RevoLix New Laser for Surgery

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RevoLixNew Laser for Surgery

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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

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

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Epidemiology of BPHHistologic Prevalence Around
the World
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Whats LUTS?

• Voiding (obstructive)
• symptoms
• Hesitancy
• Weak stream
• Straining to pass urine
• Prolonged micturition
• Feeling of incompletebladder emptying
• Urinary retention

• Storage (irritative or
• filling) symptoms
• Urgency
• Frequency
• Nocturia
• Urge incontinence

LUTS is not specific to BPH not everyone
withLUTS has BPH and not everyone with BPH has
LUTS
Blaivas JG. Urol Clin North Am 19851221524
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Surgical Treatment

• Transurethral resection of prostate (TUR-P), Gold
  standard procedure
• Laser prostatectomy
• GreenLight PVP
• RevoLix Thulium laser
• ?????? UROLAS 980

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The TUR-P

• Indication
• Contraindications
• Procedures ???
• Complications

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TUR-P
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Laser Prostatectomy
1. PVP 2. Thulium3. Diode
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ABSORPTION vs. AVELENGTH
120W
70W
200W
980nm is 2300 times more absorbed in H2O than
532nm532nm is 74 times more absorbed in HbO2
than 980nm
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Thulium laser vaporization for Benign Prostatic
Hypertrophy Outcome

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RevoLix Laser Type and Specification

• Laser type Diode Pumped Solid State
  Laser DPSS (Thulium ? 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

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Optical Penetration Depth
Diode 980nm
RevoLix???
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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.
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Prostate tissue after VapoResection with RevoLix
X20 X40
X100
No deep penetration ! Only 0.2 mm necrosis
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Remove Mediam lobe of Prostate
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Remove Lateral lobe of Prostate
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RevoLix in Urology Ureter Stricture
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• To evaluated the clinical outcome of BPH

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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

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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

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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 O
P permit PVP nursing prepare anesthesia
prepare Specific test TRUS urodynamics Others v
ital signs C fleet enema Diet NPO 3 way
foley, irrigationRemoving foley
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Results

• OP time median 1.45 hours
• Hospital stay (mean) 2 days
• 75 (93) need overnight irrigation for lt12hours
• Mean duration of catheterization lt16 hours

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Results of Thulium laser in 80 patients
Initial 3 months 6 months
12 months
AUA-SI 27.75.7 8.74.5
6.85.0 6.24.7 Peak flow (ml/s) 2.33.7
16.55.1 16.45.2 14.86.1 QOL 4.41.1
1.040.65 1.040.65 1.640.92
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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 Bladd
er neck stenosis/stricture 1 1.25 Prostate
cancer 6 7.5
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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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Thank You