&lt;title&gt;Hi-tech of the prostate: interstitial laser coagulation of benign prostatic hypertrophy&lt;/title&gt;

Muschter, R.; Hofstetter, A.; Hessel, Stefan; Keiditsch, E; Rothenberger, K; Schneede, P.; Frank, K.

doi:10.1117/12.137385

Cited by 28 publications

(13 citation statements)

References 3 publications

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“…The new concept of minimally invasive BPH treatment developed by our group [14,30] is based on the creation of intraprostatic coagulation lesions. In contrast to any heat treatment where energy from an applicator inside the urethra is delivered to the periurethral prostatic tissue, in interstitial energy delivery the urethra would not be affected.…”

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Technique and results of interstitial laser coagulation

Muschter¹,

Hofstetter²

1995

World J Urol

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By use of thermal "ablation" techniques to apply heat to the prostate from the urethra, the coagulation volume is limited by the limited penetration depth of suitable radiation sources, e.g., lasers, and by heat conduction. Secondarily, the coagulated tissue is removed by sloughing. Interstitial heat application was expected to overcome these problems. Our initial in vitro and animal studies using different light guides for interstitial Nd:YAG laser radiation showed that small, carbonized lesions were created by bare fibers, whereas large, homogeneous coagulation zones measuring up to 2 cm in diameter were produced by specially designed ITT (interstitial thermotherapy) fibers, which secondarily resulted in marked volume reduction by atrophy. Further experiments using such applicators resulted in an operation technique suitable for clinical routine in the treatment of symptomatic benign prostatic hyperplasia (BPH). These laser applicators are inserted into the prostate either transurethrally through a cystoscope under direct vision or percutaneously from the perineum under transrectal ultrasound guidance. The number of placements depends on the size and configuration of the gland. Radiation parameters were optimized for each system. To avoid charring, relatively low levels of laser power and long radiation periods (e.g., 7 W for 10 min) or power-formatting programs (e.g., stepwise reduction of power from 20 to 7 W for a total radiation time of 3 min) are applied. Beginning in July 1991, more than 350 unselected patients with BPH were treated with interstitial laser coagulation in our department, of whom 239 were followed for at least 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

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Technique and results of interstitial laser coagulation

Muschter¹,

Hofstetter²

1995

World J Urol

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“…7,8,[11][12][13] The in vitro studies in muscle, liver, kidney, and the potato models showed that treatment volumes increased with la ser power and irradiation time unless charring oc- …”

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Initial human clinical experience with diode laser interstitial treatment of benign prostatic hyperplasia

Muschter

Rosette

Whitfield

et al. 1996

Urology

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Objectives. To report the initial results of treatment of outlet obstruction induced by benign prostatic hy perplasia (BPH) using interstitial laser coagulation performed with the Indigo 830 nm diode laser system. Methods. A group of 112 men with lower urinary tract symptoms caused by BPH underwent treatment with the Indigo 830 nm laser system between October 1994 and November 1995. Patients were assessed prior to treatment and at specified post-treatment intervals for symptom score, uroflow, postvoid residual, and prostate volume. Adverse events and changes in laboratory parameters were monitored at each post-treatment visit to investigate safety of the procedure. Results. Symptom score decreased from 20.9 at initial measurement to 9,6 at 3 months after procedure and 7.9 at 6 months. Uroflow rate increased from 8.0 m i l s initially to 15.2 and 14.2 mL/s at 3 and 6 months, respectively. Residual bladder volumes decreased from 105 mL initially to 59 and 38 mL at 3 and 6 months, respectively. There were no major complications (impotence, sustained incontinence, significant blood loss). Minor complications occurred in a small number of patients but were generally associated with urinary tract infection in patients with catheters. Three patients (2.7%) required retreatment and underwent transurethral resection of the prostate. Conclusions. Interstitial laser coagulation using an 830-nm diode laser system appears to be a promising new treatment, with substantial improvements in objective and subjective parameters of obstruction and a favorable side-effect profile. UROLOGY 48: 223-228, 1996.

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“…Both neodymium: yttrium-aluminum-garnet (Nd:YAG) laser (1,064 nm) and diode laser (800 -1,000 nm) energies are used for interstitial laser coagulation because of their relatively deep penetration in water, efficient volumetric tissue heat loading, and ability to be delivered through flexible optical fibers (see also table 1 for details). 1,2 The optimal irradiation parameters vary for different laser wavelength and applicator combinations. 2,3,4 The goal of creating the largest coagulative volume in the shortest surgical time is accomplished by initiating irradiation with a relatively high power to heat the tissue rapidly and coagulate the blood vessels, followed by reduction of laser power to maintain the temperature in the center of the lesion at a high level just below the carbonization threshold and allow further expansion of the lesion.…”

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New surgical treatment options in patients with benign prostate hyperplasia (BPH)

et al. 2003

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Benign prostatic hyperplasia (BPH) is a common disease in males older than 50 years of age. 75-80% of this population is considered to have some degree of BPH causing clinical symptoms and requiring urological treatment. Transurethral resection of the prostate (TUR-P) is currently the standard surgical treatment modality for BPH. In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives have been sought. Various types of Laser techniques such as interstitial Laser coagulation and side-firing technology have been proposed. Numerous studies have shown that Laser procedures safely and effectively reduce the volume of the prostate. Intra-and postoperative bleeding are nearly unknown complications for Laser procedures, whereas this is the most relevant complication for the TUR-P. Due to significant tissue edema after Laser treatment, patients commonly show delayed time to void adequately and, therefore, catheter drainage is often necessary for 3 to 21 days. Retrograde ejaculation is reported to occur less (0-10%) compared to TUR-P (> 60%). Urinary tract infections are very common after interstitial laser coagulation. Although not many long-term clinical data are available, various studies have shown that BPH patients improve in symptom score, flow rate and post-void residual up to 3 years after Laser treatment. This paper presents a concise review of efficacy, advantages and disadvantages of the most frequently used Laser techniques as well as the long-term clinical data compared to TUR-P.

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<title>Hi-tech of the prostate: interstitial laser coagulation of benign prostatic hypertrophy</title>

Cited by 28 publications

References 3 publications

Technique and results of interstitial laser coagulation

Technique and results of interstitial laser coagulation

Initial human clinical experience with diode laser interstitial treatment of benign prostatic hyperplasia

New surgical treatment options in patients with benign prostate hyperplasia (BPH)

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