Larry A. Tansey

Extensive neodymium-yag photoirradiation of the prostate in men with obstructive prostatism

OBJECTIVE To determine if high-dosage, extensive photoirradiation of the prostate could be used safely in men with large prostate glands and obstruction, coupled with acceptable clinical results. METHODS Treatment of 25 men consecutively with eight quadrant photoirradiation of the prostate. Treatment of the next 25 men with high-dosage energy up to 109,000 joules. Simultaneous transrectal needle biopsy of the prostate performed on all 50 men after treatment. Patients evaluated with four- to sixteen-month follow-up. RESULTS Success rate of 86 percent on all patients with mean American Urological Association (AUA) symptom score decreasing by nineteen points and mean peak uroflow rate increasing by 7.9 cc. Needle biopsy after high-dosage laser therapy shows no laser effect on the peripheral zone. CONCLUSIONS High-dosage laser energy can be used safely, and allows us to treat large prostates with excellent clinical results and minimal complications.

Neodymium-yag laser: New treatment for urethral stricture disease

This is a preliminary report concerning the use of Neodymium-YAG laser for urethral strictures. A new technique, not previously described, is explained, and the early results and complications are analyzed. The results were documented with urethrograms and uroflowmetry. We believe the Nd:YAG laser is a safe and effective means of treating urethral strictures. Also it reduces the cost of treatment, and the patients return to work in four to five days.

Depth of penetration of the neodymium:yttrium-aluminum-garnet laser in the human prostate at various dosimetry☆

OBJECTIVE To determine depth of thermal penetration by the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser at various dosimetry in the human prostate and to compare results of two techniques of laser application, single spot versus whole tissue photoirradiation. METHODS Twelve men with Stage T2 (B) cancer of the prostate consented to laser prostatectomy immediately prior to a planned radical prostatectomy. In the first 3 patients (group I) the prostate was treated with the Nd:YAG laser in one spot area of each lobe. The next 9 patients underwent photoirradiation of all endoscopically visible tissues on one side of the prostate at different dosimetries: 60 W at sixty seconds (group II), 50 W at sixty seconds (group III), and 40 W at ninety seconds (group IV). Depth of laser penetration was measured from both histologic and gross evaluations of removed specimens within twenty-four hours. RESULTS Thermal necrosis in group I showed an inconsistent depth of penetration even with the same amount of laser energy. Groups II, III, and IV all demonstrated clearly demarcated areas of thermal necrosis. Group II showed the greatest depth of laser effect among all groups, with a mean depth of 1.75 cm. No laser effect is detected near the true capsule of the prostate on any specimen. CONCLUSIONS High dosage laser energy application at 60 W and sixty seconds of pulse duration with the whole tissue treatment provide the greatest depth of penetration in the human prostate while maintaining safety for the capsular area.

Adenocarcinoma in a Müllerian Duct Cyst

A case of adenocarcinoma involving a müllerian duct cyst is presented. The presentation, treatment, and pathological and radiological appearance are discussed. The embryology and history of this entity are reviewed.

Use of ND:YAG laser in treatment of bladder cancer

A total of 53 patients were treated with neodymium:yttrium-aluminum garnet (Nd:YAG) laser and followed up for two years. Three patients had carcinoma in situ (CIS); 4 had Ta lesions; and 28 had TINxMo, 8 had T2NxMo, and 10 had T3NxMo lesions. The patients with CIS received a combination of Nd:YAG laser and intravesical bacillus Calmette Guérin (BCG) instillation. The remainder of the patients received no supplementary chemotherapy. No tumor recurrence was noted in those with Ta lesions. Tumor recurred in 18 per cent of patients with T1 lesions, and 33 per cent of those with T2 lesions; 80 per cent of patients with T3 lesions had resistant or residual tumors. In patients with CIS, there was no tumor recurrence. Nd:YAG laser is effective in Ta, T1, and T2 bladder cancers, with low recurrence rate and minimal complications. In very select, high-risk patients with small lesions, and in those who refuse cystectomy, there may be a place for laser therapy for either palliation or definitive treatment of T3 invasive tumors of the bladder.

Experience with the Small-carrion Penile Prosthesis in the Treatment of Organic Impotence

Since certain animals are endowed with an os penis the concept of using penile implants was a natural development. Herein we report on our experience with the Small-Carrion penile prosthesis in 23 patients. The surgical technique is described as well as several examples of postoperative results. The major complication encountered was infection. All patients were able to accomplish coitus without significant difficulty. Proper patient selection and the attitude of the sexual partner constitute the major factors in the ultimate success or failure of the procedure.

K.T.P 532 laser in treatment of urethral strictures

We have had experience in the treatment of 20 patients with 22 strictures with this new laser that has a unique ability to cut and coagulate with minimal forward scatter to help prevent the formation of new scar tissue. All of the patients have had attempts of treatment of the strictures unsuccessfully in the past. The laser was effective in 68.2% of the patients to keep the urethra open and patent although the follow-up periods have been short at the time of this report ranging from six months to fourteen months. This new laser may have some promise in the treatment of urethral stricture disease.

Pheochromocytoma with Hypercalcemia: Case Report and Review of Literature

We report a case of severe hypercalcemia and a pheochromocytoma of the right adrenal gland. The patient underwent adrenalectomy, following which the hypercalcemia disappeared. Parathormone assay of the adrenal tumor revealed high levels of activity despite normal serum parathormone activity. This suggests that the etiology of hypercalcemia in patients with pheochromocytoma is related to ectopic secretion of a parathormone ectopic peptide-like substance.

Depth of penetration of the neodymium: yttrium-aluminum-garnet laser in the human prostate and clinical results of high-dose laser energy in 50 patients

SummaryWe evaluated the treatment of the human prostate with the Nd:YAG laser using a Cytocare Prolase II fiber. We utilized this first in 12 patients prior to radical prostatectomy and then appropriately serially sectioned the prostate to measure the depth of penetration. The studies clearly revealed that 60 W of power and 60 s of pulse duration gave the most consistent depth of penetration in the human prostate model. This depth of penetration averaged 2 cm in the glands that were removed. At the same time there was absolutely no evidence of damage to the neurovascular bundle or to the capsule of the prostate using the above-mentioned dosimetry regime. This study was then transferred to our initial experience in treating 50 patients with benign prostatic hypertrophy and obstructive voiding symptoms. The first 25 patients were also treated with so-called spot radiation of the prostate, whereas the second 25 patients were treated by total photoirradiation of all visible endoscopic tissue. The results reveal that both groups of patients had a fairly highly satisfactory result as measured objectively with American Urological Association (AUA) symptom scores and uroflow studies. In the latter group (photoirradiation of all visible endoscopic tissue) a significantly higher dose of laser energy was utilized and a smaller failure rate was noted on a long-term basis in patients who subsequently came to transurethral resection of the prostate (TURP) because of failure of the laser procedure. At the same time that the patients were treated, all 50 patients underwent multiple random needle biopsies of the peripheral zone of the prostate, and at no time was there any evidence of a laser effect in the capsule of the human prostate from a dosimetry of 60 W and 60 s of pulse duration and total photoirradiation of the entire prostate. Very large doses of energy were used, ranging up to 110,000 J per case. It is our impression that the 60-W/60-s protocol will consistently yield the best results in terms of success of laser prostatectomy as measured objectively with uroflow and AUA symptom score as well as providing total safety in term of the absence of damage to the capsule of the prostate despite photoirradiation of all visible viable tissue at high total doses of energy.

Use of bupivacaine as block to relieve postoperative pain in pediatric orchiopexy and hernia repair

Bupivacaine was utilized for postoperative analgesia in patients undergoing orchiopexy and hernia repair. In a study of 75 pediatric patients, ranging in ages from twelve months to twelve years, who had undergone orchiopexy and hernia repair during a three-year period, 42 received bupivacaine hydrochloride as a local infiltration block anesthesia to relieve postoperative pain; 33 patients did not receive bupivacaine. Patients receiving bupivacaine had less postoperative pain and were more comfortable when leaving the hospital within a few hours after surgery.