Current state of the art photoselective vaporization prostatectomy: laser therapy for benign prostatic hyperplasia

Abstract

Since the beginning of this millennium, laser technology for prostatectomy, specifically the 532 nm green light wavelength has steadily gained clinical utility, potentially replacing trans urethral resection of the prostate (TURP). Multiple clinical studies demonstrate that its unique features of minimal invasiveness with minimal morbidity are combined in a desirable, safe and efficacious procedure to treat benign prostatic hyperplasia (BPH). Early outcomes studies based on the 80 W KTP laser system are comparable to those of TURP, and favor the 532 nm laser technology especially in the light of decreased morbidity with the laser. This review will focus on the rationale for treatment and survey the data surrounding the current state of photoselective laser vaporization of the prostate, including multicenter studies, series comparing to TURP, treatment of large prostates and its use in high surgical risk and anticoagulated patients who are not ideal candidates for TURP or open prostatectomy. Finally, the new higher power 532 nm laser technology will be presented, highlighting the technological advances that will segueway the future for this technology.

Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis

“…2,3 Currently, the main treatment options for BPH include pharmacological therapy, such as a-adrenergic blockers and 5a-reductase inhibitors, or surgery, such as transurethral resection of the prostate (TURP), transurethral incision of the prostate and open simple prostatectomy. 4 Although TURP is the current 'gold standard' treatment for moderate-to-severe LUTS secondary to BPH, 5,6 the procedure has some limitations. Several studies 7,8 have demonstrated that the rate of complications following TURP, including transfusions, infections, urethral strictures, sexual dysfunction, urinary incontinence, urinary retention and the development of transurethral resection (TUR) syndrome, is almost 20%.…”

In vitro investigation of wavelength‐dependent tissue ablation: Laser prostatectomy between 532 nm and 2.01 µm

“…Multiple studies on numerous surgical therapies have been conducted to treat BPH, and among the minimally invasive therapeutic modalities, application of laser light has gained much attention for more than a decade due to low morbidity, short hospitalization time, and good hemostasis [3][4][5]. Contingent upon the applied wavelength (l) and its interaction with prostatic tissue, laser prostatectomy has been involved in developing various techniques including coagulation, enucleation, and vaporization [6].…”

Update on photoselective vaporization of the prostate

“…The laser beam itself is improved, and maximum focus with negligible divergence of power is now maintained even within a distance of 3 to 5 mm from the fiber, allowing for vaporization to be consistently efficient despite variable changes in distance between fiber and tissue [37].…”