Download - Laser Turp Surgical Management
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LASER TURP
Dr. Mohan KeshavamurthyMBBS,MS, MCh(Uro),FRCS(C),FASTS
SENIOR CONSULTANT UROLOGIST & TRANSPLANT SURGEON
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BENIGN PROSTATIC HYPERPLASIA
BPH-age related/androgen dependent
Increase in cell numbers or impaired programmed
cell death
Prostate has perpetual response to androgens unlike
any other organ
Familial predisposition/autosomal dominant
inheritance in younger patients needing surgery
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BPH
Destabilises reservoir ,weakens the pump and
increases pipe resistance
Detrusor instability- frequency/urgency Decreased detrusor contractility- poor
stream, hesitancy, increased residual urine
Increased urethral resistance retention ofurine
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BASIC TOOLS
Clinical evaluation
DRE
TRUS PSA
Urine culture
Co morbid factors-diabetes/hypertension/coronory disease
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COMPLICATIONS
Bladder stones
UTI
Bladder decompensation Incontinence
Hematuria
Acute retention
Compromised renal function/azotemia
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TREATMENT OPTIONS
Do nothing/alternative medicine????????
Medical management
Surgical management Innovative individualised methods
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MEDICAL MANAGEMENT
Alpha blockers
Androgen suppressors
Aromatase inhibitors Plant extracts
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MEDICAL THERAPY
Irritative symptoms > obstructive
No complications
Lifetime commitment Periodic followup
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SURGICAL MANAGEMENT
LASER TURP GOLD STANDARD
CONVENTIONAL TURP
TUIP
Open prostatectomy
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SEARCH CONTINUES..
IN 2004,AFTER CONVENTIONAL TURP,
MORBIDITY 15-20%MORTALITY 0.2-2.5 %
TRANSFUSION RATE 5-11%
2nd INTERVENTION 10-15%
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LIFE
LASER INDUCED FLOW ENHANCEMENT
AS A NEW GOLD STANDARD FOR BPH
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ADVANTAGES-LASER TURP
No Blood loss
No need to stop blood thinners
Ideal for large glands> 100 g
Safe in High risk patients
After Joint replacement Flexible scope,Flat position
No TURP Syndrome
Short Stay Procedure
Small calibre resectoscope. 18 Ch
Small calibre foley for shorter duration
No late Urethral Strictures
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LIFE SLV
Excellent hemostasis
Faster ablation rate
Unrestricted probe lifelarge glands possible
Absorption in water along with Hb decreases risk of
bladder/ureteric orifice damage
Invisible to human eye. Does not impair vision during
procedure
Smoother cavity surface left
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RESECTION TIME
Conventional wisdom of resection time beinglimited to 60 min
Conventional TURP . 1g/min
Holmium Laser... 0.5 g/min
KTP Green Light. 1-2 g/min
Diode 3-4 g/min
upto 160 wattsrevolutionary design
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Depth of Laser Penetration
Biggest drawback of Nd:Yag laser was the
extensive depth of penetration
Holmium is a contact laser..predictabledepth of penetration but no control
DIODE. What u see is what u get
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Seite 17
Transmission of different wavelengths
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DIODE LASER
Mobile equipment
No specific power requirement
No warmup time
Sturdyresets automatically with power outage
AnyOT ,anypatient ,anywhere ,anytime
Versatile
Local service support
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PATIENT DETAILS
Elderly gentleman
Diabetic, Hypertensive
Coronary artery stenting 2 years prior
Acute Retention of urinecatherised
TURP deferred since patient was on blood thinners
Cardiologist worried about the ongoing UTI
colonising the stent
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CONVENTIONAL TURP
Blood thinners to be stopped a week prior
Heparin to be started to cover the week
Heparin to be stopped 6 hours prior to surgery
Procedure usually requires blood transfusion
Patient to be managed I the coronary care unit (CCU)
postoperatively
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LASER TURP
Patient was admitted at FORTIS hospital with urinary
catheter in place
Blood thinners were not stopped
LASER TURP was performed under short lasting
laryngeal mask general anaesthesia
Procedure lasted 20 min
Uneventful recovery
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CONCLUSION
LASER TURP is a safe ,short stay procedure for
benign enlargement of prostate.
Ideal for High risk patients
Cost Effective
Fortis Hospitals has the entire laser armamentarium
as well as core competence to perform laser
urological procedures