経尿道的超音波ガイド下前立腺切除術(TULIP)

-手技と1年後の成績-

抄録

Thity cases of benign prostatic hyperplasia (BPH) were treated with transurethral ultrasound-guided prostatectomy (TULIP) procedure and followed for 1 year. The treatment system (TULIP system) was manufactured by Intra-Sonix, Inc., USA. The device is composed of a 20 F transurethral probe incorporationg laser beam window and ultrasound transducer, a 7.5MHZ, 90°sector ultrasound scanner and a laser generator(Nd-YAG). Under epidural anesthesia, the TULIP probe, covered with a sleeve, was inserted. The probe was fixed in the prostatic urethra by pressurizing the sleeve to 2 atomospheres by distilled water. Then the laser fixed at 40W was applied into the prostate. A single pass consisted of moving the probe along the urethra from the bladder neck to the level of vermontanum under the real-time ultrasound guidance with a speed of 1mm/sec. These passes were applied 9 times from 2 to 10 o'clock. Suprapubic cystostony was inserted.
The evaluation was estimated by symptom score (modified Boyarsky's symptom score), maximum flow rate (MFR), residual urine (RU) and prostate volume (PV). The mean age of the patients was 73.9 years (62-92 years old). The numbers of patients evaluable at 3 months and 1 year were 30 and 26, respectively. Four patients could not be evaluated because of unrelated death (1), frail general conditions (2) and prostatectomy (1). The changes of evaluation parameters(pre→3 months→1 year)were symptom score(24.6→→9.8→6.2), MFR(7.0→> 13.8→14.7), RU(49→18→16), and PV(36.8→> 24.6→32.3). Excepting PV, which regained at 1 year, all the parameters improved at 3 months and remained or even further improved at 1 year