KTRK-TV Reporter Christi Myers reported recently on a procedure being performed by UTMB’s Dr. Eric Walser. “There may soon be a new option for men suffering from prostate cancer. The treatment involves a laser and has already shown promising results in studies overseas. This laser procedure is something in between watchful waiting and the radical prostate surgery. And right now they’re testing it with men who have early cancer.”
One of the biggest problems with kidney cancer (also known as renal cell carcinoma or RCC) is removing it. Obvious, you say.
However, the reason is not what you might think.
The surgical options for resecting (cutting-out) kidney cancer are well-developed and usually pretty straightforward. The kidney containing the tumor is removed (nephrectomy) or just a part of the kidney might be removed if the tumor is small (partial nephrectomy). All of this is just fine– as long as you have a second kidney that is normal and can pull duty for the one you are about to lose. But some people don’t have this option due to chronic kidney disease from diabetes or high blood pressure. Years of these conditions can lead to so much kidney damage that these patients cannot afford to lose even a part of one kidney– They risk permanent renal failure and may need kidney dialysis treatment for the rest of their lives.
The patient in this picture has 2 kidney cancers in his right kidney (arrows) and has no options for surgery due to long-standing kidney disease and poor function. What are his options?
Two cancers in the right kidney (arrows)– oh my. You are looking at a CT “slice” (cut section of the human body) from the patient’s feet looking toward the head.
Remove the kidney and probably start dialysis treatments three times per week for the rest of his life. This is very difficult for families’ finances/schedule and for the patient’s sense of well-being
Do nothing and hope the cancers grow slowly and don’t spread. This is unlikely to happen.
Perform regional tumor therapy consisting of needle-puncture and ablation (destruction) of the tumors only, while preserving as much of the kidney as possible. This option was chosen for this patient to treat his cancer in a way that maximized tumor destruction but minimized risk of permanent renal failure.
Several “cryoprobes” inserted through the back. The tips are guided into the tumors using guidance from CT scanner images
Figures 3 (right) and 4 (below) show the “Cryoprobes” inserted into the tumors with guidance by a CT (computed tomography) scanner. “Ice-balls” (white arrows) form as the freezing process envelopes the tumors. This treatment takes about 2 hours and involves admission overnight. Post procedure pain is minor and goes away in less than a week with pain medications or just Advil/Tylenol.
Grey fuzzy blobs (“iceballs”–white arrows) surround the bright needles that are embedded into the kidney cancers
By the way, the patient’s renal function dropped slightly after the procedure but returned to baseline about a week later and he requires no dialysis. To monitor how successfully we killed these tumors, we repeat a CT or MRI scan in about 3 months. If some tumor remains alive, further treatment is considered and is generally easier and safer than the first procedure.
In brain surgery, a mistake can mean a disability or death. So how do you teach a neurosurgeon without mistakes? In this recent newscast by the Houston ABC affiliate KTRK, Christi Myers shows how Dr. Jaime Gasco uses a 3-D brain simulator. UTMB has one of only five simulators in the United States. In the first two UTMB studies, they found that medical students who were going into neurosurgery were 30 percent to 50 percent more accurate if they trained on the computer brain simulator.
This is a high-resolution high-strength magnetic resonance (MRI) image of the prostate gland below the bladder. Notice the 6 mm dark spot to your left (white arrow on the right side of the prostate). This represents an early prostate cancer confined to the gland. Often, these small cancers can be treated with lasers and no surgery.
Cross sectional MRI view of prostate gland with needle guide in the rectum preparing for biopsy
Large opening MRI scanner where we perform prostate diagnosis, biopsy and treatment. No radiation used for any of these procedures!
UTMB is proud to introduce a complete MRI solution for analysis, planning, biopsy and possible non-surgical ablative treatment of prostate cancer. The advanced imaging capabilities and biopsy tools allow state-of-art imaging and intervention for men experiencing persistently elevated PSA (prostate specific antigen) levels suspicious for prostate cancer.
This new paradigm for evaluating and treating men with prostate cancer is a cooperative effort of the UTMB radiology and urology departments. The diagnostic MRI requires no special preparation and no rectal instruments and is highly sensitive and specific for focal cancers in the prostate gland. The prostate biopsy, done at a different setting, involves MRI-guidance and tissue sampling of areas of the prostate gland considered suspicious by the previous diagnostic MRI.
While many men will require radiation or surgical treatment, some focal prostate cancers can be watched with follow up MRI’s and some can even be ablated using laser or freezing technology– both treatments which fortunately have a very low risk of causing impotence or urinary problems.
CT and MR screening techniques are increasing the early detection of tumors and cancers. Dr. Eric Walser explains how at UTMB new ablation therapies permit radiologists to treat cancers that were previously undetectable or too small to treat with open surgery.
Ablation therapy is a minimally invasive procedure that utilizes probes which conduct one of four different types of energy to kill tumors. And because ablation therapy is minimally invasive, patient recovery time is greatly reduced. Get additional details online or call (409) 747-0100.
Our hands are extensions of our brain. We use them to sense and change the world around us.
Every day each of us uses our hands to navigate through our private obstacle course; there are knobs and wheels to be turned buttons to be pushed wrappers to be unwrapped strings to be tied heavy things to be lifted. Most of the time we accomplish this so effortlessly we hardly give any thought to our amazing hands. They just work. It’s only when our hands are injured that we become painfully aware of our dependence on these finely tuned instruments.
Specialized training in hand surgery has greatly improved the outcome of hand injuries. Minimally invasive techniques use much smaller incisions sometimes with the aid of a camera. By avoiding a larger incision the patient recovers faster has less scarring and fewer potential complications.
One of the most well-known and popular minimally invasive techniques used in hand surgery today is for the treatment of carpal tunnel syndrome. Traditionally the surgery is performed with an incision on the palm one to two inches long.
Many patients don’t realize there is also an endoscopic technique invented by a physician born and raised right here in Texas City, Dr. John Agee. His system which I use in my practice reduces the incision to less than half an inch. I find that patients recover faster and have less pain after this endoscopic release. (more…)