Transurethral prostatic tissue ablation via a single needle delivery system: initial experience with radio-frequency energy and ethanol.

We report an initial clinical experience to evaluate the safety and efficacy of outpatient prostatic ablation for the treatment of symptomatic benign prostatic hyperplasia (BPH) using local anesthesia (OPAL) with radio-frequency energy and intraprostatic absolute ethanol injection (EI). Twenty-three patients were treated with OPAL and five patients were treated with EI. Pre-operative data for all patients included international prostate symptom score (IPSS), quality of life score (QL), maximum flow rate (Q(max)), and post void residual determination. Prostate specific antigen (PSA) and transrectal ultrasound prostate volume determination were also done for EI patients. Needle deployment into the prostate was carried out at the 2, 4, 8 and 10 o'clock positions for lateral lobe hyperplasia and the 6 o'clock position for middle lobe hyperplasia. IPSS, QL, Q(max) and post void residual data were collected at 1, 3, 6 and 12 months post procedure. Both procedures resulted in statistically significant reductions of IPSS and QL. Trends towards improvement were seen both for Q(max) and post void residual, with Q(max) significantly improved after OPAL. Among EI patients, the prostate volume was reduced at 6 months post treatment to 37.2+/-17.9 g from 53.0+/-19.0 g (P=0.03) preoperatively. OPAL was safe but suffered from a high re-treatment rate. EI demonstrated encouraging results with regards to safety, symptom improvement and prostate volume reduction.

Use of alfentanil sedation anesthesia with the Dornier HM3 lithotripter.

Our results with the combination anesthetic technique of midazolam-alfentanil during elective outpatient extracorporeal shock wave lithotripsy on the Dornier HM3 (N = 79) were compared with those of epidural anesthesia in the same setting (N = 81). The mean anesthesia time and recovery room time were significantly shorter (72.85 v 113.58 minutes and 115.0 v 159.20 minutes, respectively) with the combination technique. No procedures in the alfentanil group had to be discontinued because of patient discomfort. Side effects with alfentanil were minimal, and oxygen saturation remained above 90% for all patients. Combination midazolam-alfentanil anesthesia is safe and allows the urologist to treat renal and ureteral calculi effectively and efficiently without using general or regional anesthesia.

Retrograde percutaneous nephrolithotomy: urological treatment of a urological problem.

We present our experience during a 22-month period with the retrograde approach to gain renal access for percutaneous stone removal in 71 consecutive patients. The retrograde puncture technique is fast and accurate, and it allows the physician to perform a 1-stage operation, saving the patient time, frustration and expense. The Lawson technique was used in all patients and it was successful in all but 2. In those 2 patients the Hawkins-Hunter technique was successful. There were no intraoperative or postoperative complications related to this approach. Except for 1 patient who suffered a post-procedure pulmonary embolus, no transfusions were required. The targeted stone was removed in 1 procedure in 61 of 71 patients (86 per cent). Ten patients required another procedure to remove the targeted stone or a second stone. Percutaneous procedures still are required for certain stone problems or when extracorporeal shock wave lithotripsy is not readily available. The ability of the urologist to perform this easy procedure will allow him more choice in how to manage stone patients.