1. RevoLix New 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

5. Epidemiology of BPH Histologic Prevalence Around the World

9. 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

10. 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

11. The TUR-P Indication : Contraindications : Procedures : ???
Complications :

12. TUR-P

13. Laser Prostatectomy
1. PVP
2. Thulium 3. Diode

14. 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

15. 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

16. 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

17. Optical Penetration Depth
Diode 980nm
RevoLix銩雷射

18. 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.

19. Prostate tissue after VapoResection with RevoLix
X X X100
No deep penetration ! Only 0.2 mm necrosis

20. Remove Mediam lobe of Prostate

21. Remove Lateral lobe of Prostate

22. RevoLix in Urology: Ureter Stricture術前 術後

23. To evaluated the clinical outcome of BPH

24. Materials and Methods Between Oct 2007 and May 2009
The age of (average 76.4)
80 patients with BPH treated with Thulium laser therapy

25. Patients Acute urinary retention: 38 (47.5%)
Pre-OP PSA: (mean 8.78)
Preop PV: mL (mean 85mL)
T-zone: Mean 58mL

26. 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

27. 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

28. Results of Thulium laser in 80 patients
Initial months months months
AUA-SI
Peak flow (ml/s)
QOL

29. Morbidity Profile
Iterm No Incidence%
Incontinence
UTI
Hematuria
Urine retention
Reop for check bleeding
Impotence
Bladder neck stenosis/stricture
Prostate cancer

30. 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

31. Thank You