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1、林口長庚紀念醫院高齡泌尿外科 崔克宏醫師,RevoLixNew Laser for Surgery,Introduction,BPH 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,Benign prostatic hyp
2、erplasia(BPH)is a common disease process that affects an age,Epidemiology of BPHHistologic Prevalence Around the World,Blaivas JG.Urol Clin North Am 1985;12:21524,Whats LUTS?,Voiding(obstructive)symptomsHesitancyWeak streamStraining to pass urineProlonged micturitionFeeling of incompletebladder empt
3、yingUrinary retention,Storage(irritative orfilling)symptomsUrgencyFrequencyNocturiaUrge incontinence,LUTS is not specific to BPH not everyone withLUTS has BPH and not everyone with BPH has LUTS,Surgical Treatment,Transurethral resection of prostate(TUR-P),Gold standard procedureLaser prostatectomy:G
4、reenLight PVPRevoLix:Thulium laser雙極利尿雷射 UROLAS 980,The TUR-P,Indication:Contraindications:Procedures:?Complications:,TUR-P,Laser Prostatectomy,1.PVP2.Thulium3.Diode,ABSORPTION vs.AVELENGTH,980nm is 2300 times more absorbed in H2O than 532nm532nm is 74 times more absorbed in HbO2 than 980nm,200W,120
5、W,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 LaserDPSS(Thulium 銩 Laser)(The 2 micron laser is excited by an internal diode laser.)Wavelength:2 micrometerPower:5 Watt 70 Watt,adj
6、ustableOperational mode:Continuous Wave(cw)Chopped:50 milliseconds to continuousDelivery system:Flexible silica fibres,Optical Penetration Depth,Diode 980nm,RevoLix銩雷射,RevoLix:Fields of Application,Endourology:TUR-Laser,Opening of Strictures,Incisions,Excisions,Ablation of Bladder Tumours.Open Urolo
7、gy: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 clini
8、cal outcome of BPH,Materials and Methods,Between Oct 2007 and May 2009The 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 informati
9、on evaluation for assessing the results of implementing Thulium laser,CategoryAdmissionDay1(OP)Day2(dischage),Lab testCBC,U/A,Bun Cr,EKGSugar,Na,K,Cl,albuminRadiologyCXR,KUBPharmacologyIVFCantibioticsIM analgesicsAnalgesics(oral)CAntibiotics(oral)COP&AnesthesiaOP permitPVPnursing prepareanesthesia p
10、repareSpecific testTRUSurodynamicsOthersvital signsCfleet enemaDietNPO3 way foley,irrigationRemoving foley,Results,OP time:median 1.45 hoursHospital stay(mean):2 days75(93%)need overnight irrigation for 12hoursMean duration of catheterization:16 hours,Results of Thulium laser in 80 patients,Initial
11、3 months 6 months 12 months,AUA-SI27.7+5.7 8.7+4.5 6.8+5.0 6.2+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+0.92,Morbidity Profile,ItermNoIncidence%,Incontinence00UTI56.2Hematuria11.25Urine retention22.5Reop for check bleeding11.25Impotence00Bladder neck stenosis/stricture11.25Prostate cancer 67.5,Conclusions,Thulium 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,
