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High-Intensity Focused Ultrasound (HIFU)
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
HIFU treatment does offer some advantages over other methods of thermal ablation. It is minimally invasive and it does not rely on radiation, allowing for repetition without any long-term effects. However, as in the case of ultrasound, HIFU sound waves do not readily pass through solid structures or air. Additionally, HIFU requires the use of general anesthesia and larger glands require larger treatment times. The procedure itself involves placement of a HIFU transducer covered by a condom in the rectum. To help diminish the thermal effects on the rectum during the HIFU procedure, the rectum is generally irrigated with cold and degassed water concurrently with the real-time ultrasound. HIFU-treated lesions can become visible as hyperechoic areas in real time. Traditionally, this is a same-day procedure performed under general anesthesia that typically lasts 1–3 hours, depending on the size of the gland. Generally, the patient will have bladder drainage via a urethral catheter or suprapubic catheter for 2 weeks. If the patient has a concomitant transurethral resection of the prostate (TURP), then the urethral catheter is generally left only for a few days.
The prostate and seminal vesicles
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In men who are very concerned about the development of sexual dysfunction after transurethral resection of the prostate (TURP), the use of drugs may be helpful. Two classes of drug have been used in the treatment of men with BOO. Alpha-adrenergic blocking agents inhibit the contraction of smooth muscle that is found in the prostate. The other class of drug is the 5a-reductase inhibitors, which inhibit the conversion of testosterone to DHT, the most active form of androgen. These drugs, when taken for a year, result in a 25% shrinkage of the prostate gland. Both groups of drugs are effective; however, a-blockers work more quickly and, although the 5 a-reductase inhibitors have fewer side effects, they need to be taken for at least 6 months, and their effect is greatest in patients with large (>50 g) glands. Drug therapy results in improvements in maximum flow rates by about 2 mL/s more than placebo and results in a mild (20%) improvement in symptom scores. TURP, however, results in improvements in maximum flow rates from 9-18 mL/s and a 75% improvement in symptom scores. These drugs are expensive in comparison with their effectiveness, and a significant proportion of men who try these drugs will subsequently undergo TURP. They may be best targeted at men who have failed an initial trial of watchful waiting and who wish to avoid surgery for a period.
Urology
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Bladder cancer is the most common malignancy of the urinary tract; the incidence is four times higher in men than in women. Tumours are divided into those which invade the muscle (muscle-invasive bladder cancer) and those that do not (non-muscle-invasive bladder cancer). Trans-urethral resection of bladder tumour (TURBT) is the first-line treatment for patients with non-muscle-invasive bladder cancer. This procedure is similar to trans-urethral resection of the prostate (TURP), as is the anaesthetic management. During endoscopic resection, if the tumour lies over the obturator nerve electrocautery can cause adduction of the lower limb–muscle relaxation may be required. The high rate of recurrence and progression after TURBT necessitates the use of adjuvant treatments, and repeat cystoscopies.
Oxford’s clinical experience in the development of high intensity focused ultrasound therapy
Published in International Journal of Hyperthermia, 2021
Ishika Prachee, Feng Wu, David Cranston
HIFU has been shown to be a very promising approach for prostate conditions, especially prostate cancer. More than 100 sites across Europe use trans-rectal HIFU therapy [2]. Currently, Sonablate®500 (Focus Surgery, Indianapolis, IN, USA), an American transrectal machine, is being used in Oxford for HIFU treatment of prostate cancer. The success of this can have a significant impact on the key treatment modalities used for prostate cancer. Whole gland therapy with transrectal US-guidance has an unwanted side effect profile including acute urinary symptoms; transurethral resection of the prostate (TURP) is therefore sometimes required prior or post-HIFU. However, HIFU is a favourable method for focal ablation. This minimises the effects of whole gland ablation including sexual, urinary and bowel side effects.
Reduced bleeding with DRY CUT® transurethral resection of the prostate (TURP) compared to standard TURP
Published in Scandinavian Journal of Urology, 2019
Carin Sjöström, Mats Bergkvist, Helena Thulin, Anders Kjellman, Andreas Thorstenson
This material represents all the patients who underwent transurethral resection of the prostate during 4 years of standard TURP and 4 years of DRY CUT® TURP at our institution. The large number of patients and the similarity of the two groups increase the validity of the data. There was no randomization between the groups, which is a limitation. Data was retrospectively collected from medical charts in a standardized fashion. Due to the retrospective design, data is missing in some patients. Somewhat surprisingly, we found that the preoperative prostate volume was not reported in a substantial number of patients, especially in the first study period. The method of calculating bleeding by measuring haemoglobin in irrigation fluid is established, but since that method was not used at all times, especially when the perioperative bleeding was very limited this is a weakness to the method.
Transurethral Resection of the Prostate: are We Following the Guidelines? - Outcomes from the Global Prevalence of Infections in Urology (GPIU) Study
Published in Journal of Chemotherapy, 2019
Bela Köves, Peter Tenke, Zafer Tandogdu, Tommaso Cai, Florian Bogenhard, Björn Wullt, Kurt Naber, Riccardo Bartoletti, Mete Cek, Ekaterina Kulchavenya, Tamara Perepanova, Adrian Pilatz, Gernot Bonkat, Truls Erik Bjerklund Johansen, Florian Wagenlehner
Transurethral resection of the prostate (TURP) is one of the most commonly performed urological procedures worldwide. Perioperative infectious complication rates remain unclear and literature reports indicate a wide range of 1–26%,1 with 1–4% rate of urosepsis.1 To prevent the risk of these infectious complications, the Guidelines on Urological Infections of the European Association of Urology (EAU)2 provide detailed recommendations regarding infection control measures for TURP procedures, similarly to other relevant international guidelines.3–5 The most important measures are preoperative microbiological investigations, catheter care and perioperative antibiotic prophylaxis. Urine cultures should always be performed before endourological procedures to identify asymptomatic bacteriuria which requires preoperative treatment. Since bacterial colonization of indwelling catheters is inevitable in case of long-term catheterization, they should be replaced, if in place for more than 7 days. Perioperative antibiotic prophylaxis can effectively decrease the risk of infectious complications associated with TURP, therefore the administration of perioperative antibiotics is mandatory.