林口長庚紀念醫院高齡泌尿外科 崔克宏醫師 revolix new laser for surgery
TRANSCRIPT
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林口長庚紀念醫院林口長庚紀念醫院高齡泌尿外科 高齡泌尿外科
崔克宏崔克宏醫師醫師
RevoLix
New Laser for Surgery
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IntroductionIntroduction
• BPH is a major cause of LUTS in men
• Half of all men over the age of 50 will develop this condition, also known as Benign Prostatic Hyperplasia
• By the time a man reaches his 70's or 80's, 80% will experience urinary symptoms
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• Benign prostatic hyperplasia (BPH) is a common disease process that affects an age
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Epidemiology of BPHEpidemiology of BPHHistologic Prevalence Around the WorldHistologic Prevalence Around the World
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Blaivas JG. Urol Clin North Am 1985;12:215–24
What’s LUTS?What’s LUTS?Voiding (obstructive)symptoms• Hesitancy• Weak stream• Straining to pass urine• Prolonged micturition• Feeling of incomplete
bladder emptying• Urinary retention
Storage (irritative orfilling) symptoms• Urgency• Frequency• Nocturia• Urge incontinence
LUTS is not specific to BPH LUTS is not specific to BPH – – not everyone withnot everyone withLUTS has BPH and not everyone with BPH has LUTSLUTS has BPH and not everyone with BPH has LUTS
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Surgical TreatmentSurgical Treatment
• Transurethral resection of prostate (TUR-P), Gold standard procedure
• Laser prostatectomy:
GreenLight PVP
RevoLix : Thulium laser
雙極利尿雷射 UROLAS 980
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The TUR-PThe TUR-P
•Indication :
•Contraindications :
•Procedures : ???
•Complications :
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TUR-PTUR-P
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Laser ProstatectomyLaser Prostatectomy
1. PVP2. Thulium3. Diode
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ABSORPTION vs. ABSORPTION vs. AVELENGTHAVELENGTH
980nm is 2300 times more absorbed in H2O than 532nm532nm is 74 times more absorbed in HbO2 than 980nm
200W
120W 70W
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Thulium laser vaporization Thulium laser vaporization for Benign Prostatic for Benign Prostatic
Hypertrophy: OutcomeHypertrophy: Outcome
林口長庚紀念醫院林口長庚紀念醫院高齡泌尿外科 高齡泌尿外科
崔克宏崔克宏醫師醫師
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RevoLixRevoLix: Laser Type and Specification: Laser Type and Specification
Laser type: Diode Pumped Solid State LaserDPSS (Thulium 銩 Laser)
(The 2 micron laser is excited by an internal diode laser.)
Wavelength: 2 micrometer
Power: 5 Watt – 70 Watt, adjustable
Operational mode: Continuous Wave (cw)
Chopped: 50 milliseconds to continuous
Delivery system: Flexible silica fibres
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Optical Penetration Depth
K T P532 nm
D io de830 nm
N d:YA G1064 nm
H o:YA G2100 nm
C O 2
10 m
Tissu e
0.8 m m
5 m m
10 m m
0.4 m m 0.02 m m
Diode 980nm RevoLix 銩雷射
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RevoLix: Fields of ApplicationRevoLix: Fields of Application
Endourology: TUR-Laser,Opening of Strictures,Incisions, Excisions,Ablation of Bladder Tumours.
Open Urology: Excision of Tumours from the Cortex of the Kidney,Bladder Surgery.
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Prostate tissue after VapoResection with RevoLix
X20 X40 X100
No deep penetration ! Only 0.2 mm necrosis
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Remove Mediam lobe of ProstaRemove Mediam lobe of Prostatete
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Remove Lateral lobe of Remove Lateral lobe of ProstateProstate
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RevoLix in Urology: Ureter StrictRevoLix in Urology: Ureter Strictureure
術前
術後
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• To evaluated the clinical outcome of BPH
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Materials and MethodsMaterials and Methods
• Between Oct 2007 and May 2009
• The age of 54-94 (average 76.4)
• 80 patients with BPH treated with Thulium laser therapy
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PatientsPatients
• Acute urinary retention: 38 (47.5%)
• Pre-OP PSA: 3.6-28.53 (mean 8.78)
• Preop PV: 43.5-120 mL (mean 85mL)
• T-zone: Mean 58mL
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Categories of information evaluation for assessing the results of implementing Thulium laser
Category Admission Day1(OP) Day2(dischage)
Lab test CBC,U/A, Bun Cr, EKGSugar, Na, K, Cl, albumin
Radiology CXR, KUB
Pharmacology IVF Cantibiotics IM analgesics
Analgesics (oral) CAntibiotics(oral) C
OP&Anesthesia OP permit PVP
nursing prepareanesthesia prepare
Specific test TRUSurodynamics
Others vital signs Cfleet enema DietNPO 3 way foley, irrigationRemoving foley
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ResultsResults
• OP time: median 1.45 hours
• Hospital stay (mean): 2 days
• 75 (93%) need overnight irrigation for <12hours
• Mean duration of catheterization: <16 hours
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Results of Thulium laser in 80 patients
Initial 3 months 6 months 12 months
AUA-SI 27.7+5.7 8.7+4.5 6.8+5.0 6.2+4.7
Peak flow (ml/s) 2.3+3.7 16.5+5.1 16.4+5.2 14.8+6.1
QOL 4.4+1.1 1.04+0.65 1.04+0.65 1.64+0.92
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Morbidity Profile
Iterm No Incidence%
Incontinence 0 0
UTI 5 6.2
Hematuria 1 1.25
Urine retention 2 2.5
Reop for check bleeding 1 1.25
Impotence 0 0
Bladder neck stenosis/stricture 1 1.25
Prostate cancer 6 7.5
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ConclusionsConclusions
• Thulium laser offers rapid tissue ablation and resection in patients with BPH
• The laser is a new technology to most urologists, the expense, safety precautions, long term effectiveness, and general acceptance
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Thank YouThank You