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 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 BPH Histologic Prevalence Around the World

What’s 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 – not everyone with LUTS has BPH and not everyone with BPH has LUTS Blaivas JG. Urol Clin North Am 1985;12:215–24

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 120W 70W 200W 980nm is 2300 times more absorbed in H2O than 532nm 532nm is 74 times more absorbed in HbO2 than 980nm

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 980nm RevoLix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

Category Admission Day1(OP) Day2(dischage) 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

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-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

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

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