多波光雷射經尿道攝護腺切除術治療攝護腺肥大的成果

許家豪¹、朱懿柏¹、吳子翔¹、蔡德甫¹²、邱文祥¹³、黃一勝¹²

^；1新光吳火獅紀念醫院 外科部泌尿科；²輔仁大學醫學系 泌尿科；³陽明大學醫學系 泌尿科

Treatment outcomes of benign prostatic enlargement by laser vaproresection of the prostate (Multipulse Thulium+1470 laser system)

Chia-Hao Hsu¹, Yi-Bo Chu¹, Tzu-Hsiang Wu¹, Te-Fu Tsai^1,2, Allen W. Chiu¹³, Thomas I.S. Hwang^1,2

1Division of urology, Department of surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei

2 School of Medicine, Nation Yang-Ming University, Taipei

3 School of Medicine, Fu-Jen Catholic University, Taipei

Purpose: Monopolar transurethral resection of the prostate (M-TURP) is the gold standard procedure for the surgical treatment of benign prostatic enlargement (BPE) with bladder outlet obstruction, and the invention of laser modality used in TURP improves the outcomes and reduce the morbidity. MultiPulse Thulium+1470 laser system (MultiPulse laser) combining Thulium:YAG 120W (1940nm) and Module 30W (1470nm) is a new laser modality for BPE. We herein report the outcomes of MultiPulse laser TURP for BPH in our institution.

Materials and Methods: From 2015 October to 2017 February, 105 patients with had received MultiPulse laser TURP. Demographics, prostate volume, serum PSA level, operation time and post-operatvie complications were collected by medical record review. Moreover, 71 patients who underwent M-TURP during the same period in our hospital were compared. Subgroup analysis comparing the outcomes between different prostate volume. All the comparisons used the software MedCalc.

Results: Among the 105 patients receiving MultiPulse laser TURP, the mean age was 69.8 ± 8.7 years old (M-TURP: 69.4 ± 7.4). The mean prostate volume was 63.1 ± 29.3 gm (M-TURP: 49.7 ± 24.6) and the mean serum PSA level was 11.3 ± 4.7 ng/mL (M-TURP: 7.0 ± 1.9). The mean operative time was 67.5 ± 30.0 minutes which is superior to M-TURP (96.5 ± 47.9). The mean hospital stay was 5.2± 2.2 days and was comparable with M-TURP. Neither postoperative blood transfusion nor acute urine retention was noted. The complication rate was superior in Multipulse laser group. Subgroup analysis revealed the advantage of Multipulse laser TURP that is significant in prostate volume larger than 30 mL.

Conclusions: The MultiPulse Thulium+1470 laser, is a feasible and safe modality for patient with BPE, especially with larger prostate (prostate volume larger than 30 mL).  The preliminary outcome is more effective than M-TURP. Further study with larger patients group and long-term follow-up is mandatory.