614 THE JOURNAL OF UROLOGy®
4, Supplement, Wednesday, May 23, 2007
in IPSS, QOL, Qmax and PVR were durable to 24 months post-
operatively. Mean operative time was 93.3±30.0minutes. Serum sodium
and hematocrit did not changed significantly. 91%(N=98) were treated as
outpatients(<12hrs) and the remaining 9%(N=10) were admitted for 1 or 2
hospital days. Mean catheterization times were 28.6±11.4hours(12-
72hrs). 12patients were needed staged procedure during 6 to 12months
postoperatively. Staged procedure was performed easily due to less
bleed and short operation time. Complications included delayed bleeding
10(7%), transient post-operative retention 4(5.6%), urge incontinence
18(16.7%), short term(<14days) transient dysuria(17%), long
term(14>days) dysuria(9%), and retrograde ejaculation in sexually
possible men(42.4%).
CONCLUSIONS: PVP using high-power KTP laser energy
continues to demonstrate safe and efficacious treatment outcomes for up
to 24months but careful operation techniques are needed for decreasing
complications. Staged procedure is more preferable in old and risk
patients. Long follow-up will further validate this new modality as the
standard for surgical treatment of huge BPH.
T•ble1. Tr-..tmentouteomwofPVPCp<O.fl01, '*p<0.011
Basefone(n-108) 3M (n•108) 4 M (n=94) 12M (n"68) 24Min-32)
IPSS 24.7±11.1 12.5:tS.t' 11.8:1:4.o' tMz4.s" 14.2±11.6"
QOL 4.8t0.6 1.9t0,&" 1. tto.7" 1.0,t0.s' Ul<tO.fl,
am.(mu-) 5.1±3.1 . 18.6~.~~· 17.0t5.1" 14.1)±3.5' 13. 6:1:4.3
PVR{ml) 19M±87.5 1'05t36.2' 88i25.1" 422±7.9" 38.31l1.9"
PV!mn 121.8:1:53.0 63.9t15.6- 61.4:1:14.6" 88;1:1:14.1" 73.2:1:.14.:f"
Source of Funding: None
1848
REVOLIX 70 WATT 2 MICRON CONTINUOUS WAVE LASER
V APORESECTION OF THE PROSTATE. PRELIMINARY RESULTS
AFTER A ONE YEAR FOLLOW-UP
Thorsten Bach*, Thomas R W Herrmann, Roman Ganzer, Andreas J
Gross. Hamburg, Germany, Hannover, Germany, Regensburg, Germany.
INTRODUCTION AND OBJECTIVE: Laser treatment of benign
prostatic hyperplasia becomes more popular. Introduced laser systems
(e.g. Holmium, KTP) have limitations due to their laser physics. The
Revolix laser combines the advantages of the Holmium:YAG laser with
the comfort of a continuous wave laser beam. This study reports the
preliminary results of vaporesection of the prostate, using the 2 micron
continuous wave (cw) laser.
METHODS: 54 consecutive patients were treated with the 70 Watt
Revolix laser for BPH. The mean age was 61 years (56-82 years). Mean
volume of the gland was 30.3 cern (12 - 38 cern). A 550 micron RigiFib
bare ended fibre was used in combination with a 26 French continuous
flow laser resectoscope. Measured outcomes were resection time,
decrease in hemoglobin and transfusion rate, catheter-time, improvement
in urinary flow rate, post-voiding-residual urine (PVR), AUA-SS and QoL
score.
RESULTS: Average resection time was 52 minutes. After crossing
the learning curve, a tissue ablation of approximatly 1.5 g/min is possible.
Transfusions were not necessary in any patient. Catheter time was 1,7
days (1 to 3 days). Q-max significantly improved from 4.2 to 20.1 ml in
average. PVR decreased from 86 to 12 mi. AUA-SS and QoL-Score
improved from 19.8 to 6.9 and 4 to 1 respectively. No patient required re-
hospitalisation.
CONCLUSIONS: Altough longer follow-up is needed, this
preliminary results indicate that Revolix 2 micron cw vaporesection of the
prostate is a safe and efficient procedure. One year follow up data
showed a significant improvement in voiding symptoms and patients
quality of life.
Source of Funding: None
1849
SYSTEMATIC EVALUATION OF 21JM THULIUM LASER DEVICE FOR
TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN AN EX-
VIVO MODEL
Gunnar Wendt-Nordahl*, Stefanie Huckele, Patrick Honeck, Peter Aiken,
Thomas Knoll, Maurice S Michel, Axel Hlicker. Mannheim, Germany.
INTRODUCTION AND OBJECTIVE: In the last decades various
laser devices have been introduced to challenge conventional
transurethral resection of the prostate (TURP) as standard therapy of
benign prostatic enlargement. We report our experimental experience
with a lately developed thulium laser working on a wavelength of 21.1m and
Vol177, No.
compare it to the gold standard of TURP and potassium-titanyl-phosphate
(KTP)-Laser. As the wavelength of 21.1m offers a high absorption in water,
exceptional tissue ablation qualities are expected of the device.
METHODS: The well-established ex-vivo model of the isolated
blood-perfused porcine kidney was used to evaluate the Revolix Laser
system (Lisa Laser products, Katlenburg-Lindau, Germany) at different
output powers (30, 50, 60 and 70 Watt). The results were compared to
the 80 Watt KTP-Laser (Laserscope, USA) and conventional TURP. N=5
experiments were carried out per parameter. Porcine kidneys were
weighed before and after 10 minutes of laser ablation in an area of
3x3cm; the weight difference marked the amount of ablated tissue.
Bleeding was determined by the weight difference of a swab before and
after it was placed on bleeding surface for 60 seconds after ablating an
area of 9cm2 . Samples of the ablated area were taken and processed for
histological determination of the coagulation zone.
RESULTS: The thulium laser displayed an increasing tissue
ablation capacity at higher output powers. At 70 Watt tissue ablation
reached 6.56±0.69g after 10 minutes. The KTP-Laser displayed a
significantly lower ablation rate of 3.99±0.48g (p<0.05), whereas only 30
seconds were needed to resect the tissue in the same surface area using
TURP, resulting in 8.28±0.38g of tissue ablation. The bleeding rate at 70
Watt was 0.16±0.07g/min for the Revolix Laser compared to
0.21±0.07g/min for the KTP-Laser and 20.14±2.03g/min for TURP
(p<0.05). The corresponding depths of the coagulation zones were
264. 7±41.31Jm for the thulium laser compared to 666.9±64.01Jm for the
KTP-Laser (p<0.05) and 287.1±27.51Jm for TURP. Compared to TURP,
the coagulation zone appeared much denser under the microscope.
CONCLUSIONS: The Revolix thulium laser offers a higher tissue
ablation capacity compared to the KTP-Laser and displays similar
haemostatic capabilities. Compared to TURP both tissue ablation and
bleeding rate are significantly lower. Clinical studies are necessary to
confirm the promising ex-vivo results of thulium laser ablation of the
prostate.
Source of Funding: None
1850
CAVITATIONAL ULTRASOUND: A POTENTIAL MINIMALLY
INVASIVE THERAPY FOR BPH
Alison M Lake*, Timothy L Hall, Kathleen Kieran, J B Fowlkes, Charles A
Cain, William W Roberts. Ann Arbor, MI.
INTRODUCTION AND OBJECTIVE: Symptoms of benign prostatic
hypertrophy (BPH) increasingly affect men as they age, and the
estimated prevalence of BPH in men over age 80 reaches 90 percent.
Increasingly, minimally invasive therapies for the treatment of BPH are
being sought and developed. We describe a non-invasive technology
which precisely non-thermally ablates prostate tissue.
METHODS: We developed and tested an annular 18-element,
750-kHz phased array ultrasound system which delivered high intensity
(22 kW/cm 2 ), short ultrasound pulses (15 cycles= 20 microsec) at pulse
repetition frequencies from 15-200 Hz. Following institutional animal care
committee approval, ultrasound pulses in varying grid configurations were
delivered transcutaneously to ablate a 1 cm 3 volume of prostate tissue for
a total of 10 lesions in 6 anesthetized dogs. A diagnostic ultrasound
probe provided in-line real-time focal zone imaging. Immediately following
treatment, the prostate was grossly examined, sectioned, and submitted
for histology.
RESULTS: In all prostates, a well-demarcated cavity containing
liquefied material was present at the ablation site. Microscopically, the
targeted volume was characterized by debris and absence of cellular
structure. A narrow margin of cellular injury was noted, beyond which
there was no apparent tissue damage. lntraprocedural imaging
demonstrated a temporally and spatially changing hyperechoic zone at
the focus, indicative of cavitation and suggesting effective tissue ablation.
CONCLUSIONS: Histotripsy is capable of precise prostate tissue
destruction and results in a liquefied material within the targeted ablation
zone. It is this characteristic of cavitation, the liquefaction of target tissue,
that may ameliorate post-procedure urinary symptomatology and may
reduce the risk of urinary retention. Ongoing research focuses on
characterization of the effect of cavitation on urethral tissue and the
hemostatic properties of cavitational tissue ablation.
Source of Funding: Coulter Translational Research Program