Review – Benign Prostatic ObstructionLaser Treatment of Benign Prostatic Obstruction: Basics and Physical Differences
Introduction
Transurethral resection of the prostate (TURP) and open prostatectomy are considered the gold standard in the treatment of benign prostatic obstruction (BPO) [1], [2]. However, considerable morbidity is associated with both procedures. TURP is associated with low morbidity in smaller prostates, but problems increase with rising volume [1]. Similarly, open surgery for high-volume glands is coupled with associated morbidity [2], [3]. Several laser-based minimally invasive treatment options have been introduced to achieve symptom improvement with reduced morbidity. Although multiple lasers are in use, confusion exists about laser–tissue interaction. Several physical aspects, such as the best possible wavelength and the way of applying laser energy, remain to be clarified.
This structured review is based on the outcome of a European Association of Urology Section of Uro-Technology (ESUT) expert meeting involving physicists, technicians, and urologists focussing on the basic science of laser radiation generation, transmission, and laser–tissue effects. A systematic comparison of the physical backgrounds of the various devices was performed.
Section snippets
Evidence acquisition
This paper is based on the second expert meeting on laser treatment of BPO organised by the ESUT. In addition, we performed a systematic literature search using the Medline, Embase, and PubMed databases. Inclusion criteria were meta-analyses, randomised controlled studies, reviews, and controlled cohort and experimental studies providing information on basic laser science and application for treatment of BPO. In addition, we included the expert opinions of participating urologists, physicists,
Generation of laser radiation
Laser is an acronym for “light amplification by stimulated emission of radiation.” The envelope “light radiation” shows that escaping energy is simply light of a defined wavelength and direction. This light is created by a quantum mechanical principle of “stimulated emission” of radiation of an excited laser medium (active media: gas, crystal, glass, dye). Excitation of the laser medium can be achieved by various principles (eg, excitation by photons from a flash lamp). Some of the excitation
Conclusions
Although laser treatment of BPO has gained widespread acceptance, controversy continues about the physical properties and background of laser radiation generation and laser–tissue interaction. Knowledge about the effects of different wavelengths on the targeted tissue is mandatory. The term laser prostatectomy should only be mentioned in combination with laser type or wavelength. Available laser systems have proven clinical efficacy comparable with the well-established gold standard. Knowledge
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Necrosis zone depth after bipolar plasma vaporization and resection in the human prostate
2023, Asian Journal of UrologyHolmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials
2022, European Urology FocusCitation Excerpt :Possible explanations for the higher incidence in the HoLEP cohort could be that because of its strictly anatomical enucleation, ablation may be more radical in the apical region close to the sphincter. In addition, the deeper tissue penetration of the Ho:YAG laser in comparison to the Thu:YAG laser may be a factor [28]. It is claimed that modifications of the traditional three-lobe technique, such as early apical release and mucosal sparing, decrease the incidence of this cumbersome, although mostly self-limiting, complication [29], but comparative studies are lacking.
Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy
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These authors contributed equally.