Free-Beam and Contact Laser Coagulation

Diode Laser Vaporization for Benign Prostate Hyperplasia: Outcome After 126 Procedures

Purpose: Photoselective vaporization of the prostate (PVP) with a 940-nm diode laser is an option for treating symptoms caused by benign prostatic hyperplasia (BPH). Here, we present our experience using this technology. Methods: We prospectively evaluated 126 patients with lower urinary tract symptoms (LUTS) secondary to BPH who underwent PVP with a 940-nm diode laser from January 2011 to January 2014. The patients were assessed using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA) level, maximum urinary flow (Qmax) by uroflowmetry, postvoid residual volume, and prostate volume by ultrasound at baseline and 3, 6, 12, and 24 months after the procedure. Results: The average patient age was 68.8 ± 8.7 years (range 48-90 years), whereas the average preoperative parameters were as follows: IPSS, 26.1 ± 5.2; IPSS-QoL, 4.9 ± 0.8; Qmax, 4.5 ± 3.1 mL/s; prostate volume, 76.5 ± 35.5 mL; and PSA level, 3.9 ± 2.6 ng/mL. The average catheterization time was 24.7 ± 25.5 hours (range 3-120 hours), and the length of hospital stay was 22.4 ± 17.0 hours (range 8-144 hours). The mean follow-up duration was 17.9 months (range 1-36 months). All parameters showed significant improvement after 12 months. After 24 months, the IPSS (8.8 ± 5.4, p < 0.07), IPSS-QoL (1.6 ± 0.9, p < 0.13), Qmax (15.9 ± 7.3 mL/s, p < 0.11), and PSA level (1.2 ± 0.8 ng/mL, p < 0.11) were improved compared with the baseline, but the difference was not significant, probably due to the small number of patients evaluated in this period. No patients required a transfusion. Conclusions: The results suggest that PVP with a 940-nm diode laser is safe, effective, and durable for the treatment of LUTS secondary to BPH. The patients continue to be monitored for evaluation of the long-term results. A prospective randomized study would allow more solid conclusions regarding the technology to be reached.

Preliminary results of prostate vaporization in the treatment of benign prostatic hyperplasia by using a 200-W high-intensity diode laser

OBJECTIVES

To evaluate the efficacy and safety of a 200-W high-intensity diode laser in the treatment of benign prostatic hyperplasia.

METHODS

The prostate was vaporized by using a side-firing laser fiber (diode laser: power, 150-200 W; wavelength, 980 nm; Limmer, Germany). The following parameters were assessed at baseline, and after a follow-up period of 1- and 6 months: International Prostate Symptom Score, maximum uroflow rate, postvoid residual urine volume, and quality of life score. Prostate volume and prostate-specific antigen levels were assessed at baseline and 6 months postoperatively.

RESULTS

This study included 55 patients diagnosed with lower urinary tract symptoms secondary to BPH, who were treated between December 2007 and July 2008. The recatheterization rate was 10.9%. None of these patients required a blood transfusion or had transurethral resection syndrome. Statistically significant improvements (P < .001) were observed in the values of International Prostate Symptom Score, Q(max), postvoid residual urine volume, and quality of life score at 1- and 6 months of follow-up as compared with the respective baseline values. Transient urge incontinence was noted in 8 patients (8/55, 14.5%).Sloughing of necrotic tissues was observed on cystoscopy in 8 patients within several weeks or months after the operation. The retreatment rate (secondary transurethral resection of the prostate) was 7.3%.

CONCLUSIONS

From our preliminary data, it was evident that diode laser prostatectomy can achieve excellent hemostasis, and provide immediate relief from obstructive voiding symptoms. However, the postoperative irritative symptoms and sloughing of necrotic tissues remained to be an important issue that needed to be resolved.

980-nm Diode Laser: A Novel Laser Technology for Vaporization of the Prostate

OBJECTIVE

The wavelength 980 nm of a recently introduced diode laser system for treatment of benign prostatic enlargement offers a high simultaneous absorption in water and haemoglobin, and is postulated to combine high tissue ablative properties with a good haemostasis.

METHODS

The Ceralas HPD150 diode laser system was evaluated in the well-established ex vivo model of the isolated blood-perfused porcine kidney to evaluate tissue ablation capacity and haemostatic properties at different generator settings. A histological examination of the ablated renal tissue followed. The results were compared with the reference standards transurethral resection of the prostate (TURP) and potassium-titanyl-phosphate (KTP) laser.

RESULTS

The diode laser displays a higher tissue ablation capacity, reaching 7.24+/-1.48 g after 10 min, compared with the KTP laser (3.99+/-0.48 g; p<0.05), whereas only 30s are needed to resect the tissue in the same surface area using TURP, resulting in 8.28+/-0.38 g of tissue removal. With a bleeding rate of 0.14+/-0.07 g/min, the diode laser offers haemostatic properties equivalent to the KTP laser (0.21+/-0.07 g/min) and a significantly reduced bleeding compared with TURP (20.14+/-2.03 g/min; p<0.05). The corresponding depths of the coagulation zones are 290.1+/-46.9 microm for the diode laser, 666.9+/-64.0 microm for the KTP laser (p<0.05), and 287.1+/-27.5 microm for TURP.

CONCLUSIONS

In the standardised ex vivo investigation, the 980-nm diode laser offers a higher tissue ablation capacity and similar haemostasis compared with the KTP laser. In comparison with TURP, both tissue ablation and bleeding are significantly reduced. The promising ex vivo results warrant further clinical investigation.

Technical aspects of lasers in urology

During the course of history a variety of laser principles have been introduced in surgery. Some erroneous developments probably could have been kept out of the market place if not for the magic which accompanies the acronym LASER and with more understanding for the underlying principles governing the process when light meets tissue. The interaction of light with tissue is exemplified on the basis of natural body chromophores when compared with available lasers at different wavelengths and operational modes. Furthermore the meaning of fibre flexibility and durability is elucidated.

Laser treatment of benign prostatic hyperplasia

To evaluate the role of lasers that allow acute removal of obstructing tissue in the surgical treatment of benign prostatic hyperplasia (BPH). A MEDLINE search over the last 6 years focused on randomized trials, large case series and review articles. A total of more than 4,000 patients were analyzed with respect to the morbidity and outcome, and the advantages and disadvantages of the various lasers. Laser treatment of BPH has evolved from coagulation to enucleation. Blood loss is significantly reduced as compared to transurethral resection and open prostatectomy. Ablative/vaporizing techniques have recently become popular again with the marketing of new high-powered 80 W potassium-titanyl-phosphate (KTP) and 100 W holmium lasers. Vaporization immediately removes obstructing tissue, but tissue specimen cannot be obtained. KTP short-term results are promising, but long-term results and randomized trials are lacking. Postoperative volume reduction is less than with holmium laser enucleation of the prostate (HoLEP), and the KTP laser can be used for BPH treatment only. HoLEP allows whole lobes of the prostate to be removed. Prostates of all sizes can be operated on. It is at least as safe and effective as TURP and open prostatectomy, with significantly lower morbidity, as shown by several well-designed randomized clinical trials. It provides specimen for histological evaluation. In addition, the holmium laser can be used for the endourological treatment of stones, strictures and tumors. HoLEP appears to be a size-independent new "gold standard" in the surgical treatment of BPH.

RevoLix™ vaporesection of the prostate: initial results of 54 patients with a 1-year follow-up

Multiple laser systems for the treatment of benign prostatic hyperplasia (BPH) have been introduced. Current laser systems have limitations due to their laser physics. The RevoLix laser combines the advantages of the Holmium:YAG laser with the comfort of a continuous wave (cw) laser beam. This study reports the preliminary results of vaporesection (simultaneous vaporization and resection) of the prostate, using the 2 microm cw laser. A total of 54 consecutive patients were treated with the 70 W RevoLix laser for BPH. The mean age was 61 years. Mean prostate volume was 30.3 cc. A 550 microm RigiFib bare-ended fiber was used in combination with a 26 French laser resectoscope. Measured outcomes were resection time, decrease in hemoglobin and transfusion rate. Furthermore, the catheter time, improvement in the urinary flow rate (Q(max)), post-voiding residual urine (PVR), International Prostate Symptom Score (IPSS) and Quality of Life Index (QoL) were recorded. Average resection time was 52 min. After crossing the learning curve, a tissue ablation of 1.5 g/min was possible. Transfusions were not necessary in any patient. Catheter time was 1.7 days. Q(max) significantly improved from 4.2 to 20.1 ml on average. PVR decreased from 86 to 12 ml. IPSS and QoL-Score improved from 19.8 to 6.9 and 4 to 1, respectively. No patient required re-hospitalization. These preliminary results indicate that RevoLix vaporesection of the prostate is safe and efficient. One-year follow-up data showed a significant improvement in voiding symptoms and patients' quality of life. A longer follow-up is needed to prove the durability of these promising results.

Current role of lasers in the treatment of benign prostatic hyperplasia (BPH)

OBJECTIVE

Evaluate the current role of lasers in the treatment of benign prostatic hyperplasia (BPH).

METHODS

The results of a MEDLINE search for randomised trials and case series of the last 5 yr and published review articles were analysed for the safety and efficacy of neodymium:yttrium aluminum garnet (Nd:YAG), potassium-titanyl-phosphate (KTP), and holmium (Ho):YAG laser prostatectomy. The analysis includes 12 reports on randomised clinical trials, 2 comparative studies, 10 review articles, and a total of >5000 patients.

RESULTS

Laser treatment of BPH has evolved from coagulation to enucleation. Blood loss is significantly reduced compared with transurethral resection and open prostatectomy. Visual laser ablation of the prostate and interstitial laser coagulation cause coagulative necrosis with secondary ablation. Long postoperative catheterisation, unpredictable outcomes, and high reoperation rates have restricted the use of these techniques. Ablative/vaporising techniques have become popular again with the marketing of new high-powered 80-W KTP and 100-W Ho lasers. Vaporisation immediately removes obstructing tissue. Short-term results are promising, but large series, long-term results, and randomised trials are lacking. Holmium laser enucleation (HoLEP) allows whole lobes of the prostate to be removed, mimicking the action of the index finger in open prostatectomy. Prostates of all sizes can be operated on. It is at least as safe and effective as transurethral resection of the prostate and open prostatectomy, with significantly lower morbidity. It is the only laser procedure that provides a specimen for histologic evaluation.

CONCLUSIONS

HoLEP appears to be a size-independent new "gold standard" in the surgical treatment of BPH.