse, 30 Hz). Each laser was used 30 times as the sole modality in four consecutive pigs, yielding 120 channels. The average number of pulses needed to create a channel was 1, 11 +/- 4, and 37 +/- 8 for the CO2, Ho:YAG, and Xe:Cl lasers, respectively. All Ho:YAG and Xe:Cl channels had premature ventricular contractions. Ventricular tachycardia occurred in 70% of the Xe:Cl and 60% of the Ho:YAG channels. Only 36% of the CO2 channels had premature ventricular contractions, and only 3% of the CO2 channels had ventricular tachycardia (p CO2 channels were straight and well demarcated. The zone of structural and thermal damage extended over half the channel's diameter, measuring 0.52 +/- 0.25 mm. During transmyocardial laser revascularization, the CO2 laser synchronized with the R wave is significantly less arrhythmogenic than the Ho:YAG and Xe:Cl lasers not synchronized with the R wave. In addition, the interaction of the CO2 laser with porcine cardiac tissue is significantly less traumatic than that of the Ho:YAG and the Xe:Cl lasers.

  20. Hyperfine-interaction-driven suppression of quantum tunneling at zero field in a holmium(III) single-ion magnet

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yan-Cong; Liu, Jun-Liang; Chen, Xiao-Ming; Tong, Ming-Liang [Key Lab. of Bioinorganic and Synthetic Chemistry of Ministry of Education, School of Chemistry, Sun Yat-Sen Univ., Guangzhou (China); Wernsdorfer, Wolfgang [Institut Neel, CNRS and Universite Joseph Fournier, Grenoble (France); Institute of Nanotechnology, Karlsruhe Institute of Technology (Germany); Physikalisches Institut, Karlsruhe Institute of Technology (Germany); Liu, Dan; Chibotaru, Liviu F. [Theory of Nanomaterials Group and INPAC-Institute of Nanoscale Physics and Chemistry, Katholieke Universiteit Leuven (Belgium)

    2017-04-24

    An extremely rare non-Kramers holmium(III) single-ion magnet (SIM) is reported to be stabilized in the pentagonal-bipyramidal geometry by a phosphine oxide with a high energy barrier of 237(4) cm{sup -1}. The suppression of the quantum tunneling of magnetization (QTM) at zero field and the hyperfine structures originating from field-induced QTMs can be observed even from the field-dependent alternating-current magnetic susceptibility in addition to single-crystal hysteresis loops. These dramatic dynamics were attributed to the combination of the favorable crystal-field environment and the hyperfine interactions arising from {sup 165}Ho (I=7/2) with a natural abundance of 100 %. (copyright 2017 Wiley-VCH Verlag GmbH and Co. KGaA, Weinheim)

  1. Radiotherapeutic bandage based on electrospun polyacrylonitrile containing holmium-166 iron garnet nanoparticles for the treatment of skin cancer.

    Science.gov (United States)

    Munaweera, Imalka; Levesque-Bishop, Daniel; Shi, Yi; Di Pasqua, Anthony J; Balkus, Kenneth J

    2014-12-24

    Radiation therapy is used as a primary treatment for inoperable tumors and in patients that cannot or will not undergo surgery. Radioactive holmium-166 ((166)Ho) is a viable candidate for use against skin cancer. Nonradioactive holmium-165 ((165)Ho) iron garnet nanoparticles have been incorporated into a bandage, which, after neutron-activation to (166)Ho, can be applied to a tumor lesion. The (165)Ho iron garnet nanoparticles ((165)HoIG) were synthesized and introduced into polyacrylonitrile (PAN) polymer solutions. The polymer solutions were then electrospun to produce flexible nonwoven bandages, which are stable to neutron-activation. The fiber mats were characterized using scanning electron microscopy, transmission electron microscopy, powder X-ray diffraction, Fourier transform infrared spectroscopy, thermogravimetric analysis and inductively coupled plasma mass spectrometry. The bandages are stable after neutron-activation at a thermal neutron-flux of approximately 3.5 × 10(12) neutrons/cm(2)·s for at least 4 h and 100 °C. Different amounts of radioactivity can be produced by changing the amount of the (165)HoIG nanoparticles inside the bandage and the duration of neutron-activation, which is important for different stages of skin cancer. Furthermore, the radioactive bandage can be easily manipulated to irradiate only the tumor site by cutting the bandage into specific shapes and sizes that cover the tumor prior to neutron-activation. Thus, exposure of healthy cells to high energy β-particles can be avoided. Moreover, there is no leakage of radioactive material after neutron activation, which is critical for safe handling by healthcare professionals treating skin cancer patients.

  2. Evaluation of the Learning Curve for Transurethral Plasmakinetic Enucleation and Resection of Prostate Using a Mentor-based Approach.

    Science.gov (United States)

    Feng, Lang; Song, Jian; Zhang, Daoxin; Tian, Ye

    2017-01-01

    To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively. Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist. The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002). The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (penucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month's parameter compared with preoperative values (p<0.001). PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results. Copyright® by the International Brazilian Journal of Urology.

  3. A unique case of facial burn superinfected with Dermatobia Hominis larvae resulting in a bilateral enucleation of the eyes.

    Science.gov (United States)

    Pinos, Victor Hugo; Ortiz-Prado, Esteban; Bermeo, Carlos; León, Juan; Armijos, Luciana; Almeida, Estibaliz

    2014-10-01

    We present a case of a female Ecuadorian patient who presented a deep facial burn injury complicated with a severe infestation of Dermatobia Hominis larvae. The burn injury was complicated by severe myiasis attributable to the poor management of the wound received at home, using tropical plants, which caused a secondary infection and severe necrosis of the tissue involving the forehead, cheeks, chin, scalp, nose, mouth and the eyes resulting in a bilateral enucleation and long inpatient hospital care. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy

    Directory of Open Access Journals (Sweden)

    Mostafa Khalil

    2013-01-01

    Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.

  5. Prosthetic Rehabilitation Following Socket Reconstruction with Blair-Brown Graft and Conformer Therapy for Management of Severe Post-Enucleation Socket Syndrome--A Clinical Report.

    Science.gov (United States)

    Aggarwal, Himanshi; Singh, Saumyendra V; Kumar, Pradeep; Kumar Singh, Arun

    2015-06-01

    One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patient's life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects. © 2014 by the American College of Prosthodontists.

  6. Efficacy of transurethral prostate enucleation by bipolar system for patients with benign prostatic hyperplasia.

    Science.gov (United States)

    Sato, Katsuhiko; Obinata, Daisuke; Funakoshi, Daigo; Saito, Fuminori; Takada, Shogo; Ito, Akiko; Murata, Yasutaka; Ashikari, Daisaku; Ikado, Yuichiro; Igarashi, Tomohiro; Matsui, Tsuyoshi; Mochida, Junichi; Yamanaka, Yataro; Yamaguchi, Kenya; Takahashi, Satoru

    2016-08-01

    The aim of this paper was to evaluate the efficacies and safety of transurethral prostate enucleation by bipolar system (TUEB) for the patients with benign prostatic hyperplasia (BPH). We prospectively evaluated clinical outcomes of TUEB in 55 patients with BPH from July 2005 to January 2011. Mean ages of the patients were 69.2 years. International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QOL) were assessed before and 12 months after surgery. Serum PSA, maximal flow rate (MFR), and post-void residual (PVR) were also evaluated before and 6 and 12 months after surgery. The median prostate volumes and resection volumes were 64.1 g (interquartile range [IQR]: 48-87) and 34.4 g (25-60.2), respectively. The median operation time was 138.0 min (100.2-169.2). Total IPSS scores and IPSS-QOL were significantly improved (from 24 [17-31] to 5 [2-8] points, and from 6 [5-6] to 2 [1-2] points, both P<0.001). MFR and PVR were significantly improved 6 and 12 months after TUEB (from 6.2 [3.9-8.3] to 15.1 [10.5-20.9], and 14.6 [10.2-20.5] mL/s, P<0.0001, and from 151.5 [81.5-284.7] to 16.5 [0-30.5], and 6.0 [0-41.0] mL, P<0.0001, respectively). Serum PSA also significantly decreased, 6 and 12 months (from 7.5 [4.7-9.8] to 1.1 [0.5-1.5], and 0.6 [0.3-1.9] ng/mL, P<0.0001). Although hemoglobin decreased after operation, no case experienced blood transfusion. Three episodes of urinary tract infections, 14 cases of mild stress urinary incontinence, 2 cases of urinary retention were occurred transiently with recovery within 1 month after surgery. We identified favorable efficacy and safety of TUEB. TUEB appears to be another possibility in the treatment of BPH.

  7. YAG lasers in restorative dentistry: a histological investigation

    Science.gov (United States)

    Koort, Hans J.; Frentzen, Matthias

    1992-06-01

    An important indicator to prove the effectiveness of laser radiation and to control the side effects are histological studies of dental hard tissues. In our study, different pulsed, rare earth doped YAG-laser systems in the range from 1 micrometers to 3 micrometers were investigated. An improved plastic embedding technique based on a penetrating uv-activated PMMA-medium was developed to cut undecalcified sections of 15 micrometers thickness. The Nd:YAG laser showed wide zones of necrosis but little carbonization. The radiation of Holmium and Thullium-doped YAG lasers causes strong but well-defined zones of carbonization comparable to those of pulsed (ms) CO2 lasers. The Erbium-doped YAG-laser was the most effective system. As predominant side effects, residual zones of debris and microcracks were observed. In deeper cavities, the zones of damages increase. The side effects of the pulsed infrared laser types seem to be mainly influenced by the physical or chemical properties of the dental tissues and not by the selected laser parameters.

  8. Hysteroscopic enucleation in toto of submucous type 2 myomas: long-term follow-up in women affected by menorrhagia.

    Science.gov (United States)

    Saccardi, Carlo; Conte, Lorena; Fabris, Alberta; De Marchi, Francesca; Borghero, Angela; Gizzo, Salvatore; Litta, Pietro

    2014-01-01

    To evaluate long-term efficacy of type 2 myoma enucleation in toto. Longitudinal retrospective study (Canadian Task Force classification II-2). University obstetrics and gynecology clinic. One hundred twelve women with menorrhagia and at least 1 type 2 submucous myoma who underwent hysteroscopic myoma enucleation in toto. Clinical long-term follow-up. Success of the procedure and influence of myoma characteristics on recurrence of menorrhagia were evaluated. Mean (SD) follow-up was 58.4 (19.1) months. The success of the procedure was 88.4% (99 patients). Seventeen patients (15.2%) underwent a 2-step procedure. Among patients with relapsed menorrhagia, 10 (8.9%) underwent a repeat operation. Statistical analysis showed that number and diameter of myomas did not influence the outcome. Localization in the posterior wall of the uterus, compared with other sites, was associated with a higher percentage of resolution of menstrual symptoms (p = .03). There was no significant relationship between myomas features and risk of symptom recurrence during follow-up. The 2-step myomectomy was performed in patients with myomas >30 mm in diameter (p menorrhagia. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  9. Adverse events resulting from lasers used in urology.

    Science.gov (United States)

    Althunayan, Abdulaziz M; Elkoushy, Mohamed A; Elhilali, Mostafa M; Andonian, Sero

    2014-02-01

    To collate world reports of adverse events (AEs) resulting from lasers used in urology. The Manufacturer and User Facility Device Experience (MAUDE) database of the United States Food and Drug Administration (FDA) was searched using the term "Laser for gastro-urology use." In addition, the Rockwell Laser Industries (RLI) Laser Accident Database was searched for the following types of lasers: neodymium-doped yttrium aluminum garnet (Nd:YAG), holmium:yttrium aluminum garnet (Ho:YAG), potassium titanyl phosphate (KTP), diode and thulium:YAG (Tm:YAG). Both databases were last accessed on October 1, 2012. Overall, there were 433 AEs; 166 in MAUDE database (1992-2012) and 267 in RLI database (1964-2005). Most of the AEs (198/433 or 46%) resulted from generator failure or fiber tip breaking. Whereas there were 20 (4.6%) AEs harming medical operators, there were 159 (37%) AEs harming nonmedical operators using Nd:YAG, KTP, and diode lasers. Eye injuries ranging from mild corneal abrasions to total vision loss were reported in 164 AEs with the use of Nd:YAG, KTP, and diode lasers. Overall, there were 36 (8.3%) AEs resulting in patient harm, including 7 (1.6%) mortalities, 3 deaths from ureteral perforation using the Ho:YAG laser, and 4 deaths from air emboli using the Nd:YAG laser. Other reported patient injuries included bladder perforation resulting in urinary diversion in a patient, in addition to minor skin burns, internal burns, and bleeding in others. There were no AEs reported with the use of Tm:YAG laser. Most of the AEs reported relate to equipment failure. There were no eye injuries reported with the use of Ho:YAG lasers. Caution must be exercised when using lasers in urology, including wearing appropriate eye protection when using Nd:YAG, KTP, and diode lasers.

  10. Bipolar Plasma Enucleation of the Prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment: 3-Year Results.

    Science.gov (United States)

    Giulianelli, Roberto; Gentile, Barbara Cristina; Mirabile, Gabriella; Albanesi, Luca; Tariciotti, Paola; Rizzo, Giorgio; Buscarini, Maurizio; Falavolti, Cristina

    2017-09-01

    To investigate numerous endoscopic techniques that have been described for the treatment of benign prostate enlargement. Plasma-button enucleation of the prostate (B-TUEP) is a successful treatment option because the large surface creates a fast enucleation process, vaporization, and concomitant hemostasis. The aim of this study was to evaluate the efficacy of bipolar button electrode transurethral adenoma enucleation (B-TUEP) in saline solution. The second end point was to determine the change of International Prostate Symptom Score (IPSS), post-void residual urine, International Index of Erectile Function, transrectal ultrasound gland volume evaluation, and prostate-specific antigen. Between July 2011 and March 2012, 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). All patients were preoperatively assessed with maximum urinary flow rate, single-question quality of life assessment, IPSS and the International Index of Erectile Function questionnaires, transrectal ultrasound gland volume evaluation, prostate-specific antigen, and post-void residual urine. We observed a significant improvement at 12, 24, and 36 months in terms of maximum urinary flow rate (22.3 ± 4.74 mL/s, 23.2 ± 0.30 mL/s, and 23.6 ± 1.26 mL/s, respectively, P prostate-specific postoperative antigen levels were 0.76 ± 0.61 ng/mL, 0.7 ± 0.51 ng/mL, and 0.62 ± 0.18 ng/mL, at 12, 24, and 36 months, respectively. Two patients (4%) had persistent bladder outlet obstruction requiring reoperation. After 3-year follow-up, B-TUEP represents an effective, durable, and safe form of surgical intervention. B-TUEP is an alternative treatment for symptomatic benign prostate enlargement. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Extrascleral extension of choroidal melanoma: post-enucleation high-dose-rate interstitial brachytherapy of the orbit.

    Science.gov (United States)

    Finger, Paul T; Tena, Lawrence B; Semenova, Ekaterina; Aridgides, Paul; Choi, Walter H

    2014-01-01

    To investigate if orbital extension of uveal melanoma can be treated with high-dose-rate (HDR) brachytherapy. This study is a retrospective analysis of the results of a clinical case series was performed on 10 patients. Each underwent primary enucleation for uveal melanoma, was discovered to have orbital extension, and consented for HDR brachytherapy. By American Joint Committee on Cancer (AJCC) initial tumor grading, there was one each (T1c, T2c, T2d, and T3d, three T4c, and two T4d-staged uveal melanomas. One was AJCC-staged R2 due to orbital recurrence presenting 16 months after enucleation. (192)Ir HDR brachytherapy involved transcutaneous circumferential orbital incisions allowing for evenly spaced brachytherapy catheters into the orbit. A target dose of 32.85 Gy (range, 32.85-34 Gy) was delivered in 9-10 twice-daily fractions (range, 3.4-3.65 Gy per fraction) over 5 consecutive days. Data analysis included but was not limited to radiation therapy methods, local tumor control, side effects, and metastatic rate. In the 9 patients who tolerated treatment, there has been no orbital recurrence at a median follow-up of 18 months (range, 1-62 months). Four patients died of metastatic disease (one presented with a treated solitary liver metastasis before brachytherapy). There was no significant eyelash or eyebrow loss. There was no radiation-induced eyelid erythema, orbital infection, or contracted sockets. All orbits accepted and maintained ocular prostheses. Brachytherapy was used as an alternative to external beam radiation treatment for postenucleation orbital melanoma. This series reports complete local control, few side effects, and excellent cosmetic results. Copyright © 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  12. Targeting of liver tumour in rats by selective delivery of holmium-166 loaded microspheres: a biodistribution study

    Energy Technology Data Exchange (ETDEWEB)

    Nijsen, F.; Rook, D.; Zonnenberg, B.; Klerk, J. de; Rijk, P. van; Schip, F. van het [Dept. of Nuclear Medicine, University Medical Center, Utrecht (Netherlands); Brandt, C. [Animal Inst., Utrecht Univ. (Netherlands); Meijer, R. [Dept. of Radiology, Univ. Medical Center, Utrecht (Netherlands); Dullens, H. [Dept. of Pathology, Univ. Medical Center, Utrecht (Netherlands); Hennink, W. [Dept. of Pharmaceutics, Utrecht Univ. (Netherlands)

    2001-06-01

    Intra-arterial administration of beta-emitting particles that become trapped in the vascular bed of a tumour and remain there while delivering high doses, represents a unique approach in the treatment of both primary and metastatic liver tumours. Studies on selective internal radiation therapy of colorectal liver metastases using yttrium-90 glass microspheres have shown encouraging results. This study describes the biodistribution of 40-{mu}m poly lactic acid microspheres loaded with radioactive holmium-166, after intra-arterial administration into the hepatic artery of rats with implanted liver tumours. Radioactivity measurements showed >95% retention of injected activity in the liver and its resident tumour. The average activity detected in other tissues was {<=}0.1%ID/g, with incidental exceptions in the lungs and stomach. Very little {sup 166}Ho activity was detected in kidneys (<0.1%ID/g), thereby indicating the stability of the microspheres in vivo. Tumour targeting was very effective, with a mean tumour to liver ratio of 6.1{+-}2.9 for rats with tumour (n=15) versus 0.7{+-}0.5 for control rats (n=6; P<0.001). These ratios were not significantly affected by the use of adrenaline. Histological analysis showed that five times as many large (>10) and medium-sized (4-9) clusters of microspheres were present within tumour and peritumoural tissue, compared with normal liver. Single microspheres were equally dispersed throughout the tumour, as well as normal liver parenchyma. (orig.)

  13. Emission characteristics of holmium ions in fluoro-phosphate glasses for photonic applications

    Science.gov (United States)

    Babu, S.; Ratnakaram, Y. C.

    2016-05-01

    Optical properties of Ho3+ doped different fluorophosphate (FP) glasses have been synthesized and discussed. Thermal properties have been studied through differential scanning calorimetry (DSC).The Judd-Ofelt (J-O) intensity parameters Ωλ (λ= 2, 4, 6) from absorption spectra have been evaluated. Various radiative parameters have been obtained for the different excited states using J-O theory. From the emission spectra, different laser properties have been studied and discussed. The nature of decay curve analysis was performed for the 5F4(5S2) level. These glasses are expected to give interesting application in the field of photonic applications.

  14. Emission characteristics of holmium ions in fluoro-phosphate glasses for photonic applications

    Energy Technology Data Exchange (ETDEWEB)

    Babu, S.; Ratnakaram, Y. C., E-mail: ratnakaramsvu@gmail.com [Department of Physics, Sri Venkateswara University, Tirupati- 517502 (India)

    2016-05-23

    Optical properties of Ho{sup 3+} doped different fluorophosphate (FP) glasses have been synthesized and discussed. Thermal properties have been studied through differential scanning calorimetry (DSC).The Judd-Ofelt (J-O) intensity parameters Ω{sub λ} (λ= 2, 4, 6) from absorption spectra have been evaluated. Various radiative parameters have been obtained for the different excited states using J-O theory. From the emission spectra, different laser properties have been studied and discussed. The nature of decay curve analysis was performed for the {sup 5}F{sub 4}({sup 5}S{sub 2}) level. These glasses are expected to give interesting application in the field of photonic applications.

  15. Chromosomes in the porcine first polar body possess competence of second meiotic division within enucleated MII stage oocytes.

    Directory of Open Access Journals (Sweden)

    Tao Lin

    Full Text Available To determine whether chromosomes in the porcine first polar body (PB1 can complete the second meiotic division and subsequently undergo normal pre-implantation embryonic development, we examined the developmental competence of PB1 chromosomes injected into enucleated MII stage oocytes by nuclear transfer method (chromosome replacement group, CR group. After parthenogenetic activation (PA or in vitro fertilization (IVF, the cleavage rate of reconstructed oocytes in the IVF group (CR-IVF group, 36.4 ± 3.2% and PA group (CR-PA group, 50.8 ± 4.2% were significantly lower than that of control groups in which normal MII oocytes were subjected to IVF (MII-IVF group, 75.8 ± 1.5% and PA (MII-PA group, 86.9 ± 3.7%. Unfertilized rates was significantly higher in the CR-IVF group (48.6 ± 3.3% than in the MII-IVF group (13.1 ± 3.4%. The blastocyst formation rate was 8.3 ± 1.9% in the CR-PA group, whereas no blastocyst formation was observed in the CR-IVF group. To produce tetraploid parthenogenetic embryos, intact MII stage oocytes injected with PB1 chromosomes were electrically stimulated, treated with 7.5 μg/mL cytochalasin B for 3 h (MII oocyte + PB1 + CB group, and then cultured without cytochalasin B. The average cleavage rate of reconstructed oocytes was 72.5% (48 of 66, and the blastocyst formation rate was 18.7% (9 of 48. Chromosome analysis showed similar proportions of haploid and diploid cells in the control (normal MII oocytes and CR groups after PA; overall, 23.6% of blastocysts were tetraploid in the MII oocyte + PB1 + CB group. These results demonstrate that chromosomes in PB1 can participate in normal pre-implantation embryonic development when injected into enucleated MII stage oocytes, and that tetraploid PA blastocysts are produced (although at a low proportion when PB1 chromosomes are injected into intact MII stage oocytes.

  16. Discrete reduction patterns of parvalbumin and calbindin D-28k immunoreactivity in the dorsal lateral geniculate nucleus and the striate cortex of adult macaque monkeys after monocular enucleation.

    Science.gov (United States)

    Blümcke, I; Weruaga, E; Kasas, S; Hendrickson, A E; Celio, M R

    1994-01-01

    We analyzed the immunohistochemical distribution of the two calcium-binding proteins, parvalbumin (PV) and calbindin D-28k (CB), in the primary visual cortex and lateral dorsal geniculate nucleus (dLGN) of monocularly enucleated macaque monkeys (Macaca fascicularis and Macaca nemestrina) in order to determine how the expression of PV and CB is affected by functional inactivity. The monkeys survived 1-17 weeks after monocular enucleation. The distribution pattern of each of the proteins was examined immunocytochemically using monoclonal antibodies and compared with that of the metabolic marker cytochrome oxidase (CO). We recorded manually the number of immunostained neurons and estimated the concentration of immunoreactive staining product using a computerized image-acquisition system. Our results indicate a decrease of approximately 30% in the labeling of PV-immunoreactive (ir) neuropil particularly in those layers of denervated ocular-dominance columns receiving the geniculocortical input. There was no change in the number of PV-ir neurons in any compartment irrespective of the enucleation interval. For CB-ir, we found a 20% decrease in the neuropil labeling in layer 2/3 of the denervated ocular-dominance columns. In addition, a subset of pyramidal CB-ir neurons in layers 2 and 4B, which are weakly stained in control animals, showed decreased labeling. In the dLGN of enucleated animals, PV-ir and CB-ir were decreased only in the neuropil of the denervated layers. From these results, we conclude that cortical interneurons and geniculate projection neurons still express PV and CB in their cell bodies after disruption of the direct functional input from one eye. The only distinct decrease of PV and CB expression is seen in axon terminals from retinal ganglion cells in the dLGN, and in the axons and terminals of both geniculocortical projection cells and cortical interneurons in the cerebral cortex.

  17. Vision-Related Quality of Life and Appearance Concerns Are Associated with Anxiety and Depression after Eye Enucleation: A Cross-Sectional Study.

    Science.gov (United States)

    Ye, Juan; Lou, Lixia; Jin, Kai; Xu, Yufeng; Ye, Xin; Moss, Timothy; McBain, Hayley

    2015-01-01

    To investigate the association of demographic, clinical and psychosocial variables with levels of anxiety and depression in participants wearing an ocular prosthesis after eye enucleation. This cross-sectional study included 195 participants with an enucleated eye who were attending an ophthalmic clinic for prosthetic rehabilitation between July and November 2014. Demographic and clinical data, and self-reported feelings of shame, sadness and anger were collected. Participants also completed the National Eye Institute Visual Function Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and the Hospital Anxiety and Depression Scale. Regression models were used to identify the factors associated with anxiety and depression. The proportion of participants with clinical anxiety was 11.8% and clinical depression 13.8%. More anxiety and depression were associated with poorer vision-related quality of life and greater levels of appearance concerns. Younger age was related to greater levels of anxiety. Less educated participants and those feeling more angry about losing an eye are more prone to experience depression. Clinical variables were unrelated to anxiety or depression. Anxiety and depression are more prevalent in eye-enucleated patients than the general population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal studies need to be conducted to further elucidate the direction of causality before interventions to improve mood states are developed.

  18. Vision-Related Quality of Life and Appearance Concerns Are Associated with Anxiety and Depression after Eye Enucleation: A Cross-Sectional Study

    Science.gov (United States)

    Ye, Juan; Lou, Lixia; Jin, Kai; Xu, Yufeng; Ye, Xin; Moss, Timothy; McBain, Hayley

    2015-01-01

    Aims To investigate the association of demographic, clinical and psychosocial variables with levels of anxiety and depression in participants wearing an ocular prosthesis after eye enucleation. Methods This cross-sectional study included 195 participants with an enucleated eye who were attending an ophthalmic clinic for prosthetic rehabilitation between July and November 2014. Demographic and clinical data, and self-reported feelings of shame, sadness and anger were collected. Participants also completed the National Eye Institute Visual Function Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and the Hospital Anxiety and Depression Scale. Regression models were used to identify the factors associated with anxiety and depression. Results The proportion of participants with clinical anxiety was 11.8% and clinical depression 13.8%. More anxiety and depression were associated with poorer vision-related quality of life and greater levels of appearance concerns. Younger age was related to greater levels of anxiety. Less educated participants and those feeling more angry about losing an eye are more prone to experience depression. Clinical variables were unrelated to anxiety or depression. Conclusions Anxiety and depression are more prevalent in eye-enucleated patients than the general population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal studies need to be conducted to further elucidate the direction of causality before interventions to improve mood states are developed. PMID:26317860

  19. Vision-Related Quality of Life and Appearance Concerns Are Associated with Anxiety and Depression after Eye Enucleation: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Juan Ye

    Full Text Available To investigate the association of demographic, clinical and psychosocial variables with levels of anxiety and depression in participants wearing an ocular prosthesis after eye enucleation.This cross-sectional study included 195 participants with an enucleated eye who were attending an ophthalmic clinic for prosthetic rehabilitation between July and November 2014. Demographic and clinical data, and self-reported feelings of shame, sadness and anger were collected. Participants also completed the National Eye Institute Visual Function Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and the Hospital Anxiety and Depression Scale. Regression models were used to identify the factors associated with anxiety and depression.The proportion of participants with clinical anxiety was 11.8% and clinical depression 13.8%. More anxiety and depression were associated with poorer vision-related quality of life and greater levels of appearance concerns. Younger age was related to greater levels of anxiety. Less educated participants and those feeling more angry about losing an eye are more prone to experience depression. Clinical variables were unrelated to anxiety or depression.Anxiety and depression are more prevalent in eye-enucleated patients than the general population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal studies need to be conducted to further elucidate the direction of causality before interventions to improve mood states are developed.

  20. The Role of Hemoclips Reinforcement in the Ligation-Assisted Endoscopic Enucleation for Small GISTs in Gastric Fundus

    Directory of Open Access Journals (Sweden)

    Ge Nan

    2014-01-01

    Full Text Available Background. Endoscopic ultrasonography- (EUS- assisted band ligation has been proven to be a safe and effective procedure for the treatment of small gastrointestinal stromal tumors (GISTs apart from the relatively high risk of the postligation perforation of the gastric fundus. The aim of this study is to investigate the efficacy of hemoclip reinforcement in treating small GISTs in the gastric fundus. Method. During a standard endoscopy, a transparent cap attached to the endoscopic tip was placed over the lesion to exert sustained maximal aspiration before a rubber band was released. Once a definite ligation was confirmed by EUS, the tumor was enucleated. Four to 6 hemoclips were placed on the folds around the ligation band to reduce the tension of the ligation site. Results. The small GISTs were resected completely in 192 patients. Two cases of delayed perforation were found 72 hours after the procedure and successfully treated with an ordinary conservative method. Conclusion. Hemoclip-reinforced endoscopic band ligation with systematic follow-up using EUS appears to be a simple and effective technique for the resection of small GISTs in the gastric fundus.

  1. Detection of rare earth elements in Powder River Basin sub-bituminous coal ash using laser-induced breakdown spectroscopy (LIBS)

    Energy Technology Data Exchange (ETDEWEB)

    Tran, Phuoc [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United State; Mcintyre, Dustin [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United State

    2015-10-01

    We reported our preliminary results on the use of laser-induced breakdown spectroscopy to analyze the rare earth elements contained in ash samples from Powder River Basin sub-bituminous coal (PRB-coal). We have identified many elements in the lanthanide series (cerium, europium, holmium, lanthanum, lutetium, praseodymium, promethium, samarium, terbium, ytterbium) and some elements in the actinide series (actinium, thorium, uranium, plutonium, berkelium, californium) in the ash samples. In addition, various metals were also seen to present in the ash samples

  2. Thulium fiber laser ablation of kidney stones using a 50-μm-core silica optical fiber

    Science.gov (United States)

    Blackmon, Richard L.; Hutchens, Thomas C.; Hardy, Luke A.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2015-01-01

    Our laboratory is currently studying the experimental thulium fiber laser (TFL) as a potential alternative laser lithotripter to the gold standard, clinical Holmium:YAG laser. We have previously demonstrated the efficient coupling of TFL energy into fibers as small as 100-μm-core-diameter without damage to the proximal end. Although smaller fibers have a greater tendency to degrade at the distal tip during lithotripsy, fiber diameters (≤200 μm) have been shown to increase the saline irrigation rates through the working channel of a flexible ureteroscope, to maximize the ureteroscope deflection, and to reduce the stone retropulsion during laser lithotripsy. In this study, a 50-μm-core-diameter, 85-μm-outer-diameter, low-OH silica fiber is characterized for TFL ablation of human calcium oxalate monohydrate urinary stones, ex vivo. The 50-μm-core fiber consumes approximately 30 times less cross-sectional area inside the single working channel of a ureteroscope than the standard 270-μm-core fiber currently used in the clinic. The ureteroscope working channel flow rate, including the 50-μm fiber, decreased by only 10% with no impairment of ureteroscope deflection. The fiber delivered up to 15.4±5.9 W under extreme bending (5-mm-radius) conditions. The stone ablation rate measured 70±22 μg/s for 35-mJ-pulse-energy, 500-μs-pulse-duration, and 50-Hz-pulse-rate. Stone retropulsion and fiber burnback averaged 201±336 and 3000±2600 μm, respectively, after 2 min. With further development, thulium fiber laser lithotripsy using ultra-small, 50-μm-core fibers may introduce new integration and miniaturization possibilities and potentially provide an alternative to conventional Holmium:YAG laser lithotripsy using larger fibers.

  3. Activity coefficients in (hydrogen chloride+holmium chloride) (aq) from T=(278.15 to 328.15) K

    Energy Technology Data Exchange (ETDEWEB)

    Roy, Rabindra N. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States)]. E-mail: rroy@drury.edu; Roy, Lakshmi N. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States); Tabor, Bennett J. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States); Richards, Sarah J. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States); Cummins, Mason P. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States); Himes, Curtis A. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States); Gibbs, Stephanie N. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States); Christiansen, Edward B. [Hoffman Department of Chemistry, Drury University, Springfield, MO 65802 (United States)

    2005-07-15

    Activity coefficients of HCl in (hydrogen chloride+holmium chloride) (aq) have been calculated from the observed e.m.f.s using the Nernst equation. The temperatures ranged from (278.15 to 328.15) K at 5 K intervals and at constant total ionic strengths of (0.01, 0.025, 0.05, 0.1, 0.25, 0.5, 1.0, and 1.5) mol.kg{sup -1}. Electromotive-force measurements were made on the cell without liquid junction of the type:Pt vertical bar H{sub 2}(g,p=101.325kPa) vertical bar HCl(m{sub A}),HoCl{sub 3}(m{sub B}) vertical bar AgCl(s), vertical bar Ag(s) The results of the activity coefficients of HCl for this mixed electrolyte mixture have been interpreted in terms of the simpler Harned's equations and the ion-interaction model of Pitzer. Results show that the quadratic term is sufficient for the full range of Y{sub B} (the ionic strength fraction of the salt) to 0.9 at all the ionic strengths studied. The Pitzer's mixing parameters S{sub {theta}}{sub H,Ho} and {psi}{sub H,Ho,Cl} (including higher order electrostatic effects) and {theta}{sub H,Ho} and {psi}{sub H,Ho,Cl} (excluding higher order electrostatic effects) have been determined. These values at T=298.15 K are: S{sub {theta}}{sub H},{sub Ho}=0.115, {psi}{sub H,Ho,Cl}=-.071; and {theta}{sub H,Ho}=-.663, {psi}{sub H,Ho,Cl}=0.165. The parameters obtained in this study reproduce the activity coefficients of HCl in the mixtures within 0.015 over the entire range of ionic strengths and within 0.009 for I>=0.05 mol.kg{sup -1} over the entire temperature range.

  4. Safety of cornea and iris in ocular surgery with 355-nm lasers.

    Science.gov (United States)

    Wang, Jenny; Chung, Jae Lim; Schuele, Georg; Vankov, Alexander; Dalal, Roopa; Wiltberger, Michael; Palanker, Daniel

    2015-09-01

    A recent study showed that 355-nm nanosecond lasers cut cornea with similar precision to infrared femtosecond lasers. However, use of ultraviolet wavelength requires precise assessment of ocular safety to determine the range of possible ophthalmic applications. In this study, the 355-nm nanosecond laser was evaluated for corneal and iris damage in rabbit, porcine, and human donor eyes as determined by minimum visible lesion (MVL) observation, live/dead staining of the endothelium, and apoptosis assay. Single-pulse damage to the iris was evaluated on porcine eyes using live/dead staining. In live rabbits, the cumulative median effective dose (ED50) for corneal damage was 231 J/cm2, as seen by lesion observation. Appearance of endothelial damage in live/dead staining or apoptosis occurred at higher radiant exposure of 287 J/cm2. On enucleated rabbit and porcine corneas, ED50 was 87 and 52 J/cm2, respectively, by MVL, and 241 and 160 J/cm2 for endothelial damage. In human eyes, ED50 for MVL was 110 J/cm2 and endothelial damage at 453 J/cm2. Single-pulse iris damage occurred at ED 50 of 208 mJ/cm2. These values determine the energy permitted for surgical patterns and can guide development of ophthalmic laser systems. Lower damage threshold in corneas of enucleated eyes versus live rabbits is noted for future safety evaluation.

  5. Safety of cornea and iris in ocular surgery with 355-nm lasers

    Science.gov (United States)

    Wang, Jenny; Chung, Jae Lim; Schuele, Georg; Vankov, Alexander; Dalal, Roopa; Wiltberger, Michael; Palanker, Daniel

    2015-09-01

    A recent study showed that 355-nm nanosecond lasers cut cornea with similar precision to infrared femtosecond lasers. However, use of ultraviolet wavelength requires precise assessment of ocular safety to determine the range of possible ophthalmic applications. In this study, the 355-nm nanosecond laser was evaluated for corneal and iris damage in rabbit, porcine, and human donor eyes as determined by minimum visible lesion (MVL) observation, live/dead staining of the endothelium, and apoptosis assay. Single-pulse damage to the iris was evaluated on porcine eyes using live/dead staining. In live rabbits, the cumulative median effective dose (ED50) for corneal damage was 231 J/cm2, as seen by lesion observation. Appearance of endothelial damage in live/dead staining or apoptosis occurred at higher radiant exposure of 287 J/cm2. On enucleated rabbit and porcine corneas, ED50 was 87 and 52 J/cm2, respectively, by MVL, and 241 and 160 J/cm2 for endothelial damage. In human eyes, ED50 for MVL was 110 J/cm2 and endothelial damage at 453 J/cm2. Single-pulse iris damage occurred at ED50 of 208 mJ/cm2. These values determine the energy permitted for surgical patterns and can guide development of ophthalmic laser systems. Lower damage threshold in corneas of enucleated eyes versus live rabbits is noted for future safety evaluation.

  6. Application of ultrashort laser pulses for intrastromal refractive surgery.

    Science.gov (United States)

    Lubatschowski, H; Maatz, G; Heisterkamp, A; Hetzel, U; Drommer, W; Welling, H; Ertmer, W

    2000-01-01

    Recently, laser systems have become available which generate ultrashort laser pulses with a duration of 100-200 femtoseconds (fs). By generating micro-plasmas inside the corneal stroma with fs pulses, it is possible to achieve a cutting effect inside the tissue while leaving the anterior layers intact. The energy threshold to generate a micro-plasma with fs pulses is some orders of magnitude lower than it is for picosecond or nanosecond pulses. This results in a strong reduction of the thermal and mechanical damage of the surrounding tissue. With a titanium:sapphire fs laser system, the cutting effect on corneal tissue from freshly enucleated porcine eye globes was investigated with different pulse energies. The irradiated samples were examined by light and electron microscopy. The laser-induced pressure transients and the laser-induced bubble formation were analysed with a broadband acoustic transducer and by flash photography. With fs laser pulses, the extent of thermal and mechanical damage of the adjacent tissue is in the order of 1 microm or below and therefore comparable with the tissue alterations after ArF excimer laser ablation. Using pulse energies of approximately 1-2 microJ and a spot diameter of 5-10 microm, intrastromal cuts can be performed very precisely in order to prepare corneal flaps and lenticules. Femtosecond photodisruption has the potential to become an attractive tool for intrastromal refractive surgery.

  7. [Use of the confocal laser scanning method for determining corneal topography and corneal tissue effects in refractive corneal surgery].

    Science.gov (United States)

    Koop, N; Brinkmann, R; Schirner, G

    1996-06-01

    Refraction of the cornea head been generally measured with ophthalmometers or computer disk keratometers. We therefore used a confocal laser scanning system for measurement of the corneal topography. Enucleated tonicized pig eyes were measured before and after laser thermokeratoplasty (LTK). The topographical data were used to determine refraction and refractive change; the data were stored digitally. The single images and their differences were displayed on a PC. Unlike conventional ophthalmometry, confocal laser scanning can demonstrate the topographical shape, showing the overall topography of the cornea and local corneal effects, e.g., coagulation, mechanical lesions or high-energy laser effects. Topographical laser scanning has proven to be a generally useful method of determining refraction and surface alterations in corneal refractive surgery.

  8. Development of phosphate glass microspheres containing holmium for selective internal radiotherapy; Desenvolvimento de microesferas de vidro fosfato contendo holmio para uso em radioterapia interna seletiva

    Energy Technology Data Exchange (ETDEWEB)

    Barros Filho, Eraldo Cordeiro

    2016-11-01

    The selective internal radiotherapy is an alternative for some kinds of cancer as the hepatocellular carcinoma (HCC) or primary liver cancer treatment. In this treatment, glass or polymer microspheres containing radionuclides inside their structure are introduced in the liver through hepatic artery and trapped at the arterioles that feed the tumor. In this work, the development of phosphate glasses containing holmium for production of microspheres and their application in Brazil are proposed. The developed glasses presented suitable chemical durability, density of 2,7(3) g/cm{sup 3}, high thermal stability and the impurities contained therein do not preclude the treatment. The microspheres were produced by the flame method and the gravitational fall method, and were characterized by means of several techniques to evaluate shape, average particle size, activity and biocompatibility suitable for selective internal radiotherapy. Based in the main results, the submission to in vivo tests is proposed. (author)

  9. Activation cross sections of proton and deuteron induced nuclear reactions on holmium and erbium, related to the production of (161)Er and (160)Er medical isotopes.

    Science.gov (United States)

    Tárkányi, F; Ditrói, F; Takács, S; Hermanne, A; Baba, M

    2016-09-01

    Experimental excitation functions for long-lived products in proton induced reactions were measured with the activation method in the 37-65MeV energy range on natural holmium. Stacked foil irradiation technique and high resolution gamma spectrometry were used in order to measure cross-section data for the production of (161)Er, (160)Er and (1)(59,157)Dy. For comparison of the production routes of medically related (161)Er and (160)Er radioisotopes new experimental cross section data were deduced for the (162)Er(p,x)(161,160)Er and (162)Er(d,x)(161,160)Er reactions by re-evaluating gamma-ray spectra from earlier measurements. No earlier data were found in the literature for these reactions. The experimental data are compared with results of TALYS theoretical code reported in TENDL-2015. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Development of 166Holmium-1,2 Propylene Di-amino Tetra (Methy1enephosphonicacid) as a Possible Bone Palliation Agent

    Science.gov (United States)

    Zolghadri, Samaneh; Jalilian, Amir Reza; Yousefnia, Hassan; Bahrami-Samani, Ali; Ghannadi-Maragheh, Mohammad

    2014-01-01

    166Holmium-1,2-propylene di-amino tetra (methy1enephosphonicacid) (166 Ho-PDTMP) complex was prepared successfully using an in-house synthesized PDTMP ligand and 166 HoCl 3 . Ho-166 chloride was obtained by thermal neutron irradiation (1 × 10 13 n/cm 2 /s) of natural Ho (NO 3 ) 3 samples (specific activity = 3-5 GBq/mg), dissolved in acidic media. Radiochemical purity of 166 Ho-PDTMP was checked by instant thin layer chromatography (>99%). Stability studies of the complex in the final preparation and in the presence of human serum were performed up to 72 h. The biodistribution of 166 Ho-PDTMP and 166 HoCl 3 in wild-type rats was checked in animal tissues up to 48 h. The produced 166 Ho-PDTMP properties suggest a possible new bone palliative therapeutic to overcome the metastatic bone pains. PMID:25191109

  11. Automutilação ocular: relato de seis casos de enucleação ocular Self-mutilation: report of six cases of enucleation

    Directory of Open Access Journals (Sweden)

    Marcelo G Nucci

    2000-06-01

    Full Text Available No presente trabalho são relatados seis casos de pacientes que cometeram auto-enucleação (cinco unilaterais e uma bilateral, acompanhados no serviço de psiquiatria do Hospital das Clínicas da Unicamp nos últimos dez anos. Além disso, é feita uma revisão da literatura relacionada a esse tipo de comportamento, considerado a forma mais grave e dramática de automutilação ocular. A partir da discussão crítica comparativa entre os aspectos clínicos de cada caso relatado e os dados encontrados na literatura, concluímos que se mostram associados à auto-enucleação: pacientes esquizofrênicos que cometeram a autolesão durante episódios psicóticos agudos, fortes elementos religiosos como parte da psicopatologia, evidências de comportamento automutilatório menos grave antes da auto-enucleação e explicação do ato como relacionado a uma suposta salvação do próprio paciente ou do mundo. Algumas outras características mais específicas de nossos casos também são destacadas: longo tempo de evolução da doença no momento da auto-enucleação; crenças religiosas variando entre três diferentes igrejas cristãs (Católica, Evangélica e Testemunhas de Jeová; presença de uma forma não usual de auto-enucleação com uso de arma de fogo e presença de um caso de auto-enucleação bilateral.Six cases of self-inflicted ocular mutilation (five unilateral and one bilateral were seen and treated at a university hospital in the last ten years. The literature on ocular self-mutilations was also reviewed. Self-enucleation is considered one of the most severe and dramatic forms of self-mutilation. After comparing these patients' clinical and psychopathological data with the literature on ocular self-enucleation, it was concluded that: 1. It is more frequent in schizophrenic patients during acute episodes; 2. Symptoms with a strong religious content are very important; 3. Less severe forms of self-mutilation before self-enucleation are

  12. Comparison of the exposure rate of wrapped hydroxyapatite (Bio-Eye) versus unwrapped porous polyethylene (Medpor) orbital implants in enucleated patients.

    Science.gov (United States)

    Tabatabaee, Ziaeddin; Mazloumi, Mehdi; Rajabi, Mohammad Taher; Khalilzadeh, Omid; Kassaee, Abolfazl; Moghimi, Sasan; Eftekhar, Hassan; Goldberg, Robert A

    2011-01-01

    To compare the exposure rate of wrapped hydroxyapatite versus unwrapped porous polyethylene orbital implants in enucleated patients. Medical records of the patients who underwent primary placement of hydroxyapatite (Bio-Eye) or porous polyethylene (Medpor) orbital implants after enucleation between 2002 and 2005 in Farabi Eye Hospital were reviewed, and the occurrence of implant exposure during follow-up visits was recorded. The exclusion criteria were secondary implantation, evisceration, or follow up of less than 1 year unless the exposure had occurred in the year after surgery. In the hydroxyapatite group, the implants were wrapped either in Mersilene mesh (65%) or in donor sclera (35%). Wrapping was not performed for any patient in the porous polyethylene group. A total of 198 cases with hydroxyapatite and 53 cases with porous polyethylene implant were identified. The most common causes of enucleation in both groups were globe trauma and painful blind eye. Rate of exposure was significantly higher [odds ratio (OR) = 7.97, p < 0.001] in patients with porous polyethylene (34.0%) than in those with hydroxyapatite implant (6.1%). This association remained significant after adjustment for potential confounders. Mean time of exposure after surgery was significantly (p < 0.001) longer in patients with porous polyethylene implant. Kaplan-Meier plots depicted a significantly (p < 0.001) higher rate of exposure in patients with porous polyethylene implant during the follow-up time. Unwrapped porous polyethylene implants demonstrated a higher rate of exposure, and longer time interval to exposure, compared with wrapped hydroxyapatite implants.

  13. A compact, inexpensive infrared laser system for continuous-wave optical stimulation of the rat prostate cavernous nerves

    Science.gov (United States)

    Perkins, William C.; Lagoda, Gwen A.; Burnett, Arthur L.; Fried, Nathaniel M.

    2014-03-01

    Optical nerve stimulation (ONS) has been commonly performed in the laboratory using high-power, pulsed, infrared (IR) lasers including Holmium:YAG, diode, and Thulium fiber lasers. However, the relatively high cost of these lasers in comparison with conventional electrical nerve stimulation (ENS) equipment may represent a significant barrier to widespread adoption of ONS. Optical stimulation of the prostate cavernous nerves (CN's) has recently been reported using lower cost, continuous-wave (CW), all-fiber-based diode lasers. This preliminary study describes further miniaturization and cost reduction of the ONS system in the form of a compact, lightweight, cordless, and inexpensive IR laser. A 140-mW, 1560-nm diode laser was integrated with a green aiming beam and delivery optics into a compact ONS system. Surface and subsurface ONS was performed in a total of 5 rats, in vivo, with measurement of an intracavernous pressure (ICP) response during CW laser irradiation for 30 s with a spot diameter of 0.7 mm. Short-term, CW ONS of the prostate CN's is feasible using a compact, inexpensive, batterypowered IR laser diode system. This ONS system may represent an alternative to ENS for laboratory studies, and with further development, a handheld option for ONS in the clinic to identify and preserve the CN's during prostate cancer surgery.

  14. [HoLEP learning curve: Toward a standardised formation and a team strategy].

    Science.gov (United States)

    Baron, M; Nouhaud, F-X; Delcourt, C; Grise, P; Pfister, C; Cornu, J-N; Sibert, L

    2016-09-01

    Holmium laser enucleation of prostate (HoLEP) is renowned for the difficulty of its learning curve. Our aim was to evaluate the interest of a three-step tutorial in the HoLEP learning curve, in a university center. It is a retrospective, monocentric study of the 82 first procedures done consecutively by the same operator with a proctoring in early experience and after 40 procedures. For all patients were noted: enucleation efficiency (g/min), morcellation efficiency (g/min), percentage of enucleated tissue (enucleated tissue/adenome weigth evaluated by ultrasonography. g/g), perioperative morbidity (Clavien), length of hospital stay, length of urinary drainage, functional outcomes at short and middle term (Qmax, post-void residual volume [PVR], QOL scores and IPSS at 3 and 6months). Enucleation and morcellation efficiency were significantly higher after the second proctoring (0.87 vs 0.44g/min; Plearning curve did not interfere with functional results. The second proctoring was essential to us in order to grasp the technique. These data underlined the necessity of a pedagogic reflexion in order to built a standardized formation technique to the HoLEP. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. In vitro comparison of renal stone laser treatment using fragmentation and popcorn technique.

    Science.gov (United States)

    Klaver, Paul; de Boorder, Tjeerd; Rem, Alex I; Lock, Tycho M T W; Noordmans, Herke Jan

    2017-09-01

    To study the effectiveness of two laser techniques clinically used to fragment renal stones: fragmenting technique (FT) and popcorn technique (PT). Phantom stones were placed in a test tube filled with water, mimicking a renal calyx model. A Holmium:YAG laser was used for fragmentation using both techniques. Four series of experiments were performed with two parameters: the technique (FT or PT) and the number of stones in the test tube (one or four). The mass decrease of the phantom stones was measured before, during, and after the experiment to quantify the effect of both techniques. Visualization of PT showed that the main effect of PT takes place, when the stone moves in front of the laser fiber and is subject to direct radiant exposure. Both FT and PT resulted in a decrease in stone weight; the mass decrease of the stones subjected to FT exceeded that of the stones subjected to PT, even with less laser energy applied. This difference in mass decrease was evident in both the experiments with one and four stones. PT was less effective in decreasing stone weight compared with FT. The FT is more effective regarding the applied energy than PT, even in a shorter time period and regardless of the number of stones. This study suggests that FT is to be preferred over PT, when stones are accessible by the laser fiber. Lasers Surg. Med. 49:698-704, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  16. Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

    Science.gov (United States)

    Hutchens, Thomas C.; Gonzalez, David A.; Hardy, Luke A.; McLanahan, C. Scott; Fried, Nathaniel M.

    2017-04-01

    Hydrocephalus is a chronic medical condition that occurs in individuals who are unable to reabsorb cerebrospinal fluid (CSF) created within the ventricles of the brain. Treatment requires excess CSF to be diverted from the ventricles to another part of the body, where it can be returned to the vascular system via a shunt system beginning with a catheter within the ventricle. Catheter failures due to occlusion by brain tissues commonly occur and require surgical replacement of the catheter. In this preliminary study, minimally invasive clearance of occlusions is explored using an experimental thulium fiber laser (TFL), with comparison to a conventional holmium: yttrium aluminium garnet (YAG) laser. The TFL utilizes smaller optical fibers (450-μm OD), providing critical extra cross-sectional space within the 1.2-mm-inner-diameter ventricular catheter for simultaneous application of an endoscope for image guidance and a saline irrigation tube for visibility and safety. TFL ablation rates using 100-μm core fiber, 33-mJ pulse energy, 500-μs pulse duration, and 20- to 200-Hz pulse rates were compared to holmium laser using a 270-μm core fiber, 325-mJ, 300-μs, and 10 Hz. A tissue occluded catheter model was prepared using coagulated egg white within clear silicone tubing. An optimal TFL pulse rate of 50 Hz was determined, with an ablation rate of 150 μm/s and temperature rise outside the catheter of ˜10°C. High-speed camera images were used to explore the mechanism for removal of occlusions. Image guidance using a miniature, 0.7-mm outer diameter, 10,000 pixel endoscope was explored to improve procedure safety. With further development, simultaneous application of TFL with small fibers, miniature endoscope for image guidance, and irrigation tube for removal of tissue debris may provide a safe, efficient, and minimally invasive method of clearing occluded catheters in the treatment of hydrocephalus.

  17. A prospective study comparing bipolar endoscopic enucleation of prostate with bipolar transurethral resection in saline for management of symptomatic benign prostate enlargement larger than 70 g in a matched cohort.

    Science.gov (United States)

    Kan, Chi Fai; Tsu, Hok Leung; Chiu, Yi; To, Hoi Chu; Sze, Bonnie; Chan, Steve Wai Hee

    2014-03-01

    This study aims to compare the efficacy and safety of bipolar endoscopic enucleation of prostate with transurethral resection in saline for large BPE greater than 70 g. All patients from two urology centres who had bipolar enucleation or bipolar resection performed for large BPE greater than 70 g from December 2008 to April 2012 were prospectively assessed. The pre-operative and post-operative measures included IPSS, QOL score, uroflowmetry results, PSA and prostate volume. The perioperative measures were compared, and the post-operative complications/resumption of medical treatment for lower urinary tract symptoms were also assessed. There were 74 and 86 consecutive patients with bipolar enucleation and bipolar resection performed, respectively. No difference in pre-operative characteristics was observed between the two groups with mean prostate size 115 cc in each group. Comparing bipolar enucleation with bipolar resection, there was longer operative time (156 vs 87 min, p = 0.000), more haemoglobin drop (1.8 vs 1.1 g/dL, p = 0.006), but more prostate tissue resected (61.4 vs 45.7 g, p = 0.000). There was no difference in overall transfusion requirement and hospital stay. At 12 month after the procedure, patients with bipolar enucleation performed had better IPSS (6.4 vs 11.6, p = 0.032), QOL (1.7 vs 2.6, p = 0.040) and peak flow rate (19.5 vs 15.1 ml/s, p = 0.019). The post-operative complications had no significant difference between the two groups. For surgical treatment of big BPE, bipolar endoscopic enucleation of prostate provided superior functional outcome than bipolar resection but required longer operative time.

  18. Lasers technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    The Lasers Technology Program of IPEN is committed to the development of new lasers based on the research of optical materials and new technologies, as well to laser applications in several areas: Nuclear, Medicine, Dentistry, Industry, Environment and Advanced Research. The Program is basically divided into two main areas: Material and Laser Development and Laser Applications.

  19. Enucleation of a large true cyst in the head of pancreas instead of Whipple procedure in an 8-year old boy: a case report

    Directory of Open Access Journals (Sweden)

    Ostadian N

    2011-02-01

    Full Text Available "nBackground: Simple cysts of pancreas are smaller than complex ones and are more likely to be located at the distal tail of the pancreas. Simple cysts are often asymptomatic and can be managed conservatively by observation. There seems to be few clinical trials to suggest the best treatments method for large symptomatic cysts of pancreas located at the head of the organ."n "nCase presentation: In this report, we describe an eight-year old boy with a large symptomatic true cyst at the head of the pancreas who was successfully treated by enucleation of the cyst, instead of the Whipple's procedure, without any ensuing complications."n "nConclusion: Regarding the rarity of simple cysts in the pancreas, lack of studies to compare different surgical procedures and suggest the best methods to treat them and the considerable morbidity and even mortality of major surgeries (e.g Whipple's procedure enucleation of these cysts seem to be appropriate for treating them with no early or late complications. More studies are needed to warrant the results of this report.

  20. Imaging laser-induced thermal fields and effects

    Science.gov (United States)

    Verdaasdonck, Rudolf M.

    1995-05-01

    Laser light interaction with biological tissues is a combination of optical, thermal and mechanical effects depending on the energy applied per unit of volume per unit of time. Visualization of the phenomena with a high temporal and spatial resolution, contributes to a better understanding of the mechanism of action, especially when pulsed lasers are involved. For this goal, setups were developed based on Schlieren techniques to image the interaction of pulsed (CO2, Holmium and Excimer) and CW (CO2, Nd:YAG, Cu-vapor) lasers with physiological media and biological tissues. In a 'fast' Schlieren setup, images of shock waves and fast expanding and imploding vapor bubbles were captured using very short light flashes (10 ns-10 microseconds). These recordings suggest that these explosive vapor bubbles seem to be the main dynamism for tissue ablation. In a 'color' Schlieren setup, very small changes in optical density of the media induced by temperature gradients, were color coded. Calibration of the color images to absolute temperatures were performed by using calculated temperature distributions and by thermocouple measurements. Cameras with high speed shutters (0.1-50 ms) enabled the recording of dynamic images of the thermal relaxation and heat diffusion in tissues during variation of pulse length and repetition rate. Despite pulse lengths Schlieren techniques were applied to study the thermal characteristics of laser probes, e.g. for the treatment of Benign Prostatic Hyperplasia (BPH). In combination with thermal modeling an optimal therapy might be predicted. Schlieren techniques, generating high-speed and 'thermal' images, can provide a good understanding of the ablation mechanism and the thermo-dynamics during laser-tissue interaction with continuous wave and pulse lasers.

  1. Mid - infrared solid state lasers for spectroscopic applications

    Science.gov (United States)

    Terekhov, Yuri

    This work is devoted to study of novel high power middle-infrared (Mid-IR) laser sources enabling development of portable platform for sensing of organic molecules with the use of recently discovered Quartz Enhanced Photo Acoustic Spectroscopy (QEPAS). The ability to detect small concentrations is beneficial to monitor atmosphere pollution as well for biomedical applications such as analysis of human breath to detect earlier stages of cancer or virus activities. A QEPAS technique using a quartz tuning fork (QTF) as a detector enables a strong enhancement of measured signal when pump laser is modulated with a frequency coinciding with a natural frequency of a QTF. It is known that the detectability of acousto-optics based sensors is proportional to the square root of the laser intensity used for detection of analyte. That is the reason why commercially available semiconductor Mid-IR lasers having small output power limit sensitivity of modern QEPAS based sensors. The lack of high power broadly tunable lasers operating with a modulation frequency of quartz forks (~ 32.768 kHz) is the major motivation of this study. Commercially available Mid-IR (2-3.3 microm), single frequency, continuous wave (CW) fiber pumped lasers based on transition metal doped chalcogenides (e.g. Cr:ZnSe) prove to be efficient laser sources for organic molecules detection. However, their direct modulation is limited to several kHz, and cannot be directly used in combination with QEPAS. Hence, one objective of this work is to study and develop fiber laser pumped Ho:YAG (Er:YAG)/Cr:ZnSe tandem laser system/s. Ho (Holmium) and/or Er (Erbium) ions having long radiation lifetime (~ 10 ms) can effectively accumulate population inversion under CW fiber laser excitation. Utilization of acousto-optic (AO) modulators in the cavity of Ho:YAG (Er:YAG) laser will enable effective Q-Switching with repetition rate easily reaching the resonance frequency of a QTF. It is expected that utilization of Ho:YAG (Er

  2. Impact of pulse duration on Ho:YAG laser lithotripsy: fragmentation and dusting performance.

    Science.gov (United States)

    Bader, Markus J; Pongratz, Thomas; Khoder, Wael; Stief, Christian G; Herrmann, Thomas; Nagele, Udo; Sroka, Ronald

    2015-04-01

    In vitro investigations of Ho:YAG laser-induced stone fragmentation were performed to identify potential impacts of different pulse durations on stone fragmentation characteristics. A Ho:YAG laser system (Swiss LaserClast, EMS S.A., Nyon, Switzerland) with selectable long or short pulse mode was tested with regard to its fragmentation and laser hardware compatibility properties. The pulse duration is depending on the specific laser parameters. Fragmentation tests (hand-held, hands-free, single-pulse-induced crater) on artificial BEGO stones were performed under reproducible experimental conditions (fibre sizes: 365 and 200 µm; laser settings: 10 W through combinations of 0.5, 1, 2 J/pulse and 20, 10, 5 Hz, respectively). Differences in fragmentation rates between the two pulse duration regimes were detected with statistical significance for defined settings. Hand-held and motivated Ho:YAG laser-assisted fragmentation of BEGO stones showed no significant difference between short pulse mode and long pulse mode, neither in fragmentation rates nor in number of fragments and fragment sizes. Similarly, the results of the hands-free fragmentation tests (with and without anti-repulsion device) showed no statistical differences between long pulse and short pulse modes. The study showed that fragmentation rates for long and short pulse durations at identical power settings remain at a comparable level. Longer holmium laser pulse duration reduces stone pushback. Therefore, longer laser pulses may result in better clinical outcome of laser lithotripsy and more convenient handling during clinical use without compromising fragmentation effectiveness.

  3. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    Science.gov (United States)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  4. Laser principles.

    Science.gov (United States)

    Bogdan Allemann, Inja; Kaufman, Joely

    2011-01-01

    Since the construction of the first laser in the 1960s, the role that lasers play in various medical specialities, including dermatology, has steadily increased. However, within the last 2 decades, the technological advances and the use of lasers in the field of dermatology have virtually exploded. Many treatments have only become possible with the use of lasers. Especially in aesthetic medicine, lasers are an essential tool in the treatment armamentarium. Due to better research and understanding of the physics of light and skin, there is now a wide and increasing array of different lasers and devices to choose from. The proper laser selection for each indication and treatment requires a profound understanding of laser physics and the basic laser principles. Understanding these principles will allow the laser operator to obtain better results and help avoid complications. This chapter will give an in-depth overview of the physical principles relevant in cutaneous laser surgery. Copyright © 2011 S. Karger AG, Basel.

  5. Comparing renal function preservation after laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for clinical T1a renal tumor: using a 3D parenchyma measurement system.

    Science.gov (United States)

    Zhu, Liangsong; Wu, Guangyu; Huang, Jiwei; Wang, Jianfeng; Zhang, Ruiyun; Kong, Wen; Xue, Wei; Huang, Yiran; Chen, Yonghui; Zhang, Jin

    2017-05-01

    To compare the renal function preservation between laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy. Data were analyzed from 246 patients who underwent laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for solitary cT1a renal cell carcinoma from January 2013 to July 2015. To reduce the intergroup difference, we used a 1:1 propensity matching analysis. The functional renal parenchyma volume preservation were measured preoperative and 12 months after surgery. The total renal function recovery and spilt GFR was compared. Multivariable logistic analysis was used for predictive factors for renal function decline. After 1:1 propensity matching, each group including 100 patients. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation had a smaller decrease in estimate glomerular filtration rate at 1 day (-7.88 vs -20.01%, p radio frequency ablation assisted tumor enucleation technology has unique advantage and potential in preserving renal parenchyma without ischemia damage compared to conventional laparoscopic partial nephrectomy, and had a better outcome, thus we recommend this technique in selected T1a patients.

  6. Fiber optic muzzle brake tip for reducing fiber burnback and stone retropulsion during thulium fiber laser lithotripsy

    Science.gov (United States)

    Hutchens, Thomas C.; Gonzalez, David A.; Irby, Pierce B.; Fried, Nathaniel M.

    2017-01-01

    The experimental thulium fiber laser (TFL) is being explored as an alternative to the current clinical gold standard Holmium:YAG laser for lithotripsy. The near single-mode TFL beam allows coupling of higher power into smaller optical fibers than the multimode Holmium laser beam profile, without proximal fiber tip degradation. A smaller fiber is desirable because it provides more space in the ureteroscope working channel for increased saline irrigation rates and allows maximum ureteroscope deflection. However, distal fiber tip burnback increases as fiber diameter decreases. Previous studies utilizing hollow steel sheaths around recessed distal fiber tips reduced fiber burnback but increased stone retropulsion. A "fiber muzzle brake" was tested for reducing both fiber burnback and stone retropulsion by manipulating vapor bubble expansion. TFL lithotripsy studies were performed at 1908 nm, 35 mJ, 500 μs, and 300 Hz using a 100-μm-core fiber. The optimal stainless steel muzzle brake tip tested consisted of a 1-cm-long, 560-μm-outer-diameter, 360-μm-inner-diameter tube with a 275-μm-diameter through hole located 250 μm from the distal end. The fiber tip was recessed a distance of 500 μm. Stone phantom retropulsion, fiber tip burnback, and calcium oxalate stone ablation studies were performed ex vivo. Small stones with a mass of 40±4 mg and 4-mm-diameter were ablated over a 1.5-mm sieve in 25±4 s (n=10) without visible distal fiber tip burnback. Reduction in stone phantom retropulsion distance by 50% and 85% was observed when using muzzle brake tips versus 100-μm-core bare fibers and hollow steel tip fibers, respectively. The muzzle brake fiber tip simultaneously provided efficient stone ablation, reduced stone retropulsion, and minimal fiber degradation during TFL lithotripsy.

  7. Periodontal regenerative management of residual tunnel osseous defect results from the enucleation of lateral periodontal cyst in anterior maxilla: A rare case report

    Directory of Open Access Journals (Sweden)

    Sanjeev Kumar Salaria

    2016-01-01

    Full Text Available The lateral periodontal cyst (LPC is a nonkeratinized, noninflammatory developmental cyst occurring adjacent or lateral to tooth root. It is a relatively uncommon lesion found in the maxillary incisors and found mostly in adults during 5th to 7th decades. In this case, 45-year-old male patient reported with occasional mild discomfort between left maxillary central and lateral incisor region since 1 year. Interproximally, a well-defined round radiolucent area with corticated borders was determined radiographically between vital tooth #21 and #22. Preliminary diagnosis of LPC was established based on clinical and radiographical findings. Following enucleation of the lesion, an anticipated residual tunnel osseous defect was observed, which was managed successfully utilizing bone graft and guided tissue regeneration-assisted technique. Cystic tissue removed was examined histologically; hematoxylin- and eosin-stained sections showed features suggestive of LPC. Complete healing of tunnel defect was achieved at 1 year follow-up.

  8. Development of porcine embryos reconstituted with somatic cells and enucleated metaphase I and II oocytes matured in a protein-free medium

    Directory of Open Access Journals (Sweden)

    Gibbons John R

    2001-07-01

    Full Text Available Abstract Background Many cloned animals have been created by transfer of differentiated cells at G0/G1 or M phase of the cell cycle into enucleated M II oocytes having high maturation/meiosis/mitosis-promoting factor activity. Because maturation/meiosis/mitosis-promoting factor activity during oocyte maturation is maximal at both M I and M II, M I oocytes may reprogram differentiated cell nuclei as well. The present study was conducted to examine the developmental ability in vitro of porcine embryos reconstructed by transferring somatic cells (ear fibroblasts into enucleated M I or M II oocytes. Results Analysis of the cell cycle stages revealed that 91.2 ± 0.2% of confluent cells were at the G0/G1 phase and 54.1 ± 4.4% of nocodazole-treated cells were at the G2/M phase, respectively. At 6 h after activation, nuclear swelling was observed in 50.0-88.9% and 34.4-39.5% of embryos reconstituted with confluent cells and nocodazole-treated cells regardless of the recipient oocytes, respectively. The incidence of both a swollen nucleus and polar body was low (6.3-10.5% for all nocodazole-treated donor cell regardless of the recipient oocyte. When embryos reconstituted with confluent cells and M I oocytes were cultured, 2 (1.5% blastocysts were obtained and this was significantly (P Conclusions Porcine M I oocytes have a potential to develop into blastocysts after nuclear transfer of somatic cells.

  9. Learning transurethral resection of the prostate: A comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy.

    Science.gov (United States)

    Nnabugwu, I I; Ugwumba, F O; Udeh, E I; Ozoemena, O F

    2017-12-01

    Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource-poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource-poor settings where the traditional master-apprentice (Halstedian) approach has remained the prevalent training technique. We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. Twenty patients' files for TURP and twenty-eight patients' files for ORP met the inclusion criteria. Patients in the 2 treatment arms were similar in age (P = 0.22), body mass index (P = 0.45), proportion of prostate tissue extirpated (P = 0.38), and International Prostate Symptom Score 12-month postprocedure (P = 0.06). However, larger prostates were treated with ORP (P r = 0.78; P r = 0.89; P r = 0.23; P = 0.33) and ORP (r = 0.292; P = 0.13), with no evidence of any difference between the 2 correlation values (P = 0.84). With appropriate patient selection, especially as a newly trained Surgeon, resections in TURP are as complete as enucleations in ORP.

  10. Diffusion tensor imaging detects early cerebral cortex abnormalities in neuronal architecture induced by bilateral neonatal enucleation: An experimental model in the ferret

    Directory of Open Access Journals (Sweden)

    Andrew S Bock

    2010-10-01

    Full Text Available Diffusion tensor imaging (DTI is a technique that non-invasively provides quantitative measures of water translational diffusion, including fractional anisotropy (FA, that are sensitive to the shape and orientation of cellular elements, such as axons, dendrites and cell somas. For several neurodevelopmental disorders, histopathological investigations have identified abnormalities in the architecture of pyramidal neurons at early stages of cerebral cortex development. To assess the potential capability of DTI to detect neuromorphological abnormalities within the developing cerebral cortex, we compare changes in cortical FA with changes in neuronal architecture and connectivity induced by bilateral enucleation at postnatal day 7 (BEP7 in ferrets. We show here that the visual callosal pattern in BEP7 ferrets is more irregular and occupies a significantly greater cortical area compared to controls at adulthood. To determine whether development of the cerebral cortex is altered in BEP7 ferrets in a manner detectable by DTI, cortical FA was compared in control and BEP7 animals on postnatal day 31. Visual cortex, but not rostrally-adjacent non-visual cortex, exhibits higher FA than control animals, consistent with BEP7 animals possessing axonal and dendritic arbors of reduced complexity than age-matched controls. Subsequent to DTI, Golgi staining and analysis methods were used to identify regions, restricted to visual areas, in which the orientation distribution of neuronal processes is significantly more concentrated than in control ferrets. Together, these findings suggest that DTI can be of utility for detecting abnormalities associated with neurodevelopmental disorders at early stages of cerebral cortical development, and that the neonatally-enucleated ferret is a useful animal model system for systematically assessing the potential of this new diagnostic strategy.

  11. Holmium(III)-selective fluorimetric optode based on N,N-bis(salicylidene)-naphthylene-1,8-diamine as a neutral fluorogenic ionophore

    Science.gov (United States)

    Ganjali, Mohammad Reza; Hosseini, Morteza; Karimi, Anahita; Haji-Hashemi, Hedieh; Salavati-Niasari, Masoud; Norouzi, Parviz

    2014-03-01

    For the first time a highly sensitive and selective fluorimetric optode for determination of trace amounts of Ho3+ ions was prepared. The sensing system was prepared by incorporating of N,N-bis(salicylidene)-naphthylene-1,8-diamine (L) as a neutral Ho3+-selective fluoroionophore, in a plasticized PVC membrane containing sodium tetraphenyl borate as a lipophilic anionic additive. The response of the sensor is based on the strong fluorescence quenching of L by Ho3+ ions. At pH 5.4, the proposed sensor displays a calibration curve over a wide concentration range of 1.0 × 10-10-1.0 × 10-3 M, with a relatively fast response time of less than 1 min. In addition to high stability, high reproducibility and a relatively long working lifetime, the sensor shows a good selectivity towards Ho3+ ion with respect to common coexisting cations. The fluorescence optode was applied to determination of holmium ion contents of water samples.

  12. Magnetic susceptibilities and anisotropy studies of holmium pyrogermanate (Ho{sub 2}Ge{sub 2}O{sub 7}) crystal

    Energy Technology Data Exchange (ETDEWEB)

    Jana, S.; Ghosh, D. [Indian Association for the Cultivation of Science, Calcutta (India). Dept. of Solid State Physics; Wanklyn, B.M. [Clarendon Laboratory, University of Oxford, Oxford (United Kingdom)

    1998-03-01

    Experimental results of the magnetic susceptibilities (K {sub parallel}, K {sub perpendicular} {sub to}) and the anisotropy (K {sub perpendicular} {sub to} -K {sub parallel} ={Delta}K) of a single crystal of holmium pyrogermanate between 300 and 27 K are reported for the first time. At 300 K, {Delta}K is 4835 x 10{sup -6} emu/mol (being 10% of the mean susceptibility anti K) but at 27 K it increases by 144 times, becoming 88% of anti K. Crystal field (CF) analysis of the results was made considering D{sub 5h} site symmetry. The observed data were best fitted with CF parameters B{sub 20}=-150; B{sub 20}=300; B{sub 60}=-400; B{sub 65}=1500 (all in cm{sup -1}). Using the ground CF energy pattern, Schottky specific heat and the hyperfine splittings of the ground and first nuclear levels of {sup 165}Ho in the pyrogermanate host were calculated. The values of quadrupolar splittings of ground and first nuclear states were found to be 28.15 x 10{sup -4} and 33.42 x 10{sup -4} cm{sup -1}, respectively at 1 K. Moessbauer spectra are expected to show 12 transition lines. (orig.) 40 refs.

  13. Mathematical modeling of laser linear thermal effects on the anterior layer of the human eye

    Science.gov (United States)

    Rahbar, Sahar; Shokooh-Saremi, Mehrdad

    2018-02-01

    In this paper, mathematical analysis of thermal effects of excimer lasers on the anterior side of the human eye is presented, where linear effect of absorption by the human eye is considered. To this end, Argon Fluoride (ArF) and Holmium:Yttrium-Aluminum-Garent (Ho:YAG) lasers are utilized in this investigation. A three-dimensional model of the human eye with actual dimensions is employed and finite element method (FEM) is utilized to numerically solve the governing (Penne) heat transfer equation. The simulation results suggest the corneal temperature of 263 °C and 83.4 °C for ArF and Ho:YAG laser radiations, respectively, and show less heat penetration depth in comparison to the previous reports. Moreover, the heat transfer equation is solved semi-analytically in one-dimension. It is shown that the exploited simulation results are also consistent with those derived from the semi-analytical solution of the Penne heat transfer equation for both types of laser radiations.

  14. High-Resolution In Vivo Imaging of Regimes of Laser Damage to the Primate Retina

    Directory of Open Access Journals (Sweden)

    Ginger M. Pocock

    2014-01-01

    Full Text Available Purpose. To investigate fundamental mechanisms of regimes of laser induced damage to the retina and the morphological changes associated with the damage response. Methods. Varying grades of photothermal, photochemical, and photomechanical retinal laser damage were produced in eyes of eight cynomolgus monkeys. An adaptive optics confocal scanning laser ophthalmoscope and spectral domain optical coherence tomographer were combined to simultaneously collect complementary in vivo images of retinal laser damage during and following exposure. Baseline color fundus photography was performed to complement high-resolution imaging. Monkeys were perfused with 10% buffered formalin and eyes were enucleated for histological analysis. Results. Laser energies for visible retinal damage in this study were consistent with previously reported damage thresholds. Lesions were identified in OCT images that were not visible in direct ophthalmoscopic examination or fundus photos. Unique diagnostic characteristics, specific to each damage regime, were identified and associated with shape and localization of lesions to specific retinal layers. Previously undocumented retinal healing response to blue continuous wave laser exposure was recorded through a novel experimental methodology. Conclusion. This study revealed increased sensitivity of lesion detection and improved specificity to the laser of origin utilizing high-resolution imaging when compared to traditional ophthalmic imaging techniques in the retina.

  15. Lasers technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2014-07-01

    The Laser Technology Program of IPEN is developed by the Center for Lasers and Applications (CLA) and is committed to the development of new lasers based on the research of new optical materials and new resonator technologies. Laser applications and research occur within several areas such as Nuclear, Medicine, Dentistry, Industry, Environment and Advanced Research. Additional goals of the Program are human resource development and innovation, in association with Brazilian Universities and commercial partners.

  16. Laser handbook

    CERN Document Server

    Bass, Michael

    1985-01-01

    Volume 4 of the Laser Handbook continues the high standard set by the first three volumes which were widely acclaimed by numerous reviewers in Science, Optical Spectra and Laser Technology, as presenting an outstanding contribution to the field of laser technology.

  17. Microchip Lasers

    Science.gov (United States)

    2016-10-31

    USA E-mail: zayhowski@ll.mit.edu Abstract Microchip lasers are a rich family of solid-state lasers defined by their small size, robust integration...reliability, and potential for low-cost mass production. Continuous-wave microchip lasers cover a wide range of wavelengths, often operate single

  18. Lasers (Rev.)

    Energy Technology Data Exchange (ETDEWEB)

    Hellman, Hal

    1969-01-01

    A laser is an instrument that produces an enormously intense pencil-thin beam of light. In this booklet we shall learn what there is about the laser that gives it so much promise. We shall investigate what it is, how it works, and the different kinds of lasers there are.

  19. Generation of 70-fs pulses at 286 μm from a mid-infrared fiber laser

    Science.gov (United States)

    Woodward, R. I.; Hudson, D. D.; Fuerbach, A.; Jackson, S. D.

    2017-12-01

    We propose and demonstrate a simple route to few-optical-cycle pulse generation from a mid-infrared fiber laser through nonlinear compression of pulses from a holmium-doped fiber oscillator using a short length of chalcogenide fiber and a grating pair. Pulses from the oscillator with 265-fs duration at 2.86 {\\mu}m are spectrally broadened through self-phase modulation in step-index As2S3 fiber to 141-nm bandwidth and then re-compressed to 70 fs (7.3 optical cycles). These are the shortest pulses from a mid-infrared fiber system to date, and we note that our system is compact, robust, and uses only commercially available components. The scalability of this approach is also discussed, supported by numerical modeling.

  20. Laser photocoagulation - eye

    Science.gov (United States)

    Laser coagulation; Laser eye surgery; Photocoagulation; Laser photocoagulation - diabetic eye disease; Laser photocoagulation - diabetic retinopathy; Focal photocoagulation; Scatter (or pan retinal) photocoagulation; Proliferative ...

  1. Effects of ginkgo biloba extract on laser-induced choroidal neovascularization in rats

    Directory of Open Access Journals (Sweden)

    Chao Chen

    2013-11-01

    Full Text Available AIM: To investigate the effects of ginkgo biloba extract(EGb 761on laser-induced choroidal neovascularization(CNVin rats.METHODS: Totally 60 BN rats were randomly divided into 4 groups: normal control group, model group, experimental group, physiological saline group with 15 in each group. All CNV models were made by krypton laser. Rats in experimental group were intraperitoneally injected with 0.35% EGb761(100mg/kgevery day after laser exposure until they were sacrificed. Rats in physiological saline group were intraperitoneally injected physiological saline every day after laser exposure until they were sacrificed. Fundus fluorescein angiography(FFAwas performed on every rat on the 7th day, 14th day and the 21st day after laser exposure, then the rats were sacrificed immediately. The eyes were enucleated and processed for histopathologic examination.RESULTS: There was no choroidal fluorescein leakage staining in normal rats. There were obviously less choroidal fluorescein leakage points in experimental groups than that in the corresponding model groups(PCONCLUSION: EGb761 len inhibit the formation of laser-induced CNV in rats. The longer the time, the better curative effect.

  2. The effect of nonablative laser energy on joint capsular properties. An in vitro histologic and biochemical study using a rabbit model

    Science.gov (United States)

    Hayashi, K.; Thabit, G. 3rd; Vailas, A. C.; Bogdanske, J. J.; Cooley, A. J.; Markel, M. D.

    1996-01-01

    The purpose of this study was to evaluate the effect of laser energy at nonablative levels on joint capsular histologic and biochemical properties in an in vitro rabbit model. The medial and lateral portions of the femoropatellar joint capsule from both stifles of 12 mature New Zealand White rabbits were used. Specimens were divided into three treatment groups (5 watts, 10 watts, and 15 watt) and one control group using a randomized block design. Specimens were placed in a 37 degrees bath of lactated Ringer's solution and laser energy was applied using a holmium:yttrium-aluminum-garnet laser in four transverse passes across the tissue at a velocity of 2 mm/sec with the handpiece set 1.5 mm from the synovial surface. Histologic analysis revealed thermal alteration of collagen (fusion) and fibroblasts (pyknosis) at all energy densities, with higher laser energy causing significantly greater morphologic changes over a larger area (P 0.05). This study demonstrated that nonablative laser energy caused significant thermal damage to the joint capsular tissue in an energy-dependent fashion, but type I collagen content and nonreducible crosslinks (P > 0.05). This study demonstrated that nonablative laser energy caused significant thermal damage to the joint capsular tissue in an energy-dependent fashion, but type I Collagen content and nonreducible corsslinks were not significantly altered.

  3. Five years follow-up of a keratocyst odontogenic tumor treated by marsupialization and enucleation: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Rafael Scaf de Molon

    2015-01-01

    Full Text Available Odontogenic cysts are considered as nonneoplasic benign lesions. Among the cysts, keratocyst odontogenic tumor (KCOT is an intra-osseous tumor characterized by parakeratinized stratified squamous epithelium and a potential for aggressive, infiltrative behavior, and for the possibility to develop carcinomas in the lesion wall. Thus, the aim of this study was to describe a clinical case of KCOT in a young patient and discuss the treatment alternatives to solve this case. A 15-year-old male was referred for treatment of a giant lesion in his left side of the mandible. After the biopsy, a diagnostic of KCOT was made, and the following procedures were planned for KCOT treatment. Marsupialization was performed for lesion decompression and consequent lesion size reduction. Afterward, enucleation for complete KCOT removal was performed followed by third mandibular molar extraction. After 5 years, no signs of recurrence were observed. The treatment proposed was efficient in removing the KCOT with minimal surgical morbidity and optimal healing process, and the first and second mandibular molars were preserved with pulp vitality. In conclusion, this treatment protocol was an effective and conservative approach for the management of the KCOT, enabling the reduction of the initial lesion, the preservation of anatomical structures and teeth, allowing quicker return to function. No signs of recurrence after 5 years were observed.

  4. [Transurethral bipolar plasmakinetic enucleation and resection versus transurethral bipolar plasmakinetic resection of the prostate for BPH: a randomized controlled trial on the incidence of postoperative urinary incontinence].

    Science.gov (United States)

    Liu, Jun-Feng; Liu, Chun-Xiao; Tan, Zhao-Hui; Li, San-Xiang; Li, Xing-Zhi; Chi, Ning

    2014-02-01

    To compare the incidence rates of postoperative urinary incontinence between transurethral bipolar plasmakinetic enucleation and resection of the prostate (PKERP) and transurethral bipolar plasmakinetic resection of the prostate (PKRP), and provide evidence for the clinical application of PKERP. Totally, 180 BPH patients were equally and randomly assigned to undergo PKERP and PKRP, respectively. We measured the urinary incontinence of the patients by pad test at 24 hours after extubation and every week after surgery for 4 weeks. Meanwhile, we recorded and compared the PSA level, prostate volume, Qmax, residual urine, IPSS, QOL, and the results of pad test between the two groups before and after surgery. The incidence rates of urinary incontinence in the PKERP and PKRP groups were 35.56% and 18.89% (P 0.05). No permanent urinary incontinence was observed in either group. Compared with PKRP, PKERP has a higher incidence rate of short-term urinary incontinence in the treatment of BPH, but not that of genuine incontinence, with similar severity and recovery time.

  5. Penetration of 0.3% ciprofloxacin, 0.3% ofloxacin, and 0.5% moxifloxacin into the cornea and aqueous humor of enucleated human eyes.

    Science.gov (United States)

    Silva, G C M; Jabor, V A P; Bonato, P S; Martinez, E Z; Faria-E-Sousa, S J

    2017-07-03

    We aimed to quantify the penetration of ciprofloxacin, ofloxacin, and moxifloxacin into the cornea and aqueous humor of cadaver eyes. A total of 60 enucleated eyes, not eligible for corneal transplantation, were divided into three groups and immersed in commercial solutions of 0.3% ciprofloxacin, 0.3% ofloxacin, or 0.5% moxifloxacin for 10 min. Whole corneas and samples of aqueous humor were then harvested and frozen, and drug concentrations analyzed by liquid chromatography tandem mass spectrometry. The mean corneal concentration of moxifloxacin was twice as high as ofloxacin, and the latter was twice as high as ciprofloxacin. The mean concentration of moxifloxacin in the aqueous humor was four times higher than the other antibiotics, and the mean concentrations of ciprofloxacin and ofloxacin were statistically similar. The amount of drug that penetrated the anterior chamber after a 10-min immersion was far below the safe limit of endothelial toxicity of each preparation. Moxifloxacin demonstrated far superior penetration into the cornea and anterior chamber of cadaver eyes compared to ciprofloxacin and ofloxacin. One should not expect endothelial toxicity with the commercial eye drops of ciprofloxacin, ofloxacin, and moxifloxacin that reach the anterior chamber through the cornea.

  6. A Miniaturized, 1.9F Integrated Optical Fiber and Stone Basket for Use in Thulium Fiber Laser Lithotripsy.

    Science.gov (United States)

    Wilson, Christopher R; Hutchens, Thomas C; Hardy, Luke A; Irby, Pierce B; Fried, Nathaniel M

    2015-10-01

    The thulium fiber laser (TFL) is being explored as an alternative laser lithotripter to the standard holmium:yttrium-aluminum-garnet laser. The more uniform beam profile of the TFL enables higher power transmission through smaller fibers. In this study, a 100-μm core, 140-μm outer-diameter (OD) silica fiber with 5-mm length hollow steel tip was integrated with 1.3F (0.433-mm OD) nitinol wire basket to form a 1.9F (0.633-mm OD) device. TFL energy of 30 mJ, 500 μs pulse duration, and 500 Hz pulse rate was delivered to human uric acid stones, ex vivo. Stone ablation rates measured 1.5 ± 0.2 mg/s, comparable to 1.7 ± 0.3 mg/s using bare fiber tips separately with stone basket. With further development, this device may minimize stone retropulsion, allowing more efficient TFL lithotripsy at higher pulse rates. It may also provide increased flexibility, higher saline irrigation rates through the ureteroscope working channel, reduce fiber degradation compared with separate fiber and basket manipulation, and reduce laser-induced nitinol wire damage.

  7. Biocavity Lasers

    Energy Technology Data Exchange (ETDEWEB)

    Gourley, P.L.; Gourley, M.F.

    2000-10-05

    Laser technology has advanced dramatically and is an integral part of today's healthcare delivery system. Lasers are used in the laboratory analysis of human blood samples and serve as surgical tools that kill, burn or cut tissue. Recent semiconductor microtechnology has reduced the size o f a laser to the size of a biological cell or even a virus particle. By integrating these ultra small lasers with biological systems, it is possible to create micro-electrical mechanical systems that may revolutionize health care delivery.

  8. Novel fiber optic tip designs and devices for laser surgery

    Science.gov (United States)

    Hutchens, Thomas Clifton

    Fiber optic delivery of laser energy has been used for years in various types of surgical procedures in the human body. Optical energy provides several benefits over electrical or mechanical surgery, including the ability to selectively target specific tissue types while preserving others. Specialty fiber optic tips have also been introduced to further customize delivery of laser energy to the tissue. Recent evolution in lasers and miniaturization has opened up opportunities for many novel surgical techniques. Currently, ophthalmic surgeons use relatively invasive mechanical tools to dissect retinal deposits which occur in proliferative diabetic retinopathy. By using the tight focusing properties of microspheres combined with the short optical penetration depth of the Erbium:YAG laser and mid-IR fiber delivery, a precise laser scalpel can be constructed as an alternative, less invasive and more precise approach to this surgery. Chains of microspheres may allow for a self limiting ablation depth of approximately 10 microm based on the defocusing of paraxial rays. The microsphere laser scalpel may also be integrated with other surgical instruments to reduce the total number of handpieces for the surgeon. In current clinical laser lithotripsy procedures, poor input coupling of the Holmium:YAG laser energy frequently damages and requires discarding of the optical fiber. However, recent stone ablation studies with the Thulium fiber laser have provided comparable results to the Ho:YAG laser. The improved spatial beam profile of the Thulium fiber laser can also be efficiently coupled into a fiber approximately one third the diameter and reduces the risk of damaging the fiber input. For this reason, the trunk optical fiber minus the distal fiber tip can be preserved between procedures. The distal fiber tip, which degrades during stone ablation, could be made detachable and disposable. A novel, low-profile, twist-locking, detachable distal fiber tip interface was designed

  9. High power lasers & systems

    OpenAIRE

    Chatwin, Chris; Young, Rupert; Birch, Philip

    2015-01-01

    Some laser history;\\ud Airborne Laser Testbed & Chemical Oxygen Iodine Laser (COIL);\\ud Laser modes and beam propagation;\\ud Fibre lasers and applications;\\ud US Navy Laser system – NRL 33kW fibre laser;\\ud Lockheed Martin 30kW fibre laser;\\ud Conclusions

  10. Lasers technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    The Lasers Technology Program of IPEN is strongly committed to the study of Laser Applications on several areas: Nuclear, Medicine and Dentistry, Industry, Environment and Advanced research, aiming not only research but diffusion and innovation in association with Brazilian universities and commercial partners.

  11. [European Association of Urology guidelines on laser technologies].

    Science.gov (United States)

    Herrmann, T R W; Liatsikos, E N; Nagele, U; Traxer, O; Merseburger, A S

    2013-02-01

    The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for

  12. Experimental microendoscopic photoablative laser goniotomy as a surgical model for the treatment of dysgenetic glaucoma.

    Science.gov (United States)

    Jacobi, P C; Dietlein, T S; Krieglstein, G K

    1996-11-01

    The aim of this study was to investigate the feasibility of photoablative Er:YAG laser goniotomy under microendoscopic control in a surgical cloudy corneal model of primary infantile glaucoma. Pectinate ligaments of 12 freshly enucleated cadaver porcine eyes were treated by ab interno single-pulse (5 mJ, 200 microseconds) Er:YAG laser (2.94 microns) photoablation. Through a clear corneal incision near the limbus an ophthalmic microendoscope (18 and 20 gauge) was inserted into the anterior chamber. Internal structures were observed and photoablative laser goniotomy was conducted under video guidance. Following treatment all eyes were prepared for light and scanning electron microscopy. Anterior chamber angle structures and tissue photoablation were clearly visualized on the videoscreen using ophthalmic microendoscopy. Energy settings of 5 mJ per pulse proved to be sufficient for reproducible photoablation of pectinate ligaments, accompanied by the root of the iris falling back and exposing trabecular meshwork. This was confirmed histopathologically. Scatter thermal damage was less than 30 microns. This new therapeutic modality, which combines endoscopic visualization of the internal structures with photoablative laser goniotomy, can be effective in the management of dysgenetic glaucoma in the presence of a cloudy cornea. High reproducibility of contact laser photoablation enabled sufficient control of incision depth and was not accompanied by inadvertent tissue damage to adjacent intraocular structures.

  13. Laser device

    Science.gov (United States)

    Scott, Jill R.; Tremblay, Paul L.

    2008-08-19

    A laser device includes a virtual source configured to aim laser energy that originates from a true source. The virtual source has a vertical rotational axis during vertical motion of the virtual source and the vertical axis passes through an exit point from which the laser energy emanates independent of virtual source position. The emanating laser energy is collinear with an orientation line. The laser device includes a virtual source manipulation mechanism that positions the virtual source. The manipulation mechanism has a center of lateral pivot approximately coincident with a lateral index and a center of vertical pivot approximately coincident with a vertical index. The vertical index and lateral index intersect at an index origin. The virtual source and manipulation mechanism auto align the orientation line through the index origin during virtual source motion.

  14. Laser instrument

    Energy Technology Data Exchange (ETDEWEB)

    Cabrera, R.J.; Eagar, T.W.

    1986-04-08

    An instrument is described for intercepting a carbon dioxide incident laser beam after it has energized a desired surgical target site but before it energizes material adjacent to the surgical target site. The instrument consists of: a substrate means for transmitting energy received from a laser beam away from a surgical target site, the substrate means having a high thermal conductivity and an exterior surface; a coating means for absorbing laser energy at the wavelength of a carbon dioxide laser, the coating means covering substantially the entirety of the exterior surface of the substrate means and having a high absorptivity for energy at the wavelength of the incident laser beam; and, the coating means having thickness which is large enough to provide high absorptivity but small enough to permit absorbed energy to be readily transferred to the high conductivity substrate means, and the thickness of the coating means being not greater than 0.001 inch.

  15. Generation of 70-fs pulses at 2.86  μm from a mid-infrared fiber laser.

    Science.gov (United States)

    Woodward, R I; Hudson, D D; Fuerbach, A; Jackson, S D

    2017-12-01

    We propose and demonstrate a simple route to few-optical-cycle pulse generation from a mid-infrared fiber laser through nonlinear compression of pulses from a holmium-doped fiber oscillator using a short length of chalcogenide fiber and a grating pair. Pulses from the oscillator with 265-fs duration at 2.86 μm are spectrally broadened through self-phase modulation in step-index As 2 S 3 fiber to 141-nm bandwidth and then re-compressed to 70 fs (7.3 optical cycles). These are the shortest pulses from a mid-infrared fiber system to date, and we note that our system is compact, robust, and uses only commercially available components. The scalability of this approach is also discussed, supported by numerical modeling.

  16. High throughput laser processing

    Energy Technology Data Exchange (ETDEWEB)

    Harley, Gabriel; Pass, Thomas; Cousins, Peter John; Viatella, John

    2016-12-27

    A solar cell is formed using a solar cell ablation system. The ablation system includes a single laser source and several laser scanners. The laser scanners include a master laser scanner, with the rest of the laser scanners being slaved to the master laser scanner. A laser beam from the laser source is split into several laser beams, with the laser beams being scanned onto corresponding wafers using the laser scanners in accordance with one or more patterns. The laser beams may be scanned on the wafers using the same or different power levels of the laser source.

  17. Comparison of survival among eligible patients not enrolled versus enrolled in the Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma.

    Science.gov (United States)

    Gilson, Marta M; Diener-West, Marie; Hawkins, Barbara S

    2007-01-01

    To compare survival between patients enrolled in the Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation therapy (PERT) for large choroidal melanoma and eligible patients who did not enroll. COMS clinical center personnel prospectively reported to the COMS Coordinating Center all patients with choroidal melanoma examined between November 1986 and December 1994. Deaths of enrolled patients were reported prospectively by clinical center personnel. In a COMS ancillary study, we retrospectively searched medical records of participating clinical centers, the Social Security Death Index, and the National Death Index to determine vital status of eligible patients not enrolled. Cox proportional hazards analysis was used to compare survival within 10 years of baseline reporting and before July 31, 2000, of enrolled patients versus eligible patients not enrolled. Clinical centers that received local institutional review board approval to participate in this ancillary study prospectively reported on 129 of 299 eligible patients not enrolled in the COMS PERT trial. The baseline characteristics of the 129 patients included in this ancillary study were similar to those of the 170 patients not included; 73 patients were reported as deceased. Previously identified prognostic covariates, i.e., age and longest tumor diameter, were confirmed to predict survival in both enrolled patients and eligible patients not enrolled; trial enrollment was not predictive. After adjusting for prognostic covariates and stratifying by clinical center, the estimated hazard ratio (enrolled vs. not-enrolled) was 1.12 (95% confidence interval: 0.83 to 1.51). The results of the COMS PERT trial should be generalizable to all patients with choroidal melanoma meeting the eligibility criteria for that trial. While the methods we used may not be generalizable to all clinical trials because of unique features of the COMS, other researchers may be able to use similar methods

  18. Histopathologic evaluation of the anterior segment of eyes enucleated due to glaucoma secondary to primary lens displacement in 13 canine globes.

    Science.gov (United States)

    Alario, Anthony F; Pizzirani, Stefano; Pirie, Christopher G

    2013-07-01

    PURPOSE  To describe histologic anterior segment changes in eyes affected with primary lens displacement (PLD) and secondary glaucoma. METHODS  Histologic sections stained with H&E from canine eyes enucleated because of PLD and secondary glaucoma were examined. RESULTS  Thirteen eyes from 12 patients were evaluated. Four dogs were castrated males and eight spayed females. Median age was 8 years of age (range 3-13). Breeds included seven terriers and five other breeds. All eyes examined demonstrated varying degrees of inflammation involving the iris and cleft. Mononuclear and melanophagic infiltration of the cleft was found in all specimens. Four globes also showed polymorphonuclear infiltrate. Pre-iridal fibrovascular membranes were clearly identified in 10 of 13 eyes. Total inflammatory score was significantly greater in all globes examined compared with an age-matched group of normal dogs. The posterior pigmented iris epithelium demonstrated a consistent pattern of hyperplasia and/or hypertrophy and cystic degeneration, more prominent in the more central regions. In some cases, hyperplasia was of greatest severity in the mid-iris and associated with thinning or flattening of the pupillary region. CONCLUSIONS  These results suggest that lens instability may be associated with chronic inflammation and secondary glaucoma. Mechanical irritation from an unstable lens may result in hypertrophy and/or hyperplasia of the posterior pigmented iris epithelium and subsequent cellular exfoliation and release of melanin. An inflammatory reaction directly or indirectly related to melanin release may obstruct the outflow pathways ultimately leading to glaucoma and loss of vision. Use of topical steroids may be warranted in dogs with PLD. © 2012 American College of Veterinary Ophthalmologists.

  19. [Transurethral plasmakinetic enucleation of prostate and suprapubic small cut in the treatment of high risk and senior patient with benign prostatic hyperplasia and bladder stones].

    Science.gov (United States)

    Yu, Xiao-xiang; Zhang, Rui-ming; Zhou, Da-qing; Mo, Zeng-nan; Li, Wen-gang; Wang, Qiang; Wang, Jian; Jiang, Bo; Deng, Cheng-hui; Pang, Xiang

    2013-02-26

    To explore the safety and efficiency of transurethral plasmakinetic enucleation of prostate (TUPKEP) and suprapubic small cut in the treatment of high-risk and senior patients with benign prostatic hyperplasia and bladder stones. A retrospective review was conducted for 68 high-risk and senior patients with benign prostatic hyperplasia and bladder stones. All of them were treated by TUPKEP and suprapubic small cut. Operation was successfully performed in all 68 cases. And there was no instance of transurethral resection syndrome, shock, myocardial infarct, cerebral infarction, cerebral hemorrhage, permanent urinary incontinence or surgical site infection. Seven patients with temporal urinary incontinence recovered at a mean time of (9.48 ± 1.52) days post-operation. The mean operative duration was (48.63 ± 4.14) min and the mean volume of blood loss (50.97 ± 5.33) ml. The changes of maximum flow rate (Qmax), international prostatic symptom score (I-PSS) and quality-of-life (QOL) were statistically significant before and after operation. Qmax increased from (4.56 ± 0.35) to (18.82 ± 1.65) ml/s (P < 0.001), I-PSS decreased form (21.96 ± 1.89) to (11.23 ± 0.86) (P = 0.018) and QOL decreased from (4.94 ± 0.35) to (1.95 ± 0.32) (P = 0.011). The approach of TUPKEP and suprapubic small cut is both safe and effective in the treatment of high-risk and senior patient with benign prostatic hyperplasia and bladder stones and should be widely applied.

  20. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Lin, Youcheng; Wu, Xun; Xu, Abai; Ren, Rui; Zhou, Xueqiong; Wen, Yong; Zou, Yong; Gong, Mancheng; Liu, Chunxiao; Su, Zexuan; Herrmann, Thomas R W

    2016-09-01

    To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH). Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software. Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma. TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation "gold standard" of surgery for large BPH.

  1. Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes >80 mL: a prospective randomized study.

    Science.gov (United States)

    Ou, Rubiao; Deng, Xiangrong; Yang, Wenjun; Wei, Xinghua; Chen, Hui; Xie, Keji

    2013-07-01

    To compare the efficacy and safety of transurethral enucleation and resection of the prostate (TUERP) and transvesical prostatectomy (TVP) for patients with benign prostatic hyperplasia (BPH) and prostate volumes >80 mL. A total of 100 patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and enrolled in the study at a tertiary hospital. Patients underwent TVP or TUERP performed by one of two surgeons with experience of a large number of cases. All patients were preoperatively evaluated using patient age, prostate volume measurement, clinical characteristics of digital rectal examination, self-assessment using the International Prostate Symptom Scores (IPSS) questionnaire, a quality-of-life (QoL) questionnaire, maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), urine analysis, blood sample analysis, including determination of prostate-specific antigen (PSA) and haemoglobin concentration. All patients were assessed peri-operatively and postoperatively at 3 and 12 months. All complications were documented. Of 100 patients eligible to participate, 92 patients completed 12 months of follow-up. Patients who underwent TUERP had shorter catheterization times and hospital stays. Operation duration was not significantly different between the two surgical groups (P = 0.107). The resected adenoma weight in the TVP group was more than that in the TUERP group, but the difference was not significant (P = 0.062). There were no significant differences in IPSS, PVR, Qmax or QoL scores between the groups at 3 and 12 months. The patients in the TVP group appeared to have a better Qmax at 3 months, however, the difference was not significant (P = 0.081). Adverse events were similar in the two groups. We found that TUERP had efficacy and safety equivalent to that of TVP for patients with BPH and prostate volume >80 mL. © 2013 BJU International.

  2. Bipolar plasmakinetic transurethral resection of the prostate vs. transurethral enucleation and resection of the prostate: pre- and postoperative comparisons of parameters used in assessing benign prostatic enlargement.

    Science.gov (United States)

    Zhang, K Y; Xing, J C; Chen, B S; Liu, C X; Lau, H W; Sim, H G; Foo, K T

    2011-10-01

    Transurethral enucleation and resection of the prostate (TUERP) may offer a better treatment for benign prostatic enlargement. We compared the perioperative parameters and outcome following bipolar plasmakinetic transurethral resection of the prostate (TURP) and TUERP. Data from two independent institutions were reviewed retrospectively. 50 and 45 consecutive patients were enrolled in the TURP and TUERP groups, respectively. Pre- and postoperative parameters, including prostatic specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPSS), quality of