Kinetics and tissue repair process following fractional bipolar radiofrequency treatment.

INTRODUCTION: Fractionated radiofrequency (RF) tissue tightening is an alternative method to fractionated laser treatment of skin wrinkling, laxity and acne scars, with reduced risk of scarring or persistent pigmentation. The aim of this study was to evaluate and quantify the wound healing process after RF treatment. MATERIALS AND METHODS: 12 patients were treated with a 64-pin fractional bipolar RF device with 60 mJ/pin applied energy. Confocal laser scanning microscopy (CLSM) examination was performed on day 1, day 2, day 7 and day 14 after treatment. Clinical wound healing process was measured and expressed as a percentage. RESULTS: All patients developed erythema, mild edema and crusts at the treated areas. Two weeks after treatment clinical symptoms resolved. During ablation patients reported moderate pain. Directly after ablation microscopic ablation zones could be detected in CLSM. Measurement of MAZ at epidermis, dermo-epidermal junction and papilary dermis showed a constant diameter until two weeks after treatment. Re-epithelization of the MAZ could be detected already 1 week after treatment. However, 2 weeks after ablation the honeycomb pattern of the epidermis was not yet completely restored. DISCUSSION: Bipolar fractionated RF treatment demonstrates clinically a rapid wound healing response. The subepidermal remodelling process still ongoing after 14 days, showing new granulation tissue. Therefore, treatment intervals of at least 14 days should be recommended to allow completion of the remodelling process.

Laparoscopic vesicovaginal fistula repair with robotic reconstruction.

INTRODUCTION: To describe, to our knowledge, the first case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. A 44-year-old woman presented with a vesicovaginal fistula after vaginal hysterectomy. She had been noted to have a bladder injury that was repaired at that time. A vesicovaginal fistula developed several weeks later, and she was referred for repair. The location of the fistula was deemed amenable to repair using a robot-assisted laparoscopic approach. TECHNICAL CONSIDERATIONS: The total operative time was 280 minutes, including placement of ureteral catheters and repositioning. The estimated blood loss was 50 mL. The fistula was repaired using robot-assisted laparoscopic techniques without complications, and the patient went home on the second postoperative day. The Foley catheter was removed 2 weeks postoperatively. The patient continued to void normally without recurrence at 16 weeks of follow-up. CONCLUSIONS: Laparoscopic repair of vesicovaginal fistulas has not gained widespread acceptance owing to its technical difficulty. We describe a minimally invasive laparoscopic approach using the DaVinci robotic system to repair a vesicovaginal fistula.

Operator experience and adequate anesthesia improve treatment outcome with third-generation lithotripters.

PURPOSE: To characterize the effect of operator experience and type of anesthesia on treatment outcome when switching from the Dornier HM3 to the third-generation Dornier U/50 lithotripter. PATIENTS AND METHODS: A population of 370 consecutive patients treated by 15 urologists was divided into two groups. Group I (N = 225) included patients treated during the initial 3 months with our new lithotripter. Group II (N = 145) included patients treated during the last 3 months. Changes were made during the intervening 6 months in focusing technique, anesthesia type, coupling technique, and shockwave delivery. Information was collected regarding success of stone treatment (defined as complete clearance of stone or fragments < 3 mm at 1 month). RESULTS: There were no differences between the two groups with regard to age, sex, fluoroscopic time or maximal shockwave intensity used. Group I had a slightly higher percentage of upper ureteral stones (20% v 13%); however, the difference was not significant. Upper ureteral stones in Group II were on average significantly larger (9.4 mm v 7.3 mm; P = 0.003). Intravenous sedation was used frequently in Group I (111 patients; 49%) and not at all in Group II. General anesthesia was used more frequently in Group II than in group I (34% v 24%; P < 0.02). Spinal anesthesia also was utilized more frequently in Group II patients (66% v 28%; P < 0.0001). Overall, general or regional anesthesia was received by 100% of the patients in Group II but only 52% of the patients in group I. The success rate of stone treatment was much better for Group II than for Group I (78% v 51%; P < 0.0001). CONCLUSION: The transition from a Dornier HM3 lithotripter to a third-generation lithotripter can be difficult, but if adequate anesthesia is given to minimize patient movement and balloon pressures are optimized, stone targeting can be accurate and similar stone clearance rates can be obtained.

Assessment of murine bladder permeability with fluorescein: validation with cyclophosphamide and protamine.

OBJECTIVES: Bladder hyperpermeability should result in elevated blood levels of intravesically administered agents. Reabsorption from a hyperpermeable bladder should result in prolonged urinary excretion of an agent after parenteral administration. To test these hypotheses, urinary clearance and plasma levels of sodium fluorescein (NaF) were measured in mice before and during cyclophosphamide (CYP) and protamine-induced hemorrhagic cystitis. METHODS: To measure the plasma uptake of NaF from the bladder, 10 mg/mL NaF was instilled, either by catheter or retrograde urethral infusion, 15 minutes before retro-orbital or ventricular sampling. The plasma levels were measured 24 hours and 14 days after exposure to CYP 300 mg/kg or 15 minutes after instillation of protamine 10 mg/mL. Hourly urine concentrations were measured immediately after intraperitoneal administration of 10 mg/kg NaF. Pretreatment samples were compared with those obtained 24 hours after intraperitoneal administration of 300 mg/kg CYP. RESULTS: Urinary NaF excretion was delayed in CYP-exposed mice. A bi-exponential model provided an appropriate fit of the data, both before and after CYP administration. The plasma levels of NaF were significantly elevated at 24 hours and 14 days after CYP exposure when sampled by ventricular nick or retro-orbitally. The median concentration of fluorescein in the protamine-treated mice was significantly higher than in the control mice. CONCLUSIONS: Fluorescein can be used to measure alterations in bladder permeability after bladder mucosal injury in mice. Urinary excretion of NaF is a bi-exponential process that is delayed after bladder mucosal injury, presumably because of increased mucosal permeability and resorption from the urine into the bloodstream.

Automated noninvasive measurement of cyclophosphamide-induced changes in murine voiding frequency and volume.

PURPOSE: We developed an automated noninvasive method for studying bladder function in mice. Changes in voided volume and frequency accompanying cyclophosphamide-induced cystitis were measured using computerized digital balances. MATERIALS AND METHODS: Eight CRL CD-1 mice were given a solution of glucose and saccharin to increase urine output and studied during the dark cycle, when most voiding occurs. Urine fell directly onto electronic balance pans. The time and weight of each void was recorded. Computer programs adjusted for evaporative loss analyzed voiding data within and across sessions. After establishing stable voiding patterns 300 mg./kg. cyclophosphamide were administered intraperitoneally. The Wilcoxon signed rank test was done to compare median voided volumes, frequency and gm. per hour of urine produced before and after cyclophosphamide. RESULTS: We implemented an automated method for voiding studies in mice. After cyclophosphamide administration the number of voids per hour increased and voided volume decreased. Some mice had as much as a 70% decrease in bladder volume and a tripling of urinary frequency. Mice responded by a sustained elevation in frequency and decreased voided volume as early as 24 hours after cyclophosphamide administration or by a pattern of delayed toxicity. CONCLUSIONS: This noninvasive technique measures changes in mouse voiding patterns with great sensitivity and minimal effort. The method is applicable to murine models of interstitial cystitis, detrusor instability and other abnormal voiding states. It may be used for evaluating potential therapies for such conditions.

The timing of hormonal treatment for prostate cancer.

This article reviews publications investigating the optimal timing of androgen ablative therapy for prostate cancer. We regard with some concern retrospective series, the use of endpoints other than overall survival, the presentation of actuarial and not actual survival, and the omission of appropriate controls. Treatment of minimal residual disease and other clinical scenarios are explored.