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조직 세절기 없이 시행한 툴륨 레이져 전립선 절제술의 전립선 크기에 따른 안전성과 효과에 대한 연구 |
| 고신대학교 복음병원, 인제대학교 해운대백병원¹ |
| 박수환,강수환,김택상,정재승¹ |
Introduction: Thulium:YAG (Tm:YAG) laser is one of the new surgical laser in treating BPH. It offers a rapid ablation capacity and hemostatic properties of prostate tissue. However, the difference in the resected weight of the prostate may have an influence on the results, particularly the operation time values. Therefore, we evaluated safety and the effect of prostate size on the outcome of Tm:YAG for the treatment of symptomatic BPH.
Materials and Methods: A total of 313 men underwent Tm:YAG for BPH from March 2010 to December 2011. All patients were classified into three groups according to their prostate volume (group A, ≤60 cc: n=241; group B, 60~99cc: n=53; group C, ≥100: n=19). All patients underwent a baseline evaluation including international prostate symptom score (IPSS), prostate volume and PSA as well as urodynamic evaluation. We used a conventional 24-Fr resectoscope in Tm:YAG without a morcellator. For thulium laser prostatectomy without a morcellator, we used a vaporesection technique similar to traditional TURP.
Results: The mean prostate size was 34.7, 74.7 and 111.8 ml for groups A, B and C, respectively. Group C showed a significant higher surgical time (33.0±24.6, 68.7±30.6 and 104.4±33.5 min, P<0.001). The average of 4.3±4.3, 14.3±10.6, and 17.6±5.7 cc of tissue were retrieved in each groups (P<0.001). The postoperative prostate sizes estimated in groups A, B, and C were 19.6±5.8, 38.9±6.7, and 56.3±7.5 ml, respectively. However, the prostate sizes estimated postoperatively did not show statistical significance differences (P=0.117). There were no significant differences in improvement of IPSS scores, Qmax and PVR among the three groups. And postoperatively decrease of hemoglobin level, decrease of serum sodium and catheterization time and hospital days were observed no statistical significance differences within three groups. No patients needed a blood transfusion and no TUR syndrome were observed in all groups. And there was no severe complication related with the Tm:YAG laser prostatectomy postoperatively.
Conclusions: Tm:YAG prostatectomy is a safe and effective procedure for treating symptomatic BPH independent of prostate size with little perioperative morbidity. Although the long term durability of this new method has not been confirmed, it may be an important alternative in the treatment of BPH.
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keywords : Benign hyperplasia prostate,Thulium laser,Resection of the prostate. |
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