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New Technology
LAPAROSCOPY/NEW TECHNOLOGY
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treatment of overactive bladder (and if they are involved on the sensory side, they may in fact be useful in the interstitial cystitis variant of painful bladder syndrome). Food for thought. Alan J. Wein, M.D., Ph.D. (Hon.) 1. Andersson K-E: Prostanoid receptor subtypes: new targets for OAB drugs? J Urol 2009; 182: 2099. 2. Lee T, Hedlund P, Newgreen D et al: Urodynamic effects of a novel EP1 receptor antagonist in normal rats and rats with bladder outlet obstruction. J Urol 2007; 177: 1562.
Laparoscopy/New Technology Histotripsy of the Prostate: Dose Effects in a Chronic Canine Model T. L. Hall, C. R. Hempel, K. Wojno, Z. Xu, C. A. Cain and W. W. Roberts Department of Urology, University of Michigan, Ann Arbor, Michigan Urology 2009; 74: 932–937.
Objectives: To develop the technique of histotripsy ultrasound therapy as a noninvasive treatment for benign prostatic hyperplasia and to examine the histotripsy dose-tissue response effect over time to provide an insight for treatment optimization. We have previously demonstrated the feasibility of prostate histotripsy fractionation in a canine model. Methods: Various doses of histotripsy were applied transabdominally to the prostates of 20 canine subjects. Treated prostates were then harvested at interval time points from 0 to 28 days and assessed for histologic treatment response. Results: The lowest dose applied was found to produce only scattered cellular disruption and necrosis, whereas higher doses produced more significant regions of tissue effect that resulted in sufficient fractionation of tissue so the material could be voided with urination. Urethral tissue was more resistant to the lower histotripsy doses than was parenchymal tissue. Treatment of the urethra at the lowest doses appeared to heal, with minimal long-term sequelae. Conclusions: Histotripsy was effective at fractionating parenchymal and urethral tissue in the prostate, in the presence of a sufficient dose. Further development of this technique could lead to a noninvasive method for debulking the prostate to relieve symptoms associated with benign prostatic hyperplasia. Editorial Comment: This University of Michigan group continues to study and refine ultrasound tissue cavitation or histotripsy. A promising application is in the treatment of benign prostatic hyperplasia. I look forward to a clinical trial of this technology, which is uniquely capable of mechanically debulking prostatic tissue in a noninvasive fashion while offering us the promise of results similar to transurethral or laser prostatectomy. Jeffrey A. Cadeddu, M.D.
2465
treatment of overactive bladder (and if they are involved on the sensory side, they may in fact be useful in the interstitial cystitis variant of painful bladder syndrome). Food for thought. Alan J. Wein, M.D., Ph.D. (Hon.) 1. Andersson K-E: Prostanoid receptor subtypes: new targets for OAB drugs? J Urol 2009; 182: 2099. 2. Lee T, Hedlund P, Newgreen D et al: Urodynamic effects of a novel EP1 receptor antagonist in normal rats and rats with bladder outlet obstruction. J Urol 2007; 177: 1562.
Laparoscopy/New Technology Histotripsy of the Prostate: Dose Effects in a Chronic Canine Model T. L. Hall, C. R. Hempel, K. Wojno, Z. Xu, C. A. Cain and W. W. Roberts Department of Urology, University of Michigan, Ann Arbor, Michigan Urology 2009; 74: 932–937.
Objectives: To develop the technique of histotripsy ultrasound therapy as a noninvasive treatment for benign prostatic hyperplasia and to examine the histotripsy dose-tissue response effect over time to provide an insight for treatment optimization. We have previously demonstrated the feasibility of prostate histotripsy fractionation in a canine model. Methods: Various doses of histotripsy were applied transabdominally to the prostates of 20 canine subjects. Treated prostates were then harvested at interval time points from 0 to 28 days and assessed for histologic treatment response. Results: The lowest dose applied was found to produce only scattered cellular disruption and necrosis, whereas higher doses produced more significant regions of tissue effect that resulted in sufficient fractionation of tissue so the material could be voided with urination. Urethral tissue was more resistant to the lower histotripsy doses than was parenchymal tissue. Treatment of the urethra at the lowest doses appeared to heal, with minimal long-term sequelae. Conclusions: Histotripsy was effective at fractionating parenchymal and urethral tissue in the prostate, in the presence of a sufficient dose. Further development of this technique could lead to a noninvasive method for debulking the prostate to relieve symptoms associated with benign prostatic hyperplasia. Editorial Comment: This University of Michigan group continues to study and refine ultrasound tissue cavitation or histotripsy. A promising application is in the treatment of benign prostatic hyperplasia. I look forward to a clinical trial of this technology, which is uniquely capable of mechanically debulking prostatic tissue in a noninvasive fashion while offering us the promise of results similar to transurethral or laser prostatectomy. Jeffrey A. Cadeddu, M.D.