Release date: 2006-09-01
Laser treatment of benign prostatic hyperplasia Since laser application in the field of urology in 1966, laser treatment technology has been widely used in urology because of its advantages of safety, simplicity and less bleeding. In recent years, holmium laser, green laser and holmium laser have been introduced and put into clinical practice, which provides a new means for laser treatment of benign prostatic hyperplasia (BPH) and shows good application prospects.
HeNe Laser Helium laser is a 2.1 μm solid-state pulsed laser with dual functions of cutting and electrocoagulation, making it ideal for use in the surgical field. The holmium laser is located in the near-infrared region of the spectrum and is easily absorbed by water. Due to the high water content in the tissue, the main energy of the holmium laser is concentrated on the surface layer, which can produce good cutting and separation.
In 1995, New Zealand Gilling et al reported the first holmium laser prostatectomy (HolRP), and New Zealand physicians first completed the treatment of 480 patients. After 6 months of follow-up, the maximum urinary flow rate increased by nearly 200%, American Urology The learning (AUA) symptom score decreased by an average of about 80%, and the overall re-intubation rate was <5%. No patients required blood transfusion and no hyponatremia or respiratory syndrome (TURS) was found. Holropectomy has excellent hemostasis. Compared with transurethral resection of the prostate (TURP), intraoperative bleeding and surgical complications are less, and hospital stay is shorter. The disadvantage is that the operation time is longer, generally 20% to 30% longer than TURP.
With the widespread use of holmium lasers, the use of holmium laser prostatectomy (HolEP) for the treatment of BPH has been increasing. Compared with HolEP and TURP, German physicians showed that in addition to operative time, HolEP was superior to TURP in urinary catheter indwelling time, hospital stay and hemoglobin loss, and was superior to TURP in improving urinary symptoms and residual urine volume. Perioperative complications were less than TURP. HolEP treatment of BPH has a short operation time and is effective, with no gland size limitation. However, the technique is difficult to master and requires the operator to have extensive experience in endoscopic laser surgery.
Green laser Green laser is a green color laser with a wavelength of 532 nm, which is obtained by multiplying the Nd:YAG laser. It is characterized by shallow tissue penetration, only 0.8 mm, which is highly absorbed by oxyhemoglobin and relatively unabsorbed by water, so it is called "selective laser".
The green laser for the benign prostatic hyperplasia, PVP (selective photo-prostate vaporization) was initiated by professors such as Malek and Kuntzman. Using the principle of large affinity between green laser and hemoglobin, the power is gradually reduced to vaporize the hyperplastic gland. After the operation, the patient can stay in the catheter or leave it for only a few hours, which greatly shortens the hospital stay.
In April 2000, a five-year clinical study of green laser PVP reported by Professor Malek and Kuntzman showed that impotence and urinary incontinence did not occur after PVP, and no repeated treatment was needed. In 2001, Nagahama et al. used green laser to treat 21 patients with prostate volume <50 g. All patients showed no significant blood loss, residual urine volume, international prostate symptom score (IPSS), and quality of life improved. In 2003, Hal et al. in the United States treated 10 patients in the outpatient clinic with high-energy PVP, and achieved ideal results.
High-energy PVP is a simple, safe, and effective method for treating BPH, with the disadvantage of not being able to obtain tissue samples that can be submitted for examination.
HeNe Laser Helium laser is a new type of surgical laser that was used in clinical practice in January 2004. The wavelength range is 1.75 to 2.22 μm, with an average of 1.908 μm. It is close to the absorption peak of the laser at high temperature (1.92 μm), and the tissue absorbs more laser light during surgery. Therefore, the surgical efficiency is high and the thermal damage is small. The holmium laser can provide continuous wave and pulse wave. The former has high cutting efficiency and is mainly suitable for prostate surgery. The latter is mainly suitable for fine operation such as ureteral stricture and urethral stricture.
Our Institute of Urology, Shanghai Jiaotong University has designed a holmium laser prostate stripping resection (TmLRP-TT), which combines the high-efficiency cutting and rapid vaporization of holmium laser continuous wave, with short operation time and good safety. We compared TmLRP-TT with TURP in 124 patients with BPH and found that the short-term efficacy was similar, but TmLRP-TT had very little bleeding, no need for bladder irrigation after surgery, catheter indwelling time, postoperative hospital stay was shortened. Perioperative complications are significantly reduced and deserve further promotion.
In short, the wide application of laser technology in the field of urology and the advent of new laser technologies such as holmium laser provide a new means for minimally invasive treatment of benign prostatic hyperplasia. With the maturity of laser technology and the accumulation of clinical experience, this technology is expected to become the new gold standard for the treatment of RPH. However, the above-mentioned laser has the disadvantages of long tissue pulverization time and high treatment cost, and also limits the application to a certain extent.
Source: China Medical Tribune
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