绿光pvp的治疗良性前列腺增生（31）课件

林口長庚紀念醫院 高齡泌尿外科 崔克宏醫師 RevoLix New Laser for Surgery 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 70s or 80s, 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 Blaivas JG. Urol Clin North Am 1985;12:21524 Whats 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 LUTS is not specific to BPH not everyone withnot everyone with LUTS has BPH and not everyone with BPH has LUTSLUTS has BPH and not everyone with BPH has LUTS Surgical 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 The TUR-P Indication : Contraindications : Procedures : ? Complications : TUR-P Laser Prostatectomy 1. PVP 2. Thulium 3. Diode ABSORPTION vs. AVELENGTH 980nm is 2300 times more absorbed in H2O than 532nm 532nm is 74 times more absorbed in HbO2 than 980nm 200W 120W 70W 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 980nmRevoLix銩雷射 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 CategoryAdmissionDay1(OP)Day2(dischage) Lab testCBC,U/A, Bun Cr, EKG Sugar, Na, K, Cl, albumin RadiologyCXR, KUB PharmacologyIVFC antibioticsIM analgesics Analgesics (oral) C Antibiotics(oral)C OP& AnesthesiaOP permitPVP nursing prepare anesthesia prepare Specific testTRUS urodynamics Othersvital signsC fleet enemaDiet NPO3 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 AUA-SI27.7+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 QOL4.4+1.1 1.04+0.65 1.04+0.65 1.64+0.92 Morbidity Profile ItermNoIncidence% Incontinence00 UTI56.2 Hematuria11.25 Urine retention22.5 Reop for check bleeding11.25 Impotence00 Bladder neck stenosis/stricture11.25 Prostate cancer 67.5 Conclusions Thulium laser offers rapid ti