雷射手術在前列腺肥大症之應用: 報告分享 laser surgical …´”克宏.pdf ·...
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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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0
10
2030
40
50
60
7080
90
100
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.
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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
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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
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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
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• HPS• Diode laser• Thulium laser
Minimal Invasive Treatment of Benign Prostatic Hyperplasia
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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
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Methods
• April 2007 to January 2009• A total of 48 male patients (range, 60 to 87
years, mean 72 )
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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
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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
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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.
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• 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)
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Pre-Op Post-Op
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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
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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
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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%)
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Results• OP time: 48-110 mins (mean 65 mins)• Little bleeding loss• Indewelling foley catheterization
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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
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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
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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