绿光PVP的治疗良性前列腺增生(31)

1、revolix new laser for surgery 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 d

2、isease process that affects an age blaivas jg. urol clin north am 1985;12:21524 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 noctu

3、ria urge incontinence transurethral resection of prostate (tur- p), gold standard procedure laser prostatectomy: greenlight pvp revolix : thulium laser 雙極利尿雷射 urolas 980 indication : contraindications : procedures : ? complications : 1. pvp 2. thulium 3. diode 980nm is 2300 times more absorbed in h2

4、o than 532nm 532nm is 74 times more absorbed in hbo2 than 980nm 200w 120w 70w 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) c

5、hopped:50 milliseconds to continuous delivery system: flexible silica fibres optical penetration depth ktp 532 nm diode 830 nm nd:yag 1064 nm ho:yag 2100 nm co2 10 m tissue 0.8 mm 5 mm 10 mm 0.4 mm0.02 mm diode 980nmrevolix銩雷射銩雷射 endourology:tur-laser, opening of strictures, incisions, excisions, ab

6、lation 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 術前 術後 to evaluated the clinical outcome of bph between oct 2007 and may 2009 the age o

7、f 54-94 (average 76.4) 80 patients with bph treated with thulium laser therapy 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 catego

8、ryadmissionday1(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 f

9、leet enemadiet npo3 way foley, irrigationremoving foley 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

10、 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 thulium laser offers rapid tissue ablation and r