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PubMed · 12100945

Holmium laser prostatectomy: current techniques.

Andrew H H Tan·Peter J Gilling
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Abstract

INTRODUCTION: During the past 7 years, holmium laser prostatectomy has evolved into an enucleation procedure, incorporating the use of established surgical planes. Holmium laser enucleation of the prostate (HoLEP) uses the excellent incisional and hemostatic properties of the holmium laser wavelength. Clinical outcomes with this may be superior to transurethral resection of prostate. HoLEP is also a minimally invasive therapy for larger glands that have traditionally been treated by open prostatectomy. TECHNICAL CONSIDERATIONS: There are four steps to performing HoLEP: (a) creation of bladder neck incisions, (b) enucleation of the median lobe, (c) enucleation of the lateral lobes off the prostatic capsule, and (d) transurethral morcellation. In most cases, postoperative irrigation is not needed and the catheterization time is less than 24 hours. CONCLUSIONS: HoLEP is an emerging technique in the surgical management of benign prostatic hyperplasia. There is a learning curve with this procedure, because the technique is very different from transurethral resection of prostate.

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HolmiumHumansLaser TherapyMaleProstatectomyProstatic HyperplasiaSurgical InstrumentsTreatment OutcomeUrinary BladderJournal ArticleResearch Support, Non-U.S. Gov't

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Andrew H H Tan, Peter J Gilling. 2002. Holmium laser prostatectomy: current techniques.. https://doi.org/10.1016/s0090-4295(02)01648-5

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PubMed2007

Holmium laser treatment of benign prostatic hyperplasia: an update.

PURPOSE OF REVIEW: The surgical treatment of benign prostatic hyperplasia is a dynamic, evolving field. Holmium laser enucleation of the prostate has been one of the most rigorously analyzed interventions for benign prostatic hyperplasia. In the 12 months since July 2005, a number of important studies have been published concerning this technique. RECENT FINDINGS: In the 12-month period of this review, there have been a number of articles published on holmium laser enucleation of the prostate. Among these are five randomized controlled trials. These studies emphasize the unique advantages of holmium laser enucleation of the prostate over other surgical treatments for benign prostatic hyperplasia. SUMMARY: Holmium laser enucleation of the prostate is a more efficient procedure than competitor techniques, when grams of tissue removed per unit time are quantified. Additionally, holmium laser enucleation of the prostate is associated with a reduced length of catheterization and hospitalization when compared with other surgical therapies for men with benign prostatic hyperplasia. Outcome measures for men undergoing holmium laser enucleation of the prostate are in many cases superior to those of other modalities. It is likely that the completeness of adenoma removal with holmium laser enucleation of the prostate confers many of these advantages.

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PubMed2006

Hybrid scatter correction applied to quantitative holmium-166 SPECT.

Ho-166 is a combined beta-gamma emitter of which the betas can be used therapeutically. From the 81 keV gammas of Ho-166, SPECT images can be obtained, which give opportunities to guide Ho-166 therapy. Accurate reconstruction of Ho-166 images is currently hampered by photopeak-scatter in the patient, down-scatter in the detector, collimator and patient caused by the 1.4 MeV photons and by bremsstrahlung. We developed and validated a method for quantitative SPECT of Ho-166 that involves correction for both types of scatter plus non-uniform attenuation correction using attenuation maps. Photopeak-scatter (S) is compensated for by a rapid 3D Monte Carlo (MC) method that is incorporated in ordered subset (OS) reconstruction of the emission data, together with simultaneous correction for attenuation (A) and detector response (D); this method is referred to as OS-ADS. Additionally, for correction of down-scatter, we use a 14 keV wide energy window centred at 118 keV (OS-ADSS). Due to a limited number of available energy windows, the same 118 keV energy window was used for down-scatter correction of the simultaneously acquired Gd-153 transmission data. Validations were performed using physical phantom experiments carried out on a dual-head SPECT system; Gd-153 transmission line sources were used for acquiring attenuation maps. For quantitative comparison of OS-ADS and OS-ADSS, bottles filled with Ho-166 were placed in both a cylindrical phantom and an anthropomorphic thorax phantom. Both OS-ADS and OS-ADSS were compared with an ordered subset reconstruction without any scatter correction (OS-AD). Underestimations of about 20% in the attenuation map were reduced to a few per cent after down-scatter correction. The average deviation from the true activity contained in the bottles was +72% with OS-AD. Using OS-ADS, this average overestimation was reduced to +28% and with OS-ADSS the deviation was further reduced to 16%. With OS-AD and OS-ADS, these numbers were more sensitive to the choice of volumes of interest than with OS-ADSS. For the reconstructed activity distributions, erroneous background activity found with OS-AD was reduced by a factor of approximately 2 by applying OS-ADS and reduced by a factor of approximately 4 by applying OS-ADSS. The combined attenuation, photopeak-scatter and down-scatter correction framework proposed here greatly enhanced the quantitative accuracy of Ho-166 imaging, which is of the uppermost importance for image-guided therapies. It is expected that the method, with adapted window settings, also can be applied to other isotopes with high energy peaks that contaminate the photopeak data, such as I-131 or In-111.

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