In vitro comparison of the vaporesection of human benign prostatic hyperplasia using 70-and 120-W 2μm lasers

The purpose of the current ex vivo study was to compare the speed of vaporesection of human prostatic tissue with benign prostatic hyperplasia （BPH） and the depth of tissue damage using 70- and 120-W 2-tim laser devices. Fresh prostatic tissue specimens were obtained from five patients by open prostatectomy, and were divided into separate groups （70 and 120 W） based on the energy of the laser output （70 and 120 W, respectively）. The vaporesection speed, coagulation zone depth and the necrotic tissue layer in the prostatic tissue were evaluated. The current result showed that the speeds （mean±s.d.） of vaporesection were 5.21±0.66 and 10.39±1.15 g/5 min for the 70 and 120 W groups, respectively （P=0.000）. There was no difference in the depth of necrosis/ coagulation （0.98±0.1310.30±0.09 and 0.99±0.12/0.31±0.08 mm） for the 70 and 120 W groups, respectively. In conclusion, both 70- and 120-W 2μm laser devices had superficial tissue damage during the vaporesection of human prostate tissue; moreover, the 120-W laser offers a higher vaporesection speed than the 70-W laser.

Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.

Transurethral dividing vaporesection for the treatment of large volume benign prostatic hyperplasia using 2 micron continuous wave laser

Background The safety and efficiency of transurethral laser resection of the prostate to treat benign prostatic hyperplasia have been verified. However, this method does still not manage large volume prostates efficiently. To tackle this problem, we have designed a method of ＂transurethral dividing vaporesection of prostate＂ using a 2 micron continuous wave laser. The aim of this study was to evaluate the safety and efficiency of this method in the management of large prostates （〉80 ml）.Methods In this study, 45 cases of benign prostatic hyperplasia with a median prostatic volume of （123.7±26.7） ml （range, 80.2-159.8 ml） were treated by the same surgeon under epidural anesthesia. During the surgery, superapubic catheters were needed, and saline solution was used for irrigation. First, the prostate was divided longitudinally into several parts from the bladder neck to the prostatic apex, and then gradually incised transversely chip by chip. Intraoperative blood transfusion rate, postoperative complications, maximum urinary flow rate, International Prostate Symptom Score and quality of life scores were recorded for statistical analysis using SPSS 16.0 software.Results Intraoperatively, no transurethral resection syndrome was observed, and no blood transfusions were needed.The resected prostatic chips were easily flushed out of the bladder through the resectoscope sheath without the use of a morcellator. Median vaporesection time was （95.0±13.2） minutes （range, 75-120 minutes）, and the median retrieved and removed prostatic tissue were （25.2±5.1） g （range, 15.5-34.7 g） and （75.4±16.4） g （range, 43.8-106.1 g）, respectively. Median catheter time and hospital stay were （3.3±0.9） days （range, 3-5 days） and （4.8±1.8） days （range, 3-9 days）, respectively. After a follow-up of 6 to 12 months, two patients had stress urinary incontinence and three had anterior urethral strictures. Satisfactory improvement was seen in maximum urinary flow rate, International Prostate Symptom Score and quality of life scores.Conclusions This study showed that 2 micron laser vaporesection is a safe treatment for benign prostatic hyperplasia patients with large prostates, and the method of ＂dividing vaporesection＂ may help improve both surgical efficiency and patient outcomes.