5-year follow-up to transurethral vaporesection of the prostate using the 2 micron continuous wave laser for the treatment of benign prostatic hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the 5-year follow-up to 2 micron continuous wave laser vaporesection for the treatment of patients with low urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), and evaluate the safety and clinical effects of the treatment.</p><p><b>METHODS</b>From October 2006 to September 2007, 236 cases with low urinary tract symptom secondary to BPH were treated transurethrally under epidural or general anesthesia using the 70 Watt 2 micron laser system. Vaporesection of the prostate was performed with the traditional "U" or the "dividing" method. The 210 cases who met the inclusion criteria in this study were selected for further observation. Baseline and perioperative data were recorded and evaluated in resection time, transfusion rate, catheter-time, improvements in maximal urinary flow rate (Qmax), international prostate symptom scores (IPSS), quality of life (QoL), and post voiding residual volume (PVR).</p><p><b>RESULTS</b>Out of the 210 cases, 179 cases were followed up to 5 years finally. All the surgical procedures were successfully conducted under epidural or general anesthesia. Mean operation time was (80 ± 22) minutes, and mean retrieved prostatic tissue was (24.9 ± 4.2) g. Resected prostatic tissues could be easily flashed out of the bladder. There were no significant differences in serum sodium concentrations and hemoglobin levels before and after the surgery. Mean catheter time and hospital stay was (114 ± 35) hours and (5.7 ± 1.9) days respectively. Only one postoperative secondary hemorrhage was found and treated with blood transfusion. During the 5-year follow-up, Qmax increased from (8.6 ± 3.5) ml/s preoperatively to (23.6 ± 4.2) ml/s by the end of the follow-up (P < 0.01), IPSS and QoL-Score improved from 25.3 ± 5.2 and 4.1 ± 1.3 to 6.1 ± 3.0 and 1.4 ± 0.8 respectively (P < 0.01), and PVR decreased from (248 ± 89) ml to (15 ± 13) ml. The 3 patients developed urinary incontinence and recovered 3 months later through functional exercises with the help of acupuncture. Five patients were found to have urethral stricture 3 months after the surgery and recovered with the treatment of urethral dilatation (3 cases) or internal urethrotomy (2 cases) respectively.</p><p><b>CONCLUSIONS</b>Transurethral vaporesection of prostate using the 2 micron continuous wave laser system is a safe and effective treatment for benign prostatic hyperplasia with obvious improvements in subjective and objective voiding parameters, which were evident at 3 months after the surgery and were sustained throughout the 5-year long-term follow-up.</p>

Transurethral partial cystectomy with a 2 micron laser in diagnosis and treatment for bladder submucosal lesions in adults / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of transurethral partial cystectomy with a 2 µm laser in diagnosis and treatment for the bladder submucosal lesions in adults.</p><p><b>METHODS</b>Nine patients with suspected pathological diagnosed bladder submucosal lesions in out-patient department were diagnosed and treated transurethral with a 2 µm laser under sacral block between August 2009 and December 2010. The diameters of tumors were 1.5 - 2.5 cm. A 2 µm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with bladder wall at the base were removed together and sent for pathological examination. The surgical procedures, intraoperative hemorrhage, intraoperative and postoperative complications were observed, pathological diagnosis and postoperative follow-up were performed.</p><p><b>RESULTS</b>All operations were successful. Mean operative time was 36.4 minutes (range 25 to 47 minutes), perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage detected after surgery. Postoperative pathological diagnosis included leiomyoma in 3 cases, pheochromocytoma in 3 cases, endometriosis in 1 case and metastatic bladder cancer in 2 cases.</p><p><b>CONCLUSIONS</b>Transurethral partial cystectomy with a 2 µm laser can diagnose and treat bladder submucosal lesions. The procedures are effective and safe. Patients could get accurate pathological diagnosis without further painful and some bladder tumors can be treated by minimally invasive surgery.</p>

Transurethral dividing vaporesection for the treatment of large volume benign prostatic hyperplasia using 2 micron continuous wave laser / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>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).</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Transurethral partial cystectomy using a 2 microm continuous wave laser in treatment of bladder carcinoma: 1-year follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize and analyze the clinical features of bladder tumor patients who received transurethral partial cystectomy by 2 microm continuous wave laser, in 1 year post operation follow-up visits.</p><p><b>METHODS</b>From December 2007 to May 2008, 47 bladder carcinoma patients were treated with 2 microm laser transurethrally under sacral block. Operation characteristics, operation time, intraoperative hemorrhages and postoperative complications, and pathology staging of the tumor were observed and postoperative follow-up visits were performed.</p><p><b>RESULTS</b>All of the operation procedures were successful. The surgery time was 5 to 15 minutes. Blood loss in the operation was minimal. There was no obturator nerve reflection, and no hemorrhaging was detected after the operation. The pathological stages can be judged correctly with the obtained specimens. There was one case with peritoneum perforation. The patients received 12 to 17 months of postoperative follow-up visits, and there was no recurrence at the resection site. The survival rate was 100%.</p><p><b>CONCLUSIONS</b>Transurethral partial cystectomy in the treatment of bladder tumor by 2 microm continuous wave laser is a safe, efficient and effective method. The tumor and all the basal part of bladder wall could be excised completely and the pathological stages can be judged correctly using these specimens to fulfill partial cystectomy for the treatment of bladder carcinoma.</p>

An ex vivo study on the vaporization ratio of the prostatic tissue lased by the 2 micron laser / 中华外科杂志

<p><b>OBJECTIVES</b>To observe the vaporesection efficiency of the 2 micron laser to the prostatic gland in benign prostatic hyperplasia, and investigate the method of estimating the amount of the vaporesected prostatic tissues during transurethral vaporesection of the prostate using the 2 micron laser system in the treatment of benign prostatic hyperplasia.</p><p><b>METHODS</b>Total 9 fresh prostatic gland specimens were obtained from patients with BPH under open surgical procedures, and vaporesected under a simulated transurethral environment with the 2 micron laser system immediately after weighted. Energies and time consumptions were noted, collections of vaporesected tissue specimens and the remnants of the prostatic glands were weighted after the procedures. The ratios of the vaporized tissues and the collected tissues to the whole vaporesected tissues were calculated respectively. The vaporesection efficiency of the 2 micron laser to the prostatic tissues was also calculated.</p><p><b>RESULTS</b>Among the total lost tissues, about (65.6 +/- 1.5) percent of which were that of vaporized, and nearly (34.5 +/- 1.5) percent were resected. Linear correlation between the weight of collected prostatic tissue(x) and the weight of prostatic gland specimens(y) could be defined as a formula of [y = 3.245x - 6.475 (t = 15.097, P = 0.000)].</p><p><b>CONCLUSION</b>The amounts of the whole prostatic tissues removed by the 2 micron laser could be calculated from the collected resected prostatic specimens under a simulated transurethral surgical procedure.</p>

Suppression of tumor growth in renal cancer treatment with tumor vaccination after haploidentical bone marrow cell reconstitution / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate whether whole tumor cell vaccination strategies in combination with bone marrow transplantation (BMT) can stimulate graft-versus-tumor effect (GVT).</p><p><b>METHODS</b>Twenty-six BALB/c mice were randomly divided into 3 groups: BMT group (group A, n = 10), BMT + vaccination group (group B, n = 10), control group (group C, n = 6). (BALB/c × C57BL/6) F1 mice [CB6F1, H-2K(b/d)] were used as donors. BALB/c mice of group C were only inoculated with Renca cell (2.6 × 10(6)). Mice of group A and B were conditioned with 8 Gy irradiation, followed by infusion by bone marrow cell of CB6F1 mice on day 1, then inoculated with Renca cell (2.6 × 10(6)) on day 8. All mice of group B were immunized subcutaneous on the back with 5 × 10(5) irradiated Renca tumor cells on day 9 and day 16. All mice of group C were inoculated with Renca cell (2.6 × 10(6)) on day 8. In group A and B, all mice were analyzed by fluorescence activated cell sorter (FACS) on day 14, and 28 day after BMT. Mice were killed on day 32 after inoculation with tumor cell and collected blood sample. All tumors were taken out to be weighed and then fixed in 10% buffered formalin, embedded in paraffin, and cut into 5 µm slices. The slices were stained with HE and examined by TdT mediated-dUTP nick end labeling (TUNEL). Liver, skin, intestine, and spleen were biopsied for histopathological examination.</p><p><b>RESULTS</b>The results of chimera showed that engraftments of group A, B were full donor chimerism, and the chimerism of those remained above 90% and preserved even after 28 days. The tumor weight, tumor volume increment in the group B was lower than group A and C (P < 0.05). The tumor suppressing rates of the group A and B were 54%, 60% respectively. The area ratio of tumor necrosis and apoptosis index (AI) of the tumor in the group B were higher than group A and C (P < 0.05). Graft-versus-host disease was not observed in each group.</p><p><b>CONCLUSION</b>The mechanism of GVT after haploidentical allogeneic bone marrow transplantation with tumor vaccination may be the promotion of tumor necrosis and apoptosis.</p>

Initial experience of partial cystectomy in treatment of bladder tumor by 2 microm continuous wave laser / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics of partial cystectomy in treatment of bladder tumor by 2 microm continuous wave laser.</p><p><b>METHODS</b>A total of 18 patients with 21 bladder tumors treated by 2 microm laser via transurethral under sacral block. The diameters of tumors were between 1-3 cm. In the operation, we vaporized and cut whole wall of bladder, dissected the muscular layers from connective tissue, and sent them for pathology inspection. We reviewed these following variables: operation time, blood loss, complications during and after the operation, pathology staging of the tumor and follow-up visit.</p><p><b>RESULTS</b>All the patients were tolerated in the operation. The mean operative time was (7.4 +/- 3.3) min (range, 5-12 min). Blood loss in the operation was minimal. No patient experienced an obturator nerve reflection or a hemorrhage after the operation. One case has urine leakage. The pathology staging of the tumors were as follows: T1 stage 15 cases, total 18 tumors; and T2 stage 3 cases, total 3 tumors. The followup periods were between 3 to 6 months, and the mean period was 4.5 months. There was no recurrence in situ.</p><p><b>CONCLUSIONS</b>The 2 microm laser not only can vaporize and cut the wall of bladder finely, but also can dissect the muscular layers from connective tissue efficiently. So it can be partial cystectomy in the treatment of bladder tumor.</p>

Analyze the change of bladder tumor cells in irrigating solution after partial cystectomy by 2 microm continuous wave laser / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the change of bladder tumor cells in irrigating solution after partial cystectomy by 2 microm continuous wave laser.</p><p><b>METHODS</b>From May 2008 to December 2008, a total of 30 patients of bladder cancer, the diameters of tumors from 0.5 to 3.0 cm. The diameter being regarded as the standard, patients were divided into two groups, 10 cases in group A (diameter < 2.0 cm) 20 cases in group B (diameter >or= 2.0 cm). The pre-operative pathologic histology diagnoses of all patients by biopsy were bladder urothelial carcinoma. Partial cystectomy by 2 microm continuous wave laser was given in operation. Due to the patients in group a with smaller tumors, the tumors were washed out of the bladder through the sheath of cystoscope directly. In group B, the larger tumors were cut into blocks by laser in the bladder, and washed out. After removing the tumors and debris, bladder irrigation was performed with about 150 ml solution for 5 times, then irrigating solution was centrifuged and numbered respectively before cellular pathology examination.</p><p><b>RESULTS</b>In group A, there were no tumor cells but epithelial cells and red blood cells could be seen in 8 cases. In the other 2 cases, a small amount of integrity and shape broken tumor cells could be seen in the No.1 and No.2 piece. There was no tumor cell in No.3, No.4, and No.5 pieces. In group B, tumor cells can be seen in No.1, No.2 and No.3 pieces in 14 cases, but cell density decreased gradually. There was no tumor cell in No.4, No.5 pieces, and tumor cells can be seen in No.1 to No.4 pieces for another 6 cases, and cell density also decreased gradually, there was no tumor cell in No.5 piece.</p><p><b>CONCLUSION</b>After the surgery, 5 times of bladder irrigation in all cases of partial cystectomy by 2 microm continuous wave laser can reduce the remnants of the bladder tumor cells effectively.</p>

Continuous wave laser of 2 microm for bladder tumor treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics of 2 microm continuous wave laser vaporization resection for the treatment of bladder tumors.</p><p><b>METHODS</b>A total of 56 patients with 68 bladder tumors underwent 2 microm laser vaporization resection via a transurethral cystoscope under caudal anesthesia. In the operation, the wall of the urinary bladder was vaporized and cut, the muscular layers were removed, and then the specimens were sent for pathological inspection separately. The following variables were recorded: operation time, blood loss, complications during and after the operation, pathology staging of the tumors, and follow-up visit time.</p><p><b>RESULTS</b>All patients endured the operation. The mean surgery time was 8.8 +/- 3.3 minutes (range, 4 to 15 minutes). Blood loss was minimal, no patient experienced an obturator nerve reflection, or a hemorrhage after the operation. The pathology staging of the tumors were as follows: 40 cases (total 47 tumors) were T1 stage; 16 cases (total 21 tumors) were T2 stage. The follow-up periods were between 12 to 17 months, and the mean period was 14.5 months. Tumor recurrences were found in 3 cases, and one patients suffered two recurrences, the total recurrence rate was 5.3%. There was no primary recurrence.</p><p><b>CONCLUSIONS</b>The 2 microm continuous wave laser is a new, safe and efficacious method for the treatment of bladder tumors. Because the 2 microm laser can vaporize and cut the muscular layers of the bladder finely, it can not only treat superficial bladder tumors efficiently, but also treat some types of invasive tumors of the bladder.</p>