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26.08.2023 | Topic Paper

Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group

verfasst von: Gernot Ortner, Selcuk Güven, Bhaskar Kumar Somani, Andre Nicklas, Cesare Marco Scoffone, Cecilia Gracco, Ioannis Kartalas Goumas, Thorsten Bach, Fernando Gómez Sancha, Felipe C. A. Figueredo, Amy Krambeck, Giorgio Bozzini, Karin Lehrich, Evangelos Liatsikos, Panagiotis Kallidonis, Jean Baptiste Roche, Arkadiusz Miernik, Dmitry Enikeev, Lutfi Tunc, Naeem Bhojani, Peter Gilling, Javier Romero Otero, Angelo Porreca, Sasha Ahyai, Christopher Netsch, Ali Serdar Gözen, Udo Nagele, Thomas R. W. Herrmann, Theodoros Tokas

Erschienen in: World Journal of Urology | Ausgabe 11/2023

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Abstract

Purpose

To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications.

Methods

A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios. Settings were compared for the reported laser types, and common settings and preventive measures were identified.

Results

Twenty-two experts completed the survey with a mean filling time of 12.9 min. Ho:YAG, Thulium fiber laser (TFL), continuous wave (cw) Tm:YAG, pulsed Tm:YAG and Greenlight™ lasers are used by 73% (16/22), 50% (11/22), 23% (5/22), 13.6% (3/22) and 9.1% (2/22) of experts, respectively. All experts use anatomical enucleation of the prostate (EEP), preferentially in one- or two-lobe technique. Laser settings differ significantly between laser types, with median laser power for apical/main gland EEP of 75/94 W, 60/60 W, 100/100 W, 100/100 W, and 80/80 W for Ho:YAG, TFL, cwTm:YAG, pulsed Tm:YAG and Greenlight™ lasers, respectively (p = 0.02 and p = 0.005). However, power settings within the same laser source are similar. Pulse shapes for main gland EEP significantly differ between lasers with long and pulse shape modified (e.g., Moses, Virtual Basket) modes preferred for Ho:YAG and short pulse modes for TFL (p = 0.031).

Conclusion

Ho:YAG lasers no longer seem to be the mainstay of EEP. TFL lasers are generally used in pulsed mode though clinical applicability for quasi-continuous settings has recently been demonstrated. One and two-lobe techniques are beneficial regarding operative time and are used by most experts.

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Titel: Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
verfasst von: Gernot Ortner
Selcuk Güven
Bhaskar Kumar Somani
Andre Nicklas
Cesare Marco Scoffone
Cecilia Gracco
Ioannis Kartalas Goumas
Thorsten Bach
Fernando Gómez Sancha
Felipe C. A. Figueredo
Amy Krambeck
Giorgio Bozzini
Karin Lehrich
Evangelos Liatsikos
Panagiotis Kallidonis
Jean Baptiste Roche
Arkadiusz Miernik
Dmitry Enikeev
Lutfi Tunc
Naeem Bhojani
Peter Gilling
Javier Romero Otero
Angelo Porreca
Sasha Ahyai
Christopher Netsch
Ali Serdar Gözen
Udo Nagele
Thomas R. W. Herrmann
Theodoros Tokas
Publikationsdatum: 26.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 11/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04565-y

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Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group