Sclerosi del collo vescicale La sclerosi del collo vescicale è dovuta alla perdita di elasticità dell’uretra prostatica che non è in grado di aprirsi in maniera adeguata durante la minzione (la prostata è però di normali dimensioni).
TUIP (Trans Urethral Incision of the Prostate).
TULIP (Trans Urethral Laser Incision of the Prostate): tecnica da noi preferita perché permette l’utilizzo di laser Holmium e laser Tullio ottenendo minore sanguinamento, possibilità di conservare l’eiaculazione anterograda e minore durata del cateterismo (inferiore a 24 ore).
Fotovaporizzazione (PVP) selettiva con KTP laser.
The primary bladder neck obstruction (PBNO) has been recognized in 41-45% of young men suffering from a chronic lower urinary tract symptom (LUTS). Few studies are published in the literature about the use of laser devices in the surgical treatment of PBNO and none about the use of Thulium laser. The aim of our study is to report the results of our follow-up in the endoscopic treatment of PBNO with Thulium laser.
MATERIALS AND METHODS:
From January 2012 to January 2015, we treated 214 patients using Thulium laser for primary bladder neck sclerosis. All patients had symptoms suggestive of LUTS or prostatism: filling or irritative symptoms and voiding or obstructive symptoms. In 157 patients, the incision was performed unilaterally at 7 o’clock of the bladder neck. In 57 cases, bilateral incision was performed at 5 and 7 o’ clock without vaporizing the tissue between the two incisions. We chose to make the incision bilaterally in cases wherein a single incision was not enough to solve the obstruction from the bladder neck and prevent a recurrence. Bladder irrigation was used overnight in all cases, and the catheter was removed after 24 hours.
One hundred ninety-six patients enrolled completed 1-year follow-up: 157 patients underwent unilaterally incision and 39 bilateral incision. In 179 cases (91.3%), there was unchanged antegrade ejaculation, while reduced semen volume was reported by 14 men (7.1%) and retrograde ejaculation by only 3 (1.5%), but these patients underwent bilateral incision. The quality of orgasm and sexual satisfaction was not permanently changed by the operation.
In patients with PBNO, it is possible to perform endoscopic treatment with Thulium laser that we think is an effective and safe procedure, not affecting sexual functioning and particularly retrograde ejaculation.
La stenosi dell’uretra è il restringimento del lume uretrale che può interessare qualsiasi segmento dell’uretra.
Uretra anteriore: meato, uretra peniena, uretra bulbare
Uretra posteriore: uretra membranosa e prostatica
– Uretroplastica: ricostruzione del tratto stenotico con l’impiego di mucosa buccale o del prepuzio
– Laser Tullio o Laser Holmium: incisione del tratto stenotico che permette di rinviare il trattamento chirurgico che richiede un lungo cateterismo.
Is the laser mightier than the sword? A comparative study for the urethrotomy
Comparison of cold-knife optical internal urethrotomy and holmium:YAG laser internal urethrotomy in bulbar urethral strictures
Evaluation of the Efficacy and Safety of Laser versus Cold Knife Urethrotomy in the Management of Patients with Urethral Strictures: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis.
Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture.
Thulium laser resection for bladder neck obstruction in women.
Holmium laser endourethrotomy for the treatment of long-segment urethral strictures: a retrospective study of 190 patients.
Efficacy of transurethral bladder neck incision with 2-micron continuous wave laser (RevoLix) for the management of bladder outlet stricture in women.
Transurethral incision of the bladder neck using KTP in the treatment of bladder neck obstruction in women.
Ho:YAG-laser: treatment of vesicourethral strictures after radical prostatectomy.
Transurethral 2-microm laser in the treatment of urethral stricture.
Safety and efficacy of laser and cold knife urethrotomy for urethral stricture.
Holmium laser urethrotomy for treatment of traumatic stricture urethra: a review of 78 patients.
Low-power holmium:YAG laser urethrotomy for urethral stricture disease: comparison of outcomes with the cold-knife technique.
Comparison of treatment results between holmium laser endourethrotomy and optical internal urethrotomy forurethral stricture.
Holmium laser urethrotomy for urethral stricture.
Holmium laser core-through urethrotomy for traumatic obliterative stricures of urethra: initial experience
High-power thulium fiber laser ablation of urinary tissues at 1.94 microm.
Low-power holmium:YAG laser urethrotomy for treatment of urethral strictures: functional outcome and quality of life.
Expanding the role of photoselective vaporization of the prostate.
The Next Generation in Laser Treatments and the Role of the GreenLight High-Performance System Laser.
Bladder neck incision using a 70 W 2 micron continuous wave laser RevoLix.
IMPIEGO DEL LASER TULLIO NEL TRATTAMENTO DELLE SCLEROSI DEL COLLO VESCICALE DAL 2005 AL 2007
Dr A. PICINOTTI, Dr S. MATTIOLI, Dr.ssa M. SBRAGI
PHOTOSELECTIVE LASER VAPORIZATION OF THE PROSTATE (PVP), TRATTAMENTO LASER DELL’IPB
Mattioli S., Cremona M., Pozzoni F.
Istituto Clinico S. Ambrogio – Milano (IT)