Contemporary Interventional Ultrasonography in Urology (eBook)

Foreword 5
Contents 6
Contributors 8
Historical Background 10
Prologue 10
The Period of the Central Canal Type Transducer 10
The Period of Real-Time Intervention 11
Intervention by Transrectal Ultrasound 13
References for Interventional Ultrasound 14
References 14
Laparoscopic Ultrasonography 16
Introduction 16
Laparoscopic Ultrasonography Technology 16
The Radiologist, the Urologist, and Laparoscopic Ultrasonography 17
Lus During Renal Procedures 18
Probe Ablation: Cryotherapy 18
Probe Ablation: Radiofrequency Ablation 19
Laparoscopic Partial Nephrectomy 19
Renal Cyst Decortication 20
Laparoscopic Renal-Stone Surgery 21
Lymphocele Marsupialization 21
Miscellaneous Applications 22
Future Directions 23
Overview 23
References 23
Ultrasound-Guided Prostate Cryosurgery: State of the Art 25
Introduction 25
Background 25
Patient Selection 26
Patients at High Risk for Local Recurrence 27
Patients with Organ-Confined, Low-Volume, Low Gleason Score Disease 28
Focal Cryosurgery 28
Patients with Local Recurrence After Radiation Therapy 30
Technical Considerations in Cryosurgery 30
Saline Injection into Denonvilliers’ Fascia 30
Temperature Monitoring in Critical Areas and Improved Cryosurgical Protocols 31
Role of US in Monitoring Prostate Cryosurgery 31
Argon-Based Cryosurgical Equipment 31
Future Technical Improvements 31
Conclusions 31
References 32
Recent Advance in TRUS-Guided Prostate Brachytherapy 33
Introduction 33
Prostate Brachytherapy 33
Limitation of Current Brachytherapy 34
Potential Solutions 35
System Description 35
Hardware Components 35
System Calibration 36
Software Tools 37
Prostate Segmentation 37
Needle Segmentation 37
Seed Segmentation 39
Dosimetry 40
System Evaluation 40
Evaluation of Calibration 41
Method 41
Results 41
Needle Positioning and Orientation Accuracy by Robot 43
Needle Placement Accuracy 43
Needle Angulation Accuracy 43
Needle-Targeting Accuracy 43
Method 43
Results 43
Evaluation of the Prostate Segmentation Algorithm 44
Method 44
Results 44
Evaluation of the Needle Segmentation Algorithm 44
Method 44
Results 44
Evaluation of the Seed Segmentation Algorithm 46
Method 46
Results 46
Discussion and Conclusions 46
References 47
IntraOperative Real-Time Transrectal Ultrasound Monitoring During Energy-Free Nerve-Sparing Laparoscopic Radical Prostatectomy 49
Introduction 49
Improvement of Oncological Outcomes by TRUS Navigation 49
Recovery of Erectile Function After TRUS-Guided Nerve-Sparing LRP 53
Conclusion 54
References 54
Contemporary TRUS-Guided Prostate Biopsy for Screening and Staging 56
Introduction 56
Indications and Contraindications 56
Patient Preparation 57
Antibiotics 57
Enemas 57
Anesthesia 58
Basic Technique for TRUS-Guided Biopsy 58
Anatomy 58
Probes 58
Imaging of the Prostate 58
Basic Biopsy Technique 62
Cancer Imaging 62
Evolution of Biopsy Technique 62
Initial Biopsy: Development of the Various Protocols 62
Repeat Biopsies 64
Saturation Biopsy Protocol 65
TRUS-Directed Biopsies 65
Complications 65
Prostate Cancer Staging 65
Conclusions 66
References 66
The Use of High-Intensity Focused Ultrasound in Prostate Cancer 70
Introduction 70
Mechanism of Action 70
Pros and Cons of Different Commercial Systems 70
Patient Selection: Indications and Contraindications 72
Indications 72
Contraindications 73
Transurethral Resection of the Prostate Plus HIFU 73
The HIFU Procedure: Ablatherm ® 73
The Key Steps in the Ablatherm ® 73
Preoperative Preparation 73
Positioning the Patient and External Warming 74
Device Preparation 74
Introducing the Probe 74
Transrectal Ultrasound Simulation 74
Treatment Planning 75
Active Treatment 75
The Perioperative Phase 76
Follow up 77
Specific Measures to Avoid and Manage Complications 78
Incontinence 78
ED 78
Outcome: Munich Database 78
Future Directions 79
New Treatment Strategies 79
Improvements in the Visualization and Assessment of HIFU Lesions 79
Conclusions 79
Overview 80
References 80
Harmonic Scalpel 82
Hemostatic Principles in Relation to Active Surgical Temperatures 82
The Harmonic Scalpel 82
Hemostatic Mechanism of the Harmonic Scalpel 82
Cutting Mechanism of the Harmonic Scalpel 83
Use of the Harmonic Scalpel 83
Safety 83
Clinical Applications of the Harmonic Scalpel 85
Renal Surgery 85
Adrenal Surgery 86
Pediatric Urologic Surgery 86
Prostate and Bladder Surgery 86
References 87
Intravascular Ultrasound 89
Introduction 89
Role of Angiography in the Evaluation of Atherosclerosis 89
Intravascular Ultrasound 89
Evaluation of Atherosclerosis by Intravascular Ultrasound 90
Utility of Intravascular Ultrasound in Interventional Cardiology 91
Evaluating the Impact of Medical Therapies on Plaque Progression 93
Lowering Low-Density Lipoprotein Cholesterol 94
Promoting the Biological Activity of HDL 96
Inhibition of Cholesterol Esterification 96
Blood Pressure-Lowering Therapies 97
Monitoring the Impact of Therapies on Transplant Vasculopathy 97
Limitations of Intravascular Ultrasound 97
Overview 97
References 98
Ultrasound Application for Penile Disorders: Color Doppler Ultrasound Hemodynamic Evaluation for Erectile Dysfunction and Priapism 100
Color Doppler Ultrasound Hemodynamic Study for Erectile Dysfunction 100
Indications 100
Procedure 100
Phases of Erection and Hemodynamic Events 101
Hemodynamic Patterns 102
Interpretation of Color Doppler Ultrasound Hemodynamic Studies 102
Pitfalls of Hemodynamic Studies 102
Color Doppler Ultrasound Evaluation for Priapism 103
Procedure 103
Color Doppler Ultrasound Findings and Interpretation for Priapism 104
References 105
The Physics of Ultrasound and Some Recent Techniques Used 107
The Piezoelectric Effect 107
Characteristics of Ultrasound 107
The Principle of Ultrasound Scanning 107
The Propagation of Sound in Tissue 108
Speed of Sound 108
Attenuation 108
Focusing the ultrasonic beam 108
Limitations of Ultrasound 109
Resolution 109
Axial Resolution 109
Lateral Resolution 109
Contrast Resolution 109
Artifacts in Ultrasound 110
Enhancement 110
Shadowing 110
Reverberations 110
Mirror Artifacts 111
Propagation Speed Error 111
Newer Techniques and Methods in Urologic Ultrasound 111
Prostate Harmonic Imaging 111
Grating Lobes 111
3D Ultrasound 112
The Specific Benefits of 3D Ultrasonography of the Prostate 113
Examples of 3D Ultrasonography of the Prostate 113
Recent Developments in Transducer-Design for TRUS 114
Contrast-Enhanced Ultrasound for the Prostate 117
Introduction 117
Prostate Cancer Imaging 117
Ultrasonography 117
Color and Power Doppler Ultrasonography 118
Three-Dimensional Ultrasonography 118
Elastography 118
Contrast-Enhanced Ultrasonography 119
Contrast Agents 119
Safety 119
Technique 120
Applications 120
Contrast-Enhanced Ultrasonography of the Prostate 120
Detection of Prostate Cancer 120
Support of Prostate Cancer Treatment 121
Follow up of Prostate Cancer Treatment 122
Future Development 122
Conclusion 124
References 124
Contrast-Enhanced Ultrasound of the Kidneys 126
Introduction 126
Ultrasound Contrast 126
Diagnosis 127
Renal Artery Stenosis 127
Renal Perfusion Defects 127
Renal Trauma 127
Ureteropelvic Junction Obstruction 127
Cystic Renal Masses 128
Solid Renal Masses 128
Detection 128
Differentiation and Characterization 129
Reflux 129
Follow up 129
Transplant Kidneys 129
Ablation Techniques 129
Future 130
Treatment Monitoring 130
Targeted Imaging 130
Targeted Drug and Gene Delivery 131
Conclusion 131
References 131
The Integration of Computed Topography Imaging in Ultrasound Diagnosis: Real-Time Virtual Sonography 133
Introduction 133
Background 133
Configuration of the Entire System and Operation of Each Part 134
Obtaining CT Volume Data 134
Obtaining Information on the Position of the Probe 134
Registration of Coordinate Systems 135
Clinical Images 136
Conclusion 137
References 137
Elastography 138
Introduction 138
Sonoelastography 138
Elastography 138
Method 138
Practice 139
Studies 140
Future Directions 140
Overview 142
References 142
Ultrasonic Tissue Characterization 143
Introduction 143
Clinical Background 143
Former Work 144
Methods 145
Parameter Extraction 148
Information Model 148
Spectrum Parameters 149
System Identification Parameters: AR Model 150
Generalized Spectrum Parameters 150
First-Order Texture Parameters 151
Backscatter Distribution Parameters 151
Rayleigh Distribution 153
Rice Distribution 153
K Distribution 153
Generalized K Distribution 153
Nakagami Distribution 153
Generalized Nakagami Distribution 154
Second-Order Texture Parameters 154
Morphological Parameters 155
Clinical Features 156
Discussion of Parameter Groups 156
Classification 157
Fuzzy Inference Systems 158
Crossvalidation 161
Selection of Parameters 162
Postprocessing 163
Evaluation Stage 164
Visualization 164
Results 165
Results of Tissue Characterization 166
Case A 168
Case B 169
Discussion 170
Focus on Brachytherapy 171
Conclusion 171
References 172
Augmented Reality for Computer-Assisted Image-Guided Minimally Invasive Urology 178
Background 178
Technical Aspects of Augmented Reality 178
Initial Clinical Use of Augmented Reality in Urology: Cleveland Clinic Experience 179
Conclusions 183
References 183
Robotic Percutaneous Interventions 184
Introduction 184
Robotic Percutaneous Access of the Kidney 184
Robotic Percutaneous Access to the Prostate 187
Conclusion 188
References 188
Index 190