Bipolar resection of the bladder and prostate--initial experience with a newly developed regular sized loop resectoscope.

OBJECTIVE: Bipolar transurethral resection (TUR) has been introduced in the clinical practice nowadays. Benefits from bipolar TUR are represented by the use of saline irrigation, which avoids hypoosmotic hyperhydration (TUR-Syndrome), as well as by the reduced risk of obturator nerve stimulation. However, the previously introduced smaller bipolar resection loop caused prolonged operating-time. We report our initial experience with a newly developed regular sized loop for a bipolar resectoscope. MATERIALS AND METHODS: Different loop calibers and configurations were tested and compared to a previously introduced bipolar system and conventional resection devices in TUR of benign prostate hyperplasia (BPH) and bladder tumors (TURP and TURBT). The resected tissue was pathologically examined for thermal damage and compared to a control group of monopolar conventionally resected tissue. RESULTS: The handling of the resectoscope was comparable to that of the conventional ones. Cutting control, cutting speed and coagulation effectiveness were excellent, and no obturator nerve stimulation occurred. The resection area could easily be assessed and tissue examination showed no differences in terms of quality and quantity of thermal damages, since tissue carbonization was reduced. There was no sticking of the resected tissue on the loop. CONCLUSION: Regular sized loop bipolar resection is safe and efficient. Coagulation and cutting extent control seem superior to conventional TUR. Due to reduced carbonization, the resection ground can be easily assessed. The risk of obturator nerve stimulation is reduced. The histological quality of the tissue is not impaired. This device combines the advantage of a regular size resection loop with bipolar resection in normal saline. It has the potential to become a valuable alternative to monopolar TUR.

Bladder neck incision using a 70 W 2 micron continuous wave laser (RevoLix).

Postoperative bladder neck contracture continues to be a frequently occurring problem. Bladder neck incision (BNI) continues to be the standard mode of treatment. However, the recurrence rate appears to be high. Therefore alternative treatment options are still needed. We report about initial experience with the RevoLix 2 micron continuous wave laser for BNI after a 1-year follow-up. Fourteen patients with a second or third recurrence of bladder neck contracture after primary surgery were included into the trial. All patients reported high-grade obstruction and residual urine. BNI was performed using a 70 W 2-micron continuous wave laser (RevoLix). This laser utilizes the thulium as an active ion. Laser incisions were applied in 5 and 7o'clock lithotomy position. Remaining tissue was vaporized. Assessed outcomes were improvement in AUA-symptom-score, quality of life index and uroflowmetry, measured preoperatively, after 2 and 12 months postoperatively. Mean operating time was 7 min, mean catheterization time was 6.5 h. The mean maximum uroflow-rate improved from 9 ml/s preoperatively to 23 ml/s. AUA-symptom score improved from 22 to 8 points and quality of life index improved from four to one. Two patients developed restenosis so far. Although longer follow-up and larger sample size are needed, BNI with the RevoLix laser is a fast, safe and promising procedure in recurrent bladder neck sclerosis.

Extracellular matrix changes in knee joint cartilage following bone-active drug treatment.

Certain drugs or treatments that are known to affect bone quality or integrity might have side effects on the extracellular matrix of articular cartilage. We investigated the effects of vitamin D and calcium deficiency, estrogen deficiency, and hypercortisolism alone or in combination with bisphosphonates or sodium fluoride in an animal model, viz., the Göttingen miniature pig (n=29). The articular cartilage from knee joints was analyzed for its content of glycosaminoglycans (GAGs, as macromolecules responsible for the elasticity of articular cartilage) by a spectrometric method with dimethylene blue chloride. In cryo- or paraffin sections, alkaline phosphatase (AP, as an enzyme indicating mineralization or reorganization of articular cartilage matrix) was localized by enzyme histochemistry, and positive cells were counted, whereas differently sulfated GAGs were stained histochemically. A significant decrease in GAG content was measured in ovariectomized and long-term glucocorticoid-treated animals compared with untreated animals. In the glucocorticoid/sodium fluoride group, GAGs were significantly diminished, and significantly fewer AP-positive chondrocytes were counted compared with the control. GAG content was slightly higher, and significantly more AP-positive chondrocytes were counted in short-term glucocorticoid-treated animals then in the control group. GAGs, as part of proteoglycans, are responsible for the water-storage capacity that gives articular cartilage its unique property of elasticity. Thus, ovariectomy and long-term glucocorticoid therapy, especially when combined with sodium fluoride, have detrimental effects on this tissue.