Ultrasound monitoring during laser-assisted transurethral resection of the prostate.
Initial studies utilizing the original visual laser ablation prostatectomy (VLAP) technique of coagulation and a pilot study applying laser energy to prostate cancer led to the realization that these procedures could be monitored effectively in real time by ultrasound. Physical and chemical changes occur in prostate tissue with heating by laser energy, and these changes can be detected, not only as cavitation when the prostate tissue is vaporized, but also as a hyperechoic alteration that presumably is cell death leading to necrosis. Utilizing real-time monitoring helps assure the efficacy of the procedure and predict greater cavitation from slough of dead tissue. Monitoring by ultrasound scanning also allows following of the change of directions of the laser beam in tissue, which could be dangerous to the patient. With ultrasonography, one can make sure that the neurovascular bundle is not compromised and that the energy is not allowed to proceed past the posterior capsule of the prostate into the rectal wall. This is particularly helpful in patients with a high bladder neck but with minimal prostatic tissue posteriorly at the base. Also, the amount of tissue and the length from the verumontanum to the external sphincter can be accurately assessed and correlated with the lesion created at that level to avoid damage to the external sphincter.
Childs
S J
SJ
Department of Surgery, University of Alabama, Tuscaloosa, USA.
D016022:Case-Control Studies; D003199:Computer Systems; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography