LASER p??state?t?

1
LASERp??state?t?µ?

• ?a f?t???a st?? ?p??es?a t?? ????????a?

?????a?? ?a???d???? ?p????????? ?p?µe??t??
?? ???a?ep?st?µ?a?? ?????????? ??????? ??T G?T
?apa?e??????
2
MIST

• Minimally invasive surgical therapy
• ?e?????????? te?????? ?ss????
• epeµßat???t?ta?
• Laser
• ??p????? TURP
• ??p????? TUVP
• Plasma Vaporisation

3
The king is deadlong live the king.!?

• ?p???e? ep?st?µ????? ß?s? p?? ?a te?µ?????e? t?
  s??????? t?s? a?t??at?stas?? t?? TURP µe te??????
  MIST ?a? e?d???te?a µe ta Laser?
• ??p?? t? fa???µe?? a?t? ?fe??eta? se ep??et???
  marketing ap? t? ß??µ??a??a ?at????? µ??a??µ?t???

4
??????a laser

• ILC Indigo diode laser 830nm
• Greenlight diode pumped laser 532nm
• Revolix ThYAG laser 2090nm
• Evolve SLV diode laser 980nm
• HoLEP HoLAP holmium laser 2100nm

5
??????a laser

• ???e ?atas?e?ast?? p??ß???e? ta p?e??e?t?µata t??
  p?????t?? t??
• ???e ?e???st?? ??e? ?a pa?a??se? t?? eµpe???a t??
  ap? t?? ??????? p????
• ???? e??a? ? (??f?a??) p?a?µat???t?ta t??
  as?e???? µe BPE p?? a?a??t? t?? ?a??te??
  ?e????????? µ???d??
• ?? ?e?? ? ß?ß?????af?a?

6
???a?a µat?? st? www

• Prostate laser surgery
• By Mayo Clinic staff Prostate laser surgery has
  several potential advantages over other
  treatments for enlarged prostate. The advantages
  generally include
• Lower risk of bleeding. Because there is a low
  risk of bleeding, laser surgery can be a good
  option for men who take medication to thin their
  blood or who have a bleeding disorder that
  doesn't allow their blood to clot (coagulate)
  normally.
• Shorter or no hospital stay. Laser surgery can
  generally be done without a hospital stay (as an
  outpatient procedure) or with only one night in
  the hospital. Other prostate treatments such as
  TURP or open prostatectomy usually require a
  longer hospital stay.
• Quick recovery. Recovery from laser surgery
  generally takes seven days to two weeks. You
  should plan to take two weeks off from work after
  the procedure.
• Less need for a catheter. In most cases, laser
  surgery requires the use of a urinary catheter
  for less than 24 hours.
• More immediate results. Urinary results from
  laser surgery are noticeable right away, while it
  can take several weeks to months to see
  noticeable improvement with other enlarged
  prostate procedures or with medications.
• www.mayoclinic.com

7
Evidence Based Medicine

• ??e??e???t??? a?µ???a??a ?et????s?
• S??d??µ? TUR
• ?????e?a ??s??e?a?
• ?????e?a ?a?et???asµ??
• ?a???p???esµ? ap?te?esµat???t?ta

8
???t?µat???

• ?st???????
• F?????µe p??ta st?? ???a...?
• ?p??? PSA, fPSA, ratio, PSAV, PSAD
• TRUS ??????

European Association of Urology, Guidelines 2010,
Prostate cancer Diagnosis 6.4.5 Diagnostic
transurethral resection of the prostate
(TURP) The use of diagnostic TURP instead of
repeat biopsies is of minor importance. Its
detection rate is no better than 8 and makes it
a poor tool for cancer detection (level of
evidence 2a).
9
???t?µat???

• ??st??
• ?????... pa?? t? µ??µ????
• ???? a?t?p??t????
• ???a??st?... a??? ??? ?a p???....

10
? ßas????? ??ase t? µ???p????
11
Collaborative Review Benign Prostatic
EnlargementMeta-analysis of Functional Outcomes
and ComplicationsFollowing Transurethral
Procedures for Lower Urinary TractSymptoms
Resulting from Benign Prostatic
Enlargement.Sascha A. Ahyai, Peter Gilling,
Steven A. Kaplan, Rainer M. Kuntz,Stephan
Madersbacher, Francesco Montorsi, Mark J.
Speakman, Christian G. Stief.

• EUROPEAN UROLOGY 58 (2010) 384 397

12
EUROPEAN UROLOGY 58 (2010) 384 397

• 27 d?µ?s?e?se?? p?? af?????
• 23 RCTs
• 2245 as?e?e??
• LE 1b
• 20/23 RCTs s?????s? MIST vs TURP
• 3/23 RCTs s?????s? MIST vs ap?? OP

13
EUROPEAN UROLOGY 58 (2010) 384 397

• IPSS
• QoL
• Qmax
• PVR
• PFS
• Ep?p?????
• S??????? ??s???t?ta

14
HoLEP

• ? µ??? e?d?s??p??? µ???d?? µe ep?ßeßa??µ??a
  ?a??te?a ap?te??sµata ap? t?? ??ass??? TURP
• ?? µ??e??? t?? ad??a de ??te? pe?????sµ???
• ?????st?? ? ???d???? a?µ???a???? µeta???se??
• ?e? ?f?stata? TUR-S??d??µ?
• ?e???? follow up

15
KTP

• ??µ?f????
• ?????? p??ßeß??µ??? ??a as?e?e?? ?????? ???d????
  ?p? a?t?p??t??? a????
• ?e? ?f?stata? TUR-S??d??µ?
• ?e??te? ??a µ????? ?a? µ?s?? µe?????? p??st?te?
  µe ap?te??sµata s?????s?µa µe TURP
• ?????? ??a RCTs se µe???a ade??µata

16
?????? ??a ?a?? s?ed?asµ??e? µe??te?

• Revolix ThYAG laser 2090nm
• enucleation - vaporisation
• Evolve SLV diode laser 980nm
• twister fiber

17
Laser p??ß??µat?sµ??

• ??st?? a????? - s??t???s??
• ?aµp??? e?µ???s??
• ?????e?a ?e??????e???
• ?????e??s? ?e????????
• sidefire
• endfire
• ß???? ta??t?ta e?????s??
• ?p????? as?e???
• performance status
• fa?µa?e?t??? a????
• µ??e??? ad??a
• p??sd???e? as?e????

18
??????????? p??state?t?µ?

• t? t?p?? a????e?
• t? laser fa??eta? ????? a?t?pa??? t?? TURP
• ??? ep???
• ?a?? s?ed?asµ??e? RCTs

19
e??a??st? ??a t?? p??s??? sa?!