雷射手術在前列腺肥大症之應用: 報告分享

Laser Surgical Intervention for Benign Prostate Hyperplasia

崔克宏 醫師

林口長庚紀念醫院

高齡泌尿外科

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2030

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7080

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20-29 30-39 40-49 50-59 60-69 70-79 80-89

Pre

vale

nce

(%)

Pradhan 1975Swyer 1944Franks 1954Moore 1943Harbitz 1972Holund 1980Baron 1941Fang-Liu 1991Karube 1961

Epidemiology of BPH Histologic Prevalence Around the World

Age (y)

Roehrborn CG, McConnell JD. In: Campbell’s Urology. 8th ed. Philadelphia, Pa: W.B. Saunders Co; 2001:1297-1336.

HesitancyHesitancy Terminal dribbling Terminal dribbling StrainingStraining Prolonged voidingProlonged voiding Weak streamWeak stream IntermittancyIntermittancy RetentionRetention Overflow incontinenceOverflow incontinence

LUTS LUTS associatedassociated with BPHwith BPHVoidingVoiding ((obstructiveobstructive) symptoms) symptoms

General principles of MIT techniques

• TUR-P Gold standard• TUEVAP• Hormium-resection • SLT vaporization• Pvp laser vaporization, HPS• Diode laser vaporization• Thulium laser• Thermotherapy• Tuna• Interstitial laser coagulation• Balloons• Stents

ABSORPTION vs. AVELENGTH

980nm is 2300 times more absorbed in H2 O than 532nm 532nm is 74 times more absorbed in Hb O2 than 980nm

200W

120W 70W

• HPS• Diode laser• Thulium laser

Minimal Invasive Treatment of Benign Prostatic Hyperplasia

The Outcome of Photoselective laser vaporization prostatectomy with a

high-power KTP laser in Treating the Benign Prostate Hyperplasia of

those Patients with Acute Urinary Retention

Methods

• April 2007 to January 2009• A total of 48 male patients (range, 60 to 87

years, mean 72 )

Mean Age (years) 72American Society of Anesthesiologists score (%)

1 0

2 15.3

3 84.7

4 0

Mean Prostate Volume (gm) 59.2Mean residual urine(cc) 396International Prostate Symptom Score(Mean)20.5Bother score (Mean) 4.1Urine retention (%) 100

Results• Operation time: average value of 45 minutes• Postoperative hospital stay was 3 days, and the urethral

catheters were removed in less than 48 hrs( range 16-48 hours)

• 100% experienced 1 to 5 days of mild dysuria without specific treatment.

• 5 (10.4%) delayed transient hematuria (7 to 10 days)• 11(22.9%) urgency and hesistency• 0% Incontinence or newly developed impotence or

required surgery.• Four (8.3%) patients required Foley recatheterization for

transient urinary retention

Conclusions

• PVP is quite useful in treating those geriatric patients with bladder outlet obstruction secondary to BPH

• PVP gives the geriatric patients one more option at the urgent surgical endoscopy procedure to reduce the rate of morbidity and mortality.

• An outcome and cost analysis was performed for 20 patients treated with transurethral resection of the prostate (TUR-P), and 20 with diode laser

• Between August to November 2008 • Ages of 50 and 89 (average 76)

Pre-Op Post-Op

AUA-SI 23.7+ 5.7 9.7+ 6.5 10.2+ 6.6QoL 4.4+ 1.1 2.15+ 0.83 2+ 0.65

Initial 3 months 6 months

TUR-P Diode p-value

No. of cases 20 20Mean patient age (years) 72 76 0.849Mean DOS (days)* 5.9 0.05Equipment and accessories 3,000 11,000 < 0.001(TUR loop and Laser fiber)Post operation pain score(average) 8 4.5

Thulium laser

• A total 30 high risk group patients• Age: 70-88 ( mean 75 y/o)• Average prostate volume: 84 gm• Acute urinary retention: 15 pts (50%)• Poor motility: 6 pts (20%)

Results• OP time: 48-110 mins (mean 65 mins)• Little bleeding loss• Indewelling foley catheterization

Morbidity

• 0% patients had blood transfusion• TURP syndrome: 0• 1 (3.3%) patient had failure to voiding and

TUR-P• 1 (3.3%) patient had urethral stricture and

release after OIU• 3 (10%) pts had failure to void but release

after bladder training

Conclusion

• Laser therapy has a high tolerance but long operative times than TUR-P

• It is safe, effective and minimally invasive for high risk patients

• A attractive alternative treatment for high risk patients with obstructive

Thank You

雷射手術在前列腺肥大症之應用: 報告分享�Laser Surgical Intervention for Benign Prostate Hyperplasia投影片編號 2投影片編號 3投影片編號 4投影片編號 5投影片編號 6Minimal Invasive Treatment of Benign Prostatic HyperplasiaThe Outcome of Photoselective laser vaporization prostatectomy with a high-power KTP laser in Treating the Benign Prostate Hyperplasia of those Patients with Acute Urinary RetentionMethods投影片編號 10ResultsConclusions投影片編號 13投影片編號 14投影片編號 15投影片編號 16Thulium laser ResultsMorbidity投影片編號 20Thank You