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1、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RevoLixNew Laser for SurgeryIntroductionBPH is a major cause of LUTS in menHalf of all men over the age of 50 will develop this condition, also known as Benign Prostatic HyperplasiaBy the time a man reaches his 70s or 80s, 80% will experience urinary symptoms B
2、enign prostatic hyperplasia (BPH) is a common disease process that affects an age Epidemiology of BPHEpidemiology of BPHHistologic Prevalence Around the WorldHistologic Prevalence Around the WorldBlaivas JG. Urol Clin North Am 1985;12:21524Whats LUTS?Voiding (obstructive)symptomsHesitancyWeak stream
3、Straining to pass urineProlonged micturitionFeeling of incompletebladder emptyingUrinary retentionStorage (irritative orfilling) symptomsUrgencyFrequencyNocturiaUrge incontinenceLUTS is not specific to BPH LUTS is not specific to BPH not everyone withnot everyone withLUTS has BPH and not everyone wi
4、th BPH has LUTSLUTS has BPH and not everyone with BPH has LUTSSurgical TreatmentTransurethral resection of prostate (TUR-P), Gold standard procedureLaser prostatectomy: GreenLight PVPRevoLix : Thulium laser雙極利尿雷射 UROLAS 980 The TUR-PIndication :Contraindications :Procedures : ?Complications :TUR-PLa
5、ser Prostatectomy1. PVP2. Thulium3. DiodeABSORPTION vs. AVELENGTH980nm is 2300 times more absorbed in H2O than 532nm532nm is 74 times more absorbed in HbO2 than 980nm200W120W70WThulium laser vaporization for Benign Prostatic Hypertrophy: Outcome林口長庚紀念醫院林口長庚紀念醫院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高齡泌尿外科高齡泌尿外
6、科 崔克宏崔克宏崔克宏崔克宏醫師醫師醫師醫師RevoLix: Laser Type and SpecificationLaser type:Diode Pumped Solid State LaserDPSS (Thulium 銩 Laser)(The 2 micron laser is excited by an internal diode laser.)Wavelength:2 micrometerPower:5 Watt 70 Watt, adjustableOperational mode: Continuous Wave (cw)Chopped:50 milliseconds to
7、 continuousDelivery system: Flexible silica fibresOptical Penetration DepthDiode 980nmRevoLix銩雷射銩雷射RevoLix: Fields of ApplicationEndourology:TUR-Laser,Opening of Strictures,Incisions, Excisions,Ablation of Bladder Tumours.Open Urology: Excision of Tumours from the Cortex of the Kidney,Bladder Surger
8、y.Prostate tissue after VapoResection with RevoLixX20 X40 X100No deep penetration ! Only 0.2 mm necrosisRemove Mediam lobe of ProstateRemove Lateral lobe of ProstateRevoLix in Urology: Ureter Stricture術前術後To evaluated the clinical outcome of BPHMaterials and MethodsBetween Oct 2007 and May 2009The a
9、ge of 54-94 (average 76.4)80 patients with BPH treated with Thulium laser therapyPatientsAcute 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 58mLCategories of information evaluation for assessing the results of implementing Thulium laserC
10、ategoryAdmissionDay1(OP)Day2(dischage)Lab testCBC,U/A, Bun Cr, EKGSugar, Na, K, Cl, albuminRadiologyCXR, KUBPharmacologyIVFCantibioticsIM analgesicsAnalgesics (oral) CAntibiotics(oral)COP&AnesthesiaOP permitPVPnursing prepareanesthesia prepareSpecific testTRUSurodynamicsOthersvital signsCfleet enema
11、DietNPO3 way foley, irrigationRemoving foleyResultsOP time: median 1.45 hoursHospital stay (mean): 2 days75 (93%) need overnight irrigation for 12hoursMean duration of catheterization: 16 hoursResults of Thulium laser in 80 patients Initial 3 months 6 months 12 monthsAUA-SI27.7+5.7 8.7+4.5 6.8+5.0 6
12、.2+4.7Peak flow (ml/s)2.3+3.7 16.5+5.1 16.4+5.2 14.8+6.1QOL4.4+1.1 1.04+0.65 1.04+0.65 1.64+0.92Morbidity Profile ItermNoIncidence%Incontinence00UTI56.2Hematuria11.25Urine retention22.5Reop for check bleeding11.25Impotence00Bladder neck stenosis/stricture11.25Prostate cancer 67.5ConclusionsThulium laser offers rapid tissue ablation and resection in patients with BPHThe laser is a new technology to most urologists, the expense, safety precautions, long term effectiveness, and general acceptance Thank You
