Prostate Ablation Research Articles

Our experiences in bipolar radiofrequency thermotherapy system as an alternative treatment in LUTS.

We aimed to evaluate the efficacy of the bipolar radiofrequency thermotherapy system as a minimally invasive treatment method in lower urinary tract symptom treatment and its effect on the patients' quality of life (QoL). The thermotherapy system was applied to 118 patients between May 2016 and September 2017 with the requirement of surgical treatment for benign prostatic hyperplasia, who either could not be operated upon due to their comorbidities or preferred to undergo this procedure as an alternative treatment method. The International Prostate Symptom Score (IPSS) and QoL scores and maximal flow rate (Qmax) and post-voiding residue (PVR) values were evaluated before and after treatment. For the 80 patients who completed the 2-year follow-up period, the Qmax values were observed to be increased at each follow-up evaluation and PVR, QoL and IPSS were observed to be decreased. These changes were statistically significant from the baseline. In this study we found there was 48.8% increase in Qmax, 72.1% decrease in IPSS, 70.8% decrease in the QoL score, 51.1% decrease in PVR of 80 patients who underwent bipolar radiofrequency prostate ablation. The bipolar radiofrequency prostate thermotherapy system can be safely applied as an outpatient treatment in high-risk cases or for those who are anxious about surgical interventions.

Aquablation—image-guided robot-assisted water-jet ablation of the prostate: current advance

In recent years robot system has been widely introduced into prostatic hyperplasia treatment. Rather than pay attention to traditional laparoscopic robot, this paper focused on Image-Guided Robot-Assisted Prostate Ablation Using Water Jet-Hydrodissection. This treatment system was very mini-invasive and easy to learn. Therefore, it reduced learning curve, operation time and related complications. This paper summarized current advance on the above fields. Key words: Benign prostatic hyperplasia; Aquablation; Minimally invasive robotic surgery; Water-jet ablation; Transurethral resection of prostate

Survival and quality of life outcomes of high-intensity focused ultrasound treatment of localized prostate cancer.

BackgroundTo evaluate the survival and quality of life (QoL) outcomes of high-intensity focused ultrasound (HIFU) whole-gland ablation for localized prostate cancer.MethodsOver 8 years, men with localized prostate cancer treated with whole-gland HIFU were prospectively followed. Transrectal prostate ablation was performed under general anesthesia with Sonablate-500® (Sonacare Medical©, Charlotte, North Carolina, USA). The primary outcome was failure-free survival defined as no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer–specific mortality. Secondary outcomes included both survival outcomes and QoL measures.ResultsOf 70 men, 29.7% had International Society of Urological Pathology (ISUP) grade 1, 43.8% ISUP 2, 10.9% ISUP 3, and 15.6% ISUP 4 disease. At median follow-up of 83.4 months, overall mortality was 8.6% and prostate cancer–specific mortality 0%. Failure-free survival was 78.2% at 5 years and 71.2% at 7 years. Of all men, 7.1% of men developed metastases, with median metastasis-free survival of 75.4 months. There was negligible post-HIFU urinary incontinence or lower urinary tract symptom with a median Male Urogenital Distress Inventory score of 32 at 6 months and 33 at 12 months and median IPSS of 4 at 6 months and 3 at 12 months. Median Radiation Therapy Oncology Group rectal toxicity score was 0 throughout. In men who had mild or no erectile dysfunction at baseline (International Index of Erectile Function ≥17), the mean International Index of Erectile Function score declined to 37% from 23.5 at baseline to 14.7 at 12 months.ConclusionAt median follow-up of 7 years, whole-gland HIFU appears to have comparable survival outcomes with other cohort studies involving radical prostatectomy and radiotherapy patient. It has low impact on QoL, preserved urinary continence, and erectile function approximate to nerve-sparing prostatectomy. Whole-gland HIFU presents a potential alternative minimally invasive and safe option for the treatment of localized prostate cancer.

BIPOLAR PLASMA VAPORIZATION VERSUS QUARTZ HEAD LASER ABLATION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATEHYPERPLASIA: A COMPARATIVE STUDY OF OUTCOME AND COMPLICATIONS

Background: Benign prostatic hyperplasia (BPH) is considered one of the most common causes of lower urinary tract symptoms (LUTS), urinary obstruction and urinary retention which usually occurs above age of 40 years. Aim of the Work: to compare the short term effectiveness and complications of bipolar plasma versus laser vaporization of prostateover 6 months duration of follow up post-operative. Patients and Methods: This prospective comparative clinical study (double armed) included 128 patients with prostates less than 80 gm operated upon and followed up in the Urology Department of Ain shams University hospitals in the period from September 2015 to January 2018. The patients were divided into 2 groups: Group A 64 patients who underwent Plasma vaporization. Group B 64 Patients who underwent Quartz Laser Ablation of prostate (QLAP). Results: There were statistically significant differences between both groups as regards prostate volume reduction, PSA reduction and decrease in postvoiding residual urine more in the laser group. While IPSS and QOL reduction and uroflowmetry improvement showed higher improvement in the plasma group.Conclusion: both techniques whether laser vaporization or plasma vaporization are considered safe, effective minimally invasive procedure in managing prostatic enlargement indicated for surgery. Both techniques are similar in the outcome and both lead to improvement of all parameters of prostatic symptoms. Laser vaporization looks to be faster, has stronger power to vaporize more tissues than plasma. No serious complications occurred in both groups. Nevertheless complications are more frequent in the plasma group.

3:45 PM Abstract No. 341 Pivotal study of magnetic resonance imaging–guided transurethral ultrasound ablation in men with localized prostate cancer: 12-month clinical and imaging outcomes

MRI-guided transurethral ultrasound ablation (TULSA) is an incision-free in-bore procedure for customized prostate ablation using directional thermal ultrasound under real-time MRI thermometry guidance and control. We report 12-month outcomes from the TULSA-PRO Ablation Clinical Trial (TACT) pivotal study. TACT enrolled 115 men with localized prostate cancer at 13 sites. Treatment intent was whole-gland ablation sparing the urethra and urinary sphincter. Primary endpoints were adverse events and proportion of men with PSA reduction ≥75%. Secondary endpoints included 12-month 10-core biopsy, mpMRI and prostate volume reduction assessed by a central radiology lab, and quality of life. Median (IQR) age was 65 (59-69) years and PSA 6.3 (4.6-7.9) ng/mL. Pretreatment, 72/115 men had Gleason grade group 2 (GG2) disease. PI-RADSv2 score ≥3 lesions were present in 98/115 (85%) men, ≥4 in 77 (67%). Ablation times were 51 (39-66) min. MRI thermometry during treatment measured 98% (95-99%) thermal coverage with ablation precision of ± 1.4 mm, confirmed by immediate posttreatment CE-MRI. Grade 3 adverse events occurred in 8% of men (all resolved), with no rectal injuries or grade ≥4 events. At 12 months, 1% of men were incontinent (>1 pad/day), and 69/92 (75%) maintained erections sufficient for penetration (IIEF Q2 ≥2). PSA reduction ≥75% was achieved in 110/115 (96%), with median reduction of 95% and nadir of 0.34 ng/mL. Median (IQR) perfused prostate volume decreased from 37 (27-48) cc to 3 (2-5) cc at 12-month MRI. Of 68 men with baseline GG2 disease, 54 (79%) were free of GG2 on 12-month biopsy. Overall, 72/111 (65%) had no evidence of any cancer. Of 98 men with PI-RADSv2 ≥3 at baseline, 26 had MRI lesions at 12 months, 11/26 with biopsy-confirmed GG2 (negative predictive value, NPV, 93%). Multivariate predictors of residual GG2 included intraprostatic calcifications at screening, MRI thermal coverage, and PI-RADSv2 ≥3 at 12 months (P <0.05). The TACT Pivotal study of MRI-guided TULSA for whole-gland ablation in men with localized prostate cancer met its primary PSA endpoint, with low rates of toxicity and residual disease. MRI at 12 months detected residual GG2 disease with NPV of 93%.

141 Continuation of Antiplatelet and/or Anticoagulation in Patients Undergoing Rezūm Prostate Ablation

Rezūm is a minimally invasive technique to treat benign prostatic hyperplasia (BPH). Major advantages include no de novo erectile dysfunction and a low rate of retrograde ejaculation. Discontinuation of peri-operative antiplatelet and/or anticoagulation (APAC) is often preferred in practice to avoid bleeding complications. The objective of this study is to present our experience using Rezūm in patients continuing APAC in the perioperative setting. We retrospectively reviewed 179 patients that underwent Rezūm therapy at our institution since 7/2017. When deemed medically necessary, APAC was continued in the perioperative setting. Post-procedure catheterization regimen included a minimum of 3 days and a maximum of 4 weeks in men with preoperative catheter dependence. Outcomes included pre- and post-operative AUA symptoms score, peak flow, and postvoid residual. Bleeding-related complications and urinary tract infection rate were recorded. Fifty five patients were treated on APAC. Outcomes are reported in the Table. Briefly, the average prostate gland size was 81 grams. Significant improvements were seen in AUA symptom score, peak flow, and post void residual. Bleeding complications requiring intervention occurred in 5 (10.4%) patients, with all 5 undergoing catheter irrigation, 2 undergoing blood transfusion, and 1 undergoing cystoscopic clot evacuation. Of the five, 2 were on aspirin, 1 on apixaban, 1 on rivaraxoban, and 1 on dabigatran. Interestingly, 9/92 (9.8%) patients who were not on APAC had hematuria requiring intervention (9 catheter irrigation, 0 transfusion, and 2 cystoscopic clot evacuation).

Surgical ablation of the prostate in the elderly: A comparison of efficacy and outcomes of open and endoscopic methods

Background: Prostatic obstruction is a common problem of elderly men. This will often times require surgical removal of the prostate. Geriatric surgeries are froth with risks and complications, partly due to depleted functional reserves and comorbities. This study is designed to compare the efficacy and outcomes of three methods of prostatic ablation amongst elderly men. Patients and Methods: This study was retrospective. The study population consisted of men who had surgery for relief of prostatic obstruction. Three surgeries were considered viz: Open prostatectomy/channelization, TURP, and transurethral diode laser vaporization of the prostate (DiLVP). Inclusion criteria were men aged ≥65 years, who had any of the above procedures. Exclusion criteria were synchronous urethral stricture, and prior history of prostatic, bladder or urethral surgery. Patients' demographic, pre-operative, intra-operative and post-operative details were extracted and filled into a proforma. The primary and secondary outcome measures were documented. Data analysis was done using SPSS version 20. Statistical significance was set at a P value of Results: Records of 70 patients were reviewed. Thirty-seven of the patients (52.9%) had open prostatectomy/channelization, 21 (30%) had TURP/channelization, while the remaining 12 (17.1%) had DiLVP. The mean ages were 69.5, 73, and 67 years for groups 1, 2, and 3, respectively. The mean duration of procedure in minutes was 87.5, 75, and 70.5 for groups 1, 2, and 3, respectively (p = 0.12). The groups did not differ in terms of need for blood transfusion (p = 0.81). The groups differed significantly in terms of time to catheter removal and hospital stay. The differences in rates of post-operative complications were statistically significant (p = 0.00). The procedures had comparable long-term rates for satisfactory voiding. Conclusion: Elderly men have significant peri-operative risks. As such, the choice of surgical options for management of prostatic obstruction in them should be carefully considered. Endoscopic methods, especially DiLVP, are associated with fewer peri-operative complications in the elderly.

Magnetic Resonance-Guided Prostate Ablation.

In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade "localized" prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.

Re: Laser Prostate Ablation and Enucleation: Analysis of a National Cohort.

Re: Laser Prostate Ablation and Enucleation: Analysis of a National Cohort.

SPARED Collaboration: Patient Selection for Partial Gland Ablation in Men with Localized Prostate Cancer.

The SPARED CRN (Study of Prostate Ablation Related Energy Devices Coordinated Registry Network) is a private-public partnership between academic and community urologists, the FDA (U.S. Food and Drug Administration), the Medical Device Epidemiology Network and device manufacturers to examine the safety and effectiveness of technologies for partial gland ablation in men with localized prostate cancer. We report on a recent workshop at the FDA with thought leaders to discuss a critical framework for partial gland ablation, focusing on patient selection, surgical planning, followup, study design and appropriate comparators in terms of adverse events and cancer control outcomes. We summarize salient points from experts in urology, oncology and epidemiology that were presented and discussed in an open forum. Given the challenges in achieving patient and physician equipoise to perform a randomized trial, as well as an inherent paradigm shift when comparing partial gland ablation (inability to assess prostate specific antigen recurrence) to whole gland treatments, the group focused on objective performance criteria and goals as a platform to guide the creation of single arm studies in the SPARED CRN. This summit lays the foundation for prospective, multi-center data collection and evaluation of novel medical devices and drug/device combinations for partial gland ablation.

LBA-26 PIVOTAL TRIAL OF MRI-GUIDED TRANSURETHRAL ULTRASOUND ABLATION IN MEN WITH LOCALIZED PROSTATE CANCER

INTRODUCTION AND OBJECTIVES:MRI-guided transurethral ultrasound ablation (TULSA) is a novel minimally-invasive procedure for customized prostate ablation. We report one-year outcomes from the TULSA...

MP78-11 RANDOMIZED CONTROL TRIAL COMPARING FOCAL PROSTATE ABLATION AND RADICAL PROSTATECTOMY IN PATIENTS WITH INTERMEDIATE RISK PROSTATE CANCER. INITIAL EXPERIENCES

INTRODUCTION AND OBJECTIVES:The Focal Prostate Ablation versus Radical Prostatectomy (FARP)* is a Norwegian, prospective, parallel group randomized controlled trial that aims to compare focal ablat...

014 Prevalence of Ejaculatory Dysfunction Following Rezūm Prostate Ablation

Convective radiofrequency water vapor thermal therapy is a minimally invasive technique to treat lower bladder outlet obstruction due to BPH. Initial clinical trial data has demonstrated minimal to no detrimental effects towards sexual function, specifically in regards to ejaculatory function. We sought to evaluate the rate and risk factors for ejaculatory dysfunction following Rezūm prostate ablation. We retrospectively reviewed 81 patient charts that underwent Rezūm therapy by a single BPH surgeon since July 2017. Large glands (≥80 g) utilized stacked treatments and often received the max 15 Rezūm treatments per device. A median lobe treatment was often performed even in patients with small middle lobes. If patients were not queried on post-operative sexual function, patients were contacted by telephone. Post-operative results were compared by t-test and chi-squared analysis. Fifty four patient responses were obtained. Clinical variables are found in the attached table. Briefly, the average prostate size was 67.7 grams. Twenty six patients had preoperative retention. All but 3 patients received median lobe treatments. 11 patients (20%) noted retrograde/anejaculation. All affected patients received median lobe treatments. No clinical variable were associated with developing post-operative retrograde/anejaculation. No patients reported new onset erectile dysfunction.

100 Pilot Experience with Rezūm Prostate Ablation

100 Pilot Experience with Rezūm Prostate Ablation

245 Rezūm Prostate Ablation for Large Gland (≥80 grams) Prostates

Convective radiofrequency water vapor thermal therapy is a minimally invasive technique to treat benign prostatic hyperplasia (BPH). Previous reports have been limited to use in patients with prostate glands <80 grams. We present our initial outcomes utilizing the Rezūm system in patients with large glands (≥80 grams) in a tertiary care center. We retrospectively reviewed 150 patient charts that underwent Rezūm therapy by three BPH surgeons since July 2017. Of these, 34 patients were treated with large glands. Planned post-procedure catheterization regimen included a minimum of 3 days and a maximum of 1 month in men with preoperative catheter dependence. Large glands (≥80 g) utilized stacked treatments and often received the max 15 Rezūm treatments per device. Post-operative results were compared by t-test and chi-squared analysis. Outcomes are reported in the attached table. Briefly, the average prostate gland size was 109.9 grams. Twenty one patients were catheter dependent preoperatively. Of these, 16 (71.4%) patients no longer required catheterization at follow up. Significant improvements were seen in AUA symptom score (p=0.005) and peak flow (p=0.006), whereas post void residual trended towards improvement (p=0.066). Ten patients required additional catheterization time (average 27.5 days, Range 1-106). Post-operative complications were rare. Peri-procedural anticoagulation was associated with post-operative hematuria requiring cystostopic clot evacuation (p=0.039). In these patients with significant hematuria, bleeding was identified and controlled by cauterizing the mucosal edges of prominent median/intravesical lobes. No men reported new onset ED.

Is transurethral needle ablation of prostate out of fashion? Outcomes of single session office-based transurethral needle ablation of prostate in patients with symptomatic benign prostatic hyperplasia

PurposeTransurethral needle ablation (TUNA) is a minimally invasive procedure for the treatment of symptomatic benign prostatic hyperplasia (BPH). Compared to transurethral resection of the prostate (TURP), office-based TUNA is an attractive alternative as it is minimally invasive and avoids general anaesthesia. The aim of this study is to evaluate the efficacy of single session office-based TUNA.Materials and MethodsData of 121 patients who had undergone TUNA was retrieved from June 2008 to March 2017. Patients were followed-up with visits at 1, 3, 6, and 12-months with the International Prostate Symptom Score (IPSS), quality of life (QoL) scoring and uroflowmetry.ResultsPatients were 39 to 85 years old. The prostate volumes were 20.00 to 96.90 mL with a median of 26.95 mL. The median IPSS score pre-TUNA was 19, median QOL score pre-TUNA was 4 and median maximum urinary flow (Qmax) pre-TUNA was 10.3 mL/s. There is 65% improvement of IPSS post-TUNA (p<0.001). There is 75% improvement of QOL post-TUNA QOL (p<0.001). There is 35% improvement of Qmax post-TUNA Qmax (p<0.001). The mean relapse-free survival for TUNA is 6.123 years. The 1st, 3rd, and 5th year relapse-free survival rate were 91.7%, 76.6% and 63.7% respectively.ConclusionsOur study is the first to investigate the use of a single-setting office-based TUNA requiring minimal sedation in the Asian community. Complication rates were low in our series, with no associated mortality. When applied to selected patients, TUNA is an effective and reasonably safe alternative for the treatment of symptomatic BPH.

The comparative study of ablation shape and range in canine prostate by radiofrequency, laser and microwave

Objectives To compare the ablation volume, shape and difference of ablation by laser, radiofrequency and microwave in the prostate of vivo dogs. Methods Nine adult male beagles were randomly divided into three groups: laser group, radiofrequency group and microwave group. One ablation lesion was operated in each side of prostate, so there were a total 18 lesion under the difference combination the power and time through three types ablation. The ablation needle was punctured through perineum under guidance by Transrectal ultrasound (TRUS).The changes of ablation process and the relationship between ablation area and tip position were observed by TRUS. Contrast-enhanced ultrasound (CEUS) and dynamic-contrast enhanced magnetic resonance imaging (DCE-MRI) were used to observe the ablation area, measure each meridian, calculate the volume, which were compared with the pathological gross specimen. Results 1. Hyperechoic areas could be observed on TRUS under three types ablation, and the range gradually expanded along with time; 2. The ablation lesion could be clearly observed by CEUS and DCE-MRI, and the calculated volume was correlated with the gross specimen, with statistical significance, R = 0.98 (P = 0.00) and R = 0.93(P = 0.00) (Spearman). 3.The calculated volume under CEUS were as follows: LA: 3w/600J: 0.72ml, 3w/1200J 1.12ml, 4w/600J: 1.13ml, 4w/1200J: 1.69ml, 5w/600J:1.72ml, 5w/1200J:2.20ml; RFA: 25w /60s:0.53ml, 25w/120s: 0.61ml, 30w/60s: 0.64ml, 30w/120s: 0.84ml, 35w/ 60s: 0.85ml, 35w/120s: 1.09ml; MWA: 25w/30s: 0.62ml, 25w/60s: 0.92ml, 25w/120s: 1.14ml, 25w/180s:2.10ml, 30w/60s: 2.15ml, 30w/120s: 2.70ml; 4. The ablation volume increases with the increase of power, energy and time. The ablation volume by laser and microwave increase faster than radiofrequency. Conclusions This three types of thermal ablation can be used for prostate ablation. The appropriate ablation should be selected according to the shape and location of tumor and the characteristics of each type ablation in clinical practice.

Numerical simulation modeling of the irreversible electroporation treatment zone for focal therapy of prostate cancer, correlation with whole-mount pathology and T2-weighted MRI sequences.

Background:At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE.Methods:In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient.Results:A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383–750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386–580 V/cm) when the ablation zone volumes were used from the follow-up MRI.Conclusions:The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.

MRI-guided transurethral insonation of silica-shell phase-shift emulsions in the prostate with an advanced navigation platform.

In this study, the efficacy of transurethral prostate ablation in the presence of silica-shell ultrasound-triggered phase-shift emulsions (sUPEs) doped with MR contrast was evaluated. The influence of sUPEs on MR imaging assessment of the ablation zone was also investigated. sUPEs were doped with a magnetic resonance (MR) contrast agent, Gd2 O3 , to assess ultrasound transition. Injections of saline (sham), saline and sUPEs alone, and saline and sUPEs with Optison microbubbles were performed under guidance of a prototype interventional MRI navigation platform in a healthy canine prostate. Treatment arms were evaluated for differences in lesion size, T1 contrast, and temperature. In addition, non-perfused areas (NPAs) on dynamic contrast-enhanced (DCE) MRI, 55°C isotherms, and areas of 240 cumulative equivalent minutes at 43°C (CEM43 ) dose or greater computed from MR thermometry were measured and correlated with ablated areas indicated by histology. For treatment arms including sUPEs, the computed correlation coefficients between the histological ablation zone and the NPA, 55°C isotherm, and 240 CEM43 area ranged from 0.96-0.99, 0.98-0.99, and 0.91-0.99, respectively. In the absence of sUPEs, the computed correlation coefficients between the histological ablation zone and the NPA, 55°C isotherm, and 240 CEM43 area were 0.69, 0.54, and 0.50, respectively. Across all treatment arms, the areas of thermal tissue damage and NPAs were not significantly different (P=0.47). Areas denoted by 55°C isotherms and 240 CEM43 dose boundaries were significantly larger than the areas of thermal damage, again for all treatment arms (P=0.009 and 0.003, respectively). No significant differences in lesion size, T1 contrast, or temperature were observed between any of the treatment arms (P>0.0167). Lesions exhibiting thermal fixation on histological analysis were present in six of nine insonations involving sUPE injections and one of five insonations involving saline sham injections. Significantly larger areas (P=0.002), higher temperatures (P=0.004), and more frequent ring patterns of restricted diffusion on exvivo diffusion-weighted imaging (P=0.005) were apparent in lesions with thermal fixation. T1 contrast suggesting sUPE transition was not evident in sUPE treatment arms. The use of MR imaging metrics to predict prostate ablation was not diminished by the presence of sUPEs. Lesions generated in the presence of sUPEs exhibited more frequent thermal fixation, though there were no significant changes in the ablation areas when comparing arms with and without sUPEs. Thermal fixation corresponded to some qualitative imaging features.

Perceptions and Practice Patterns of Holmium Laser Goggles in Endourological Procedures: An Unnecessary Evil?

The holmium laser is used increasingly for a wide array of urological procedures. Laser safety goggles are mandatory at many centers for individuals within the nominal hazard zone, as set out by the institution. Recent ex vivo studies suggest standard eye wear may be equally as protective. We sought to evaluate the perceptions and practice patterns of laser safety goggles in urology. A 24-question survey was sent out through e-mail to an international e-mail list of ∼2000 urologists that were members of the Endourological Society. Data were collected anonymously using Survey Monkey. A total of 264 (14%) urologists completed the survey. Thirty-four percent worked in the community, whereas 63% worked at an academic institution. Ninety-seven percent routinely used the holmium laser. The most common uses were lithotripsy (99%), tissue incision (71%), tumor ablation (58%), and prostate ablation (26%). Formal laser training and institutional laser safety policies were reported in 76% and 64%, respectively. Forty percent of respondents routinely wore laser safety goggles. Laser adverse events were witnessed by 19%, but there were no eye injuries reported. Seventy percent of surgeons felt that laser safety goggles may impair their vision. When presented with the information that regular eye glasses may be as effective as laser goggles for preventing harm, the majority (86%) would opt for regular eye wear. Laser safety eyewear practice patterns vary greatly. Many centers have adopted policies for universal mandatory laser goggles in the operating room. With over two thirds of surgeons suggesting laser goggles impair their vision, and recent literature suggesting regular eye wear is equivalent in preventing laser-associated eye injuries, laser goggle safety policies should be updated to better match the potential hazards inherent to the device.