1 / 31

RevoLix New Laser for Surgery

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

remy
Download Presentation

RevoLix New Laser for Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RevoLixNew Laser for Surgery 林口長庚紀念醫院 高齡泌尿外科 崔克宏醫師

  2. 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

  3. Benign prostatic hyperplasia (BPH) is a common disease process that affects an age

  4. Epidemiology of BPHHistologic Prevalence Around the World

  5. What’s LUTS? Voiding (obstructive) symptoms • Hesitancy • Weak stream • Straining to pass urine • Prolonged micturition • Feeling of incompletebladder emptying • Urinary retention Storage (irritative or filling) symptoms • Urgency • Frequency • Nocturia • Urge incontinence LUTS is not specific to BPH – not everyone withLUTS has BPH and not everyone with BPH has LUTS Blaivas JG. Urol Clin North Am 1985;12:215–24

  6. 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

  7. The TUR-P • Indication : • Contraindications : • Procedures : ??? • Complications :

  8. TUR-P

  9. Laser Prostatectomy 1. PVP 2. Thulium3. Diode

  10. ABSORPTION vs. AVELENGTH 120W 70W 200W 980nm is 2300 times more absorbed in H2O than 532nm532nm is 74 times more absorbed in HbO2 than 980nm

  11. 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

  12. 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 micrometer Power: 5 Watt – 70 Watt, adjustable Operational mode: Continuous Wave (cw) Chopped: 50 milliseconds to continuous Delivery system: Flexible silica fibres

  13. Optical Penetration Depth Diode 980nm RevoLix銩雷射

  14. RevoLix: Fields of Application Endourology: TUR-Laser, Opening of Strictures, Incisions, Excisions, Ablation of Bladder Tumours. Open Urology: Excision of Tumours from theCortex of the Kidney, Bladder Surgery.

  15. Prostate tissue after VapoResection with RevoLix X20 X40 X100 No deep penetration ! Only 0.2 mm necrosis

  16. Remove Mediam lobe of Prostate

  17. Remove Lateral lobe of Prostate

  18. RevoLix in Urology: Ureter Stricture 術前 術後

  19. To evaluated the clinical outcome of BPH

  20. 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

  21. 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

  22. Categories of information evaluation for assessing the results of implementing Thulium laser Category Admission Day1(OP) Day2(dischage) Lab test CBC,U/A, Bun Cr, EKG Sugar, Na, K, Cl, albumin Radiology CXR, KUB Pharmacology IVF C antibiotics IM analgesics Analgesics (oral) C Antibiotics(oral) C OP& Anesthesia OP permit PVP nursing prepare anesthesia prepare Specific test TRUS urodynamics Others vital signs C fleet enema Diet NPO 3 way foley, irrigationRemoving foley

  23. 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

  24. Results of Thulium laser in 80 patients Initial 3 months 6 months 12 months AUA-SI 27.7+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 QOL 4.4+1.1 1.04+0.65 1.04+0.65 1.64+0.92

  25. 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

  26. 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

  27. Thank You

More Related