Tratamiento de la hipertrofia benigna de próstata con el Láser Revolix®

Abstract

The treatment of benign prostatic hyperplasia (BPH) with the Revolix laser is effective. Its versatility enables 2 types of techniques: vaporresection and vaporization. Its chromophore target is water, like the holmium laser, with the difference that it may be used in both a continuous and pulsed mode. The continuous wave enables a precise cut and excellent hemostasis without diffusion to the neighbor tissues (0.2 mm penetration below the cut zone) with an excellent vision of the operative field. We report our experience after three years of treatment. Revolix (thulium) laser has a wavelength of 2013 nm. 2 types of fibers, which reach a potency of up to 70 watts, are used to treat BPH. One frontal fiber for vaporresection and one fiber with side laser emission for vaporization. Both fibers may be combined to treat prostatic hypertrophy. Since the end of 2004 to March 2008 200 patients with BPH were treated. Prostate sizes varied from 20 to 120 g (mean 45 g). 99 patients underwent prostate vaporization, with sizes below 35 g, and 101 patients underwent vaporresection, with prostates over 35 g. Mean hospital time was 24 hours (range 1-4 hours). Mean catheterization time after laser treatment was 16 hours (range 12-72 hours). The efficacy of the treatment was evaluated with uroflowmetry, post void residual and evaluation of the symptoms with the IPSS questionnaire. The clinical results obtained after Revolix laser are comparable to those obtained after transurethral resection of the prostate, KTP laser vaporization or holmium laser enucleation. We demonstrate on important improvement of symptoms, with a decrease over 50% in the IPSS score, a significant improvement in the uroflowmetry, and a marked decrease of post void residual. No blood transfusions were required. There were only 4 patients that presented post operative acute urinary retention, requiring catheterization for a few days; all of them achieved spontaneous voiding posteriorly. No patient presented urinary incontinence after treatment with the Revolix laser. In our experience, the Revolix laser has demonstrated being safe, easy to install, with low operative cost, and a very short learning curve. Its efficacy may be better demonstrated using vapor resection for big prostates and vaporization for smaller prostates (the smaller than 35 g). The reduction of prostatic tissue is intermediate with a slight post operative discomfort and a low complication rate.