Integration of Electroporation in Urological Practice: Design and Evaluation of a New Transurethral Electrode

This study evaluates a transurethral electrode for electroporation in the porcine bladder, assessing usability, performance, and compatibility with standard urological techniques. Lack of suitable instruments has limited electroporation in the bladder. This protocol introduces a compatible, user-friendly electrode for transurethral application.

To begin, gather the required equipment for the procedure. Insert the telescope into a bridge with a working channel, and insert the instruments into the sheath. For saline, connect to the irrigation system on the sheath with an intravenous tubing set.

After filling the tube with saline and displacing the air, attach the camera head and lighting cable to the telescope base. Connect the sterile insulated cable at the electrode handle to the clean insulated cable at the external pulse generator. Set eight pulses of 100 microseconds.

Set frequency to 5, 000 hertz and voltage to 400 volts, correlating to 1000 volts per centimeter voltage to electrode distance ratio in the designated fields on the screen. Remove the cystoscopy needle from the sterile package and adjust the needle tip length to two millimeters. Acquire a bottle of 100 milligrams per milliliter calcium gluconate, and fill one or more syringes with the calcium gluconate as needed.

Connect the syringe, preferably a lure lock syringe to the distal end of the cystoscopy needle. Position the pig on the operating table and prepare it for the procedure. Open the irrigation system on the resectoscope and confirm saline flow.

Insert the resectoscope, visually guided through the urethra into the urinary bladder. Insert the cystoscopy needle through the working channel of the bridge and visualize the tip of the needle. Perform cystoscopy on the animal and inspect the urinary bladder.

Then, inject 0.3 milliliters of 100 milligram per milliliter calcium gluconate into the bladder wall, to produce a vesicle in the bladder wall, and repeat the calcium injection as needed. Remove the telescope, leaving the outer protective sheath in the urethra. Next, remove the bridge and insert the telescope into the transurethral electrode.

Insert the telescope and the electrode in the sheath to the bladder, under visual guidance. Place the electrode needle in the tissue covering the area injected with calcium gluconate. Then, apply the electric pulses either using the foot pedal or let a non-sterile assistant operate the external pulse generator to apply the pulses.

During pulse delivery, mild muscle contractions may appear. Confirm completion of the electric pulses and successful pulse delivery by reading the pulses generated and delivered on the external pulse generator. Finally, remove the telescope and electrode when every area injected with calcium gluconate has been electroporated and provide post-procedural care to the animal.

The protocol allows researchers to study usability, safety, and performance of transurethral calcium electroporation in a clinically relevant model. During the treatment, precise electrode placement and clear visualization is important to ensure accurate pulse delivery and effective treatment. Future research will include first in-human studies to evaluate the clinical safety, feasibility, and therapeutic effectiveness of calcium electroporation for treating urinary bladder tumors.