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RevoLix New Laser for Surgery 林口長庚紀念醫院 高齡泌尿外科 崔克宏醫師 Introduction • 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 • Benign prostatic hyperplasia (BPH) is a common disease process that affects an age Epidemiology of BPH Histologic Prevalence Around the World 100 90 Prevalence (%) 80 Pradhan 1975 Swyer 1944 Franks 1954 Moore 1943 Harbitz 1972 Holund 1980 Baron 1941 Fang-Liu 1991 Karube 1961 70 60 50 40 30 20 10 0 20-29 30-39 40-49 50-59 60-69 70-79 80-89 What’s LUTS? Voiding (obstructive) symptoms • Hesitancy • Weak stream • Straining to pass urine • Prolonged micturition • Feeling of incomplete bladder emptying • Urinary retention Storage (irritative or filling) symptoms • Urgency • Frequency • Nocturia • Urge incontinence LUTS is not specific to BPH – not everyone with LUTS has BPH and not everyone with BPH has LUTS Blaivas JG. Urol Clin North Am 1985;12:215–24 Surgical Treatment • Transurethral resection of prostate (TURP), Gold standard procedure • Laser prostatectomy: GreenLight PVP RevoLix : Thulium laser 雙極利尿雷射 UROLAS 980 The TUR-P •Indication : •Contraindications : •Procedures : ??? •Complications : TUR-P Laser Prostatectomy 1. PVP 2. Thulium 3. Diode ABSORPTION vs. AVELENGTH 120W 70W 200W 980nm is 2300 times more absorbed in H2O than 532nm 532nm is 74 times more absorbed in HbO2 than 980nm Thulium laser vaporization for Benign Prostatic Hypertrophy: Outcome 林口長庚紀念醫院 高齡泌尿外科 崔克宏醫師 RevoLix: Laser Type and Specification Laser type: Diode Pumped Solid State Laser DPSS (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 Optical Penetration Depth Diode 980nm KTP Diode 532 nm 830 nm RevoLix銩雷射 Nd:YAG Ho:YAG 1064 nm 0.8 mm CO2 2100 nm 10 m 0.4 mm 0.02 mm 5 mm 10 mm Tissue RevoLix: 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. Prostate tissue after VapoResection with RevoLix X20 X40 X100 No deep penetration ! Only 0.2 mm necrosis Remove Mediam lobe of Prostate Remove Lateral lobe of Prostate RevoLix in Urology: Ureter Stricture 術前 術後 • To evaluated the clinical outcome of BPH Materials 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 Patients • • • • 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 Categories of information evaluation for assessing the results of implementing Thulium laser Category Lab test Radiology Pharmacology OP& Anesthesia Specific test Others Admission Day1(OP) Day2(dischage) CBC,U/A, Bun Cr, EKG Sugar, Na, K, Cl, albumin CXR, KUB IVF antibiotics C IM analgesics Analgesics (oral) C Antibiotics(oral) C OP permit nursing prepare anesthesia prepare TRUS urodynamics vital signs fleet enema NPO PVP C Diet 3 way foley, irrigationRemoving foley Results • OP time: median 1.45 hours • Hospital stay (mean): 2 days • 75 (93%) need overnight irrigation for <12hours • Mean duration of catheterization: <16 hours Results of Thulium laser in 80 patients Initial 3 months 6 months 12 months 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 1.04+0.65 1.04+0.65 1.64+0.92 AUA-SI 27.7+5.7 4.4+1.1 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 Conclusions • 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 Thank You