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

RevoLix

New Laser for Surgery

IntroductionIntroduction

• 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

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

Epidemiology of BPHEpidemiology of BPHHistologic Prevalence Around the WorldHistologic Prevalence Around the World

Blaivas JG. Urol Clin North Am 1985;12:215–24

What’s LUTS?What’s LUTS?Voiding (obstructive)symptoms• Hesitancy• Weak stream• Straining to pass urine• Prolonged micturition• Feeling of incomplete

bladder emptying• Urinary retention

Storage (irritative orfilling) symptoms• Urgency• Frequency• Nocturia• Urge incontinence

LUTS is not specific to BPH LUTS is not specific to BPH – – not everyone withnot everyone withLUTS has BPH and not everyone with BPH has LUTSLUTS has BPH and not everyone with BPH has LUTS

Surgical TreatmentSurgical 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-PThe TUR-P

•Indication :

•Contraindications :

•Procedures : ???

•Complications :

TUR-PTUR-P

Laser ProstatectomyLaser Prostatectomy

1. PVP2. Thulium3. Diode

ABSORPTION vs. ABSORPTION vs. AVELENGTHAVELENGTH

980nm is 2300 times more absorbed in H2O than 532nm532nm is 74 times more absorbed in HbO2 than 980nm

200W

120W 70W

Thulium laser vaporization Thulium laser vaporization for Benign Prostatic for Benign Prostatic

Hypertrophy: OutcomeHypertrophy: Outcome

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

RevoLixRevoLix: Laser Type and Specification: 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

Optical Penetration Depth

K T P532 nm

D io de830 nm

N d:YA G1064 nm

H o:YA G2100 nm

C O 2

10 m

Tissu e

0.8 m m

5 m m

10 m m

0.4 m m 0.02 m m

Diode 980nm RevoLix 銩雷射

RevoLix: Fields of ApplicationRevoLix: 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 ProstaRemove Mediam lobe of Prostatete

Remove Lateral lobe of Remove Lateral lobe of ProstateProstate

RevoLix in Urology: Ureter StrictRevoLix in Urology: Ureter Strictureure

術前

術後

• To evaluated the clinical outcome of BPH

Materials and MethodsMaterials 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

PatientsPatients

• 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

Category Admission Day1(OP) Day2(dischage)

Lab test CBC,U/A, Bun Cr, EKGSugar, Na, K, Cl, albumin

Radiology CXR, KUB

Pharmacology IVF Cantibiotics IM analgesics

Analgesics (oral) CAntibiotics(oral) C

OP&Anesthesia OP permit PVP

nursing prepareanesthesia prepare

Specific test TRUSurodynamics

Others vital signs Cfleet enema DietNPO 3 way foley, irrigationRemoving foley

ResultsResults

• 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-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

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

ConclusionsConclusions

• 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

Thank YouThank You