Ambu aScope 4 disposable cystoscope - First in Canada case
Proud of our #Brunswick center to be the first #canadian site to use the #ambu aScope 4 #singleuse #cystoscope
@Ambu_Medical
for #BPH evaluation. Unbelievably quick setup, safe, secure and outstanding/unparalleled flexion& HD quality.
GREENLIGHT XPS ===> The following video highlights enucleation principles for the treatment of men with large >60-80g prostates. This segment involves the use of the Greenlight XPS system to make a 12-oclock incision down to the surgical capsule followed by laser dissection (peeling off) of the BPH adenoma. Once a pedicle of tissue is created between 3- and 5-oclock on this side, the XPS Moxy fibre can then be used to vaporize the bulk of the adenoma. The surgeon also has the choice to fully enucleate or chop the large piece into several pieces for later retrieval.
Another older laser technology is that of the DIODE 980nm laser. While it does provide great hemostasis, major draw backs to the diode and new mixed 980-1470nm EVOLVE laser is the slow tissue removal and much deeper tissue necrosis (up to 6-8mm of tissue damage). Several urologists are using this in north america since it can be done in the outpatient office setting rather than the OR /ambulatory surgical center thus rendering 3x monetary reimbursement.
==> http://www.ncbi.nlm.nih.gov/pubmed/?term=diode+laser+how+i+do+it+prostate+office
What is also more shocking is that the complications have been significantly higher with reported rates of urinary incontinence (14%), urethral stricture, secondary endoscopic procedures and high need for retreatment. Unfortunately, not all patients are well informed on the various lasers and wavelengths. As such, as part of proper informed consent, all men should be well versed on the pros-cons of the many prostate laser energies before committing to surgery. #BPH #laser #diode #evolve #980nm #prostate #complications
Another alternative to standard monopolar TURP is the use of bipolar TURP within saline solution. Monopolar surgery is commonly performed using glycine fluid - it is this solution which gets absorbed by the patient and causes electrolye abnormalities (called TURP syndrome). Here is the Olympus plasma button which causes tissue removal. Benefits to the urologist is the lack of any learning curve since the hand gestures are the same. Limitations are the extent of tissue ablation. Most often a channel is made and not all transition tissue is treated - which leads to future retreatment.
Mr. GP - end of case demonstration of the bloodless, WIDE open prostate central defect. The surgical endpoint is the capsule between the bladder neck and the urinary sphincter. Incredible results and fast recovery. From fully blocked to urinating like a young man in 24 hrs.
The following small video segment allows one to appreciate the tissue morcellator to remove any enucleated tissues
Holmium laser BPH surgery has been well studied and reported on over the last 15 yrs. HOLEP has been one of the most well scientifically studied laser BPH procedures with significantly less patient risk and complication to standard TURP and open simple prostatectomy, especially for larger prostates >80g.
Dr. Peter Gilling, Dr. Jim Lingeman and my mentor Dr. Mostifa ElHilali are true experts of Holmium Enucleation of the prostate (HOLEP). The following video demonstrates the precision of the 2100nm laser fibre and the minimal tissue damage it creates. Long learning curves, time to complete procedures and need for secondary equipment/morcellation (and risks thereof) have limited the global usage of HOLEP unfortunately. Nevertheless, the outcomes (<1% retreatment rates for BPH at 10 yrs, 70-80% PSA reductions and true ability to circumferentially treat prostate adenoma down to the surgical capsule) should be the common outcomes for ALL MEN undergoing laser procedures.
The following video highlights the quick speed of loop electrical resection of cylinder prostate chips. The cut pieces move into the bladder and are later retreived. Unfortunately, the cut current is not great for bleeding control (hemostasis) and most/all TURP patients standardly have 3-way larger Foley catheters after surgery to continue rinsing the bladder after surgery until the bleeding stops. This is the main reason why patients are hospitalized for such a longer time.
