Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar t...Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um （thulium） laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia （BPH）. This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate （TURP） during the 1-year follow-up.展开更多
目的评估经尿道铥激光前列腺剜除术(transurethral thulium laser enucleation of the prostate,TmLEP)与经尿道铥激光前列腺汽化切除术(transurethral thulium laser vaporesection of the prostate,TmLRP)治疗高危大体积(>80 mL)...目的评估经尿道铥激光前列腺剜除术(transurethral thulium laser enucleation of the prostate,TmLEP)与经尿道铥激光前列腺汽化切除术(transurethral thulium laser vaporesection of the prostate,TmLRP)治疗高危大体积(>80 mL)良性前列腺增生(benign prostatic hyperplasia,BPH)的安全性与有效性。方法回顾性分析2014年4月至2016年6月在我院行铥激光手术治疗的高危大体积BPH患者,共60例,其中30例行TmLEP,30例行TmLRP。术后随访6个月。比较两组患者术前国际前列腺症状评分(intemational prostate symptom score,IPSS)、生活质量评分(quality of life,QoL)、前列腺体积、最大尿流率(maximum urinary flow rate,Q_(max))、残余尿量(postvoidresidualurinevolume,PVR),比较两组手术时间、剜除或切除前列腺质量、留置尿管时间,比较两组术后IPSS、QoL、Q_(max)、PVR、尿控率,观察两组术中、术后常见并发症。结果患者均顺利完成手术。TmLEP组切除腺体质量多于TmLRP组,差异有统计学意义[(67.2±7.7)g比(46.8±6.8)g,P<0.05],在手术时间、术中出血量、膀胱冲洗时间、留置尿管时间方面比较差异无统计学意义(P>0.05);两组患者术后1、3、6月的IPSS、QoL、Q_(max)、PVR较术前均有较大改善,TmLEP组及TmLRP组术后3个月及6个月尿控率(均为100%)与术后1个月时(分别为83.3%,86.7%)相比明显提高,差异有统计学意义(P<0.05);两组患者在术后随访期内发生暂时性尿失禁、泌尿生殖道感染、尿道狭窄等术后并发症方面比较差异无统计学意义(P>0.05)。结论 TmLEP、TmLRP治疗高危大体积BPH均具有良好的安全性和临床疗效。对于高危大体积BPH患者,充分的术前准备和术中及术后严密监测并发症情况是成功治愈的关键。展开更多
Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the co...Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.展开更多
目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于...目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于上海市第一人民医院泌尿外科中心行TLEBRBT且术后病理提示NMIBC的共计104例患者,配合术中即刻膀胱灌注吡柔比星。回顾性分析患者的手术时间、术中出血量、术中术后并发症、导尿管留置天数、术后病理分期分级。随访患者复发及进展情况并依据病理分级与分期分层统计患者复发率。结果:104例患者均行TLEBRBT,手术时间15~60min,平均(35.71±9.16)min;术中少量出血,无闭孔神经反射及膀胱穿孔发生,留置导尿1~4d。术后病理分期Ta74例,T130例。临床病理分级低度恶性潜能(PUNLMP)16例,低级别70例,高级别18例。随访时间6~35.5个月,平均(25.05±9.97)个月;复发13例(12.5%),平均复发时间(9.65±8.46)个月,死亡2例(1.9%)。结论:TLEBRBT配合术中膀胱灌治疗NMIBC安全、疗效确切、术后病理精确,是一种理想的手术治疗方式。展开更多
文摘Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um （thulium） laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia （BPH）. This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate （TURP） during the 1-year follow-up.
文摘目的评估经尿道铥激光前列腺剜除术(transurethral thulium laser enucleation of the prostate,TmLEP)与经尿道铥激光前列腺汽化切除术(transurethral thulium laser vaporesection of the prostate,TmLRP)治疗高危大体积(>80 mL)良性前列腺增生(benign prostatic hyperplasia,BPH)的安全性与有效性。方法回顾性分析2014年4月至2016年6月在我院行铥激光手术治疗的高危大体积BPH患者,共60例,其中30例行TmLEP,30例行TmLRP。术后随访6个月。比较两组患者术前国际前列腺症状评分(intemational prostate symptom score,IPSS)、生活质量评分(quality of life,QoL)、前列腺体积、最大尿流率(maximum urinary flow rate,Q_(max))、残余尿量(postvoidresidualurinevolume,PVR),比较两组手术时间、剜除或切除前列腺质量、留置尿管时间,比较两组术后IPSS、QoL、Q_(max)、PVR、尿控率,观察两组术中、术后常见并发症。结果患者均顺利完成手术。TmLEP组切除腺体质量多于TmLRP组,差异有统计学意义[(67.2±7.7)g比(46.8±6.8)g,P<0.05],在手术时间、术中出血量、膀胱冲洗时间、留置尿管时间方面比较差异无统计学意义(P>0.05);两组患者术后1、3、6月的IPSS、QoL、Q_(max)、PVR较术前均有较大改善,TmLEP组及TmLRP组术后3个月及6个月尿控率(均为100%)与术后1个月时(分别为83.3%,86.7%)相比明显提高,差异有统计学意义(P<0.05);两组患者在术后随访期内发生暂时性尿失禁、泌尿生殖道感染、尿道狭窄等术后并发症方面比较差异无统计学意义(P>0.05)。结论 TmLEP、TmLRP治疗高危大体积BPH均具有良好的安全性和临床疗效。对于高危大体积BPH患者,充分的术前准备和术中及术后严密监测并发症情况是成功治愈的关键。
文摘Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.
文摘目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于上海市第一人民医院泌尿外科中心行TLEBRBT且术后病理提示NMIBC的共计104例患者,配合术中即刻膀胱灌注吡柔比星。回顾性分析患者的手术时间、术中出血量、术中术后并发症、导尿管留置天数、术后病理分期分级。随访患者复发及进展情况并依据病理分级与分期分层统计患者复发率。结果:104例患者均行TLEBRBT,手术时间15~60min,平均(35.71±9.16)min;术中少量出血,无闭孔神经反射及膀胱穿孔发生,留置导尿1~4d。术后病理分期Ta74例,T130例。临床病理分级低度恶性潜能(PUNLMP)16例,低级别70例,高级别18例。随访时间6~35.5个月,平均(25.05±9.97)个月;复发13例(12.5%),平均复发时间(9.65±8.46)个月,死亡2例(1.9%)。结论:TLEBRBT配合术中膀胱灌治疗NMIBC安全、疗效确切、术后病理精确,是一种理想的手术治疗方式。
