Heat Damage Zones Created by Different Energy Sources Used in the Treatment of Benign Prostatic Hyperplasia in a Pig Liver Model

Abstract

Introduction:

There are different types of transurethral prostatic surgeries and the complication profiles are different. This study aims to compare the heat damage zones (HDZ) created by five different technologies in a pig liver model.

Materials and Methods:

Monopolar resection, bipolar resection, electrovaporization, and Greenlight™ lasers of 120 and 180 W were used to remove fresh pig liver tissue in a simulated model. Each procedure was repeated in five specimens. Two blocks were selected from each specimen to measure the three deepest HDZ.

Results:

The mean of HDZ was 295, 234, 192, 673, and 567 μm, respectively, for monopolar resection, bipolar resection, electrovaporization, Greenlight laser 120 W, and Greenlight laser 180 W, respectively. The Greenlight laser produced one to three times deeper HDZ than the other energy sources (p=0.000).

Conclusion:

Both 120 and 180 W Greenlight lasers produced deeper HDZ than the other energy sources. Urologists need to be aware of HDZ that cause tissue damage outside the operative field.

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References

Oelke

, Bachmann

, Descazeaud

, et al. Guidelines of the management of male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction. European Association of Urology guidelines 2013. Available at: www.uroweb.org/gls/pdf/13_Male_LUTS_LR.pdf Last accessed February 2012 .

, Elliott

, Wilt

, et al. Practice patterns in benign prostatic hyperplasia surgical therapy: The dramatic increase in minimally invasive technologies. J Urol, 2008; 180:241–245.

Ahyai

, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol, 2010; 58:384–397.

Huang

, et al. Comparison of the microvessel diameter of hyperplastic prostate and the coagulation depth achieved with mono- and bipolar transurethral resection of the prostate. A pilot study on hemostatic capability. Scand J Urol Nephrol, 2008; 42:265–268.

Ruszat

, Wyler

, Forster

, et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol, 2007; 51:1031–1038.

Chung

, Sommer

, Brooks

. Anatomy of the lower urinary tract and male genitalia. In: Campbell-Walsh Urology. Tenth Edition. Philadelphia, PA: Saunders Elsevier, 2012, chap. 2.

Huang

, Wang

, Qu

, et al. Bipolar versus monopolar transurethral resection of prostate: Pathologic study in canines. Urology, 2007; 70:180–184.

, Wang

, Huang

, et al. Use of a novel ex-vivo model to compare the hemostatic properties of plasmakinetic resection, transurethral vaporization resection and conventional transurethral resection of the prostate. Urology, 2007; 70:1034–1038.

, Wang

, Huang

, et al. The hemostatic properties of transurethral plasmakinetic resection of the prostate: Comparison with conventional resectoscope in an ex vivo study. Urol Int, 2008; 80:292–295.

10.

Wendt-Nordahl

, Macker

, Fastenmeier

, et al. New bipolar resection device for transurethral resection of the prostate: First ex-vivo and in-vivo evaluation. J Endourol, 2005; 19:1203–1209.

11.

Kauffman

, Kang

, Choi

. The effect of laser-fiber sweeping speed on the efficiency of protoselective vaporization of the prostate in an ex vivo bovine model. J Endourol, 2009; 23:1429–1435.

12.

Maddox

, Pareek

, Ekish

, et al. Histopathologic changes after bipolar resection of the prostate: Depth of penetration of bipolar thermal injury. J Endourol, 2012; 26:1367–1371.

13.

Akgul

, Nuhoglu

, Polat

, et al. An in vitro study comparing the coagulation and cautery effects of bipolar and unipolar cutting modalities on prostatic tissue. Urol Int, 2009; 83:458–462.

14.

Huang

, Wang

, et al. Comparison of the microvessle diameter of hyperplastic prostate and the coagulation depth achieved with mono- and bipolar transurethral resection of the prostate A pilot study on hemostatic capability. Scand J Urol Nephrol, 2008; 42:265–268.

15.

Huang

, Wang

, et al. Bipolar transurethral resection of the prostate causes less bleeding than monopolar transurethral prostatectomy. Urology, 2012; 80:1116–1120.

16.

Kang

, Peng

, Stinson

. Quantitative evaluation of high power effect on 532 laser vaporization of bovine prostate in vitro . J Urol, 2010; 184:1211–1215.