Preliminary Results of Prostate Vaporization in the Treatment of Benign Prostatic Hyperplasia by Using a 200-W High-intensity Diode Laser

doi:10.1016/j.urology.2009.09.033

Urology

Volume 75, Issue 3, March 2010, Pages 658-663

https://doi.org/10.1016/j.urology.2009.09.033 Get rights and content

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.

Section snippets

Study Population

This study included 55 patients diagnosed with LUTS secondary to BPH, treated between December 2007 and July 2008. All the patients responded poorly to medical treatment. A digital rectal examination was performed, and the serum prostate-specific antigen (PSA) levels were determined. Prostate biopsy was performed if prostate cancer was suspected. The subjective symptoms were evaluated using the following parameters: International Prostate Symptom Score (IPSS), maximum uroflow rate (Q_max.),

Results

The patient characteristics are shown in Table 1. With regard to the perioperative data, the lasing time was 50.1 ± 15.4 minutes; Foley catheterization time, 34.8 ± 30.1 hours; and postoperative hospital stay was 2.8 ± 1.8 days. The Foley catheter was removed the following morning unless macroscopic hematuria was observed. Patients were discharged from hospital when they were able to void adequately. The mean follow-up was 7.5 ± 4.4 (1-14) months. During the follow-up period, 1 patient (1.8%)

Comment

In an attempt to minimize the morbidity of TURP, alternative techniques for the prostate ablation are being developed. Holmium laser enucleation of the prostate provides functional outcomes comparable to those of TURP and open prostatectomy.5, 6 However, a steep learning curve requiring 30-50 procedures, and longer operation time limited the procedure to be widely used.6, 7

The application of an 80-W GreenLight KTP laser (American Medical Systems, Minnetonka, Minnesota) for prostate vaporization

Conclusions

From our preliminary outcomes, diode laser prostatectomy can achieve excellent hemostasis, displays intraoperative safety, allows rapid tissue ablation, and provides immediate relief from obstructive voiding symptoms. However, the postoperative irritative symptoms and sloughing of necrotic tissues remain to be an important issue that needed to be resolved.

References (29)

S. Madersbacher et al.
EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines)
Eur Urol
(2004)
G. Wendt-Nordahl et al.
980-nm diode laser: a novel laser technology for vaporization of the prostate
Eur Urol
(2007)
E.A. Elzayat et al.
Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve
Eur Urol
(2007)
N. Seki et al.
Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases
J Urol
(2003)
O. Reich et al.
High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients
J Urol
(2005)
A.E. Te et al.
Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial
J Urol
(2004)
R. Ruszat et al.
Photoselective vaporization of the prostate: subgroup analysis of men with refractory urinary retention
Eur Urol
(2006)
A. Bachmann et al.
Photoselective vaporization of the prostate: the basel experience after 108 procedures
Eur Urol
(2005)
O. Reich et al.
Experimental comparison of high power (80 W) potassium titanyl phosphate laser vaporization and transurethral resection of the prostate
J Urol
(2004)
A. Bachmann et al.
Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome
Eur Urol
(2005)

T. Volkan et al.

Short term outcomes of high power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate

Eur Urol

(2005)

H. Woo et al.

Outcome of Greenlight HPS 120-W laser therapy in specific patient populations: those in retention, on anticoagulants, and with large prostates (80 ml)

Eur Urol

(2008)

R. Ruszat et al.

GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures

Eur Urol

(2008)

J. Rassweiler et al.

Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention

Eur Urol

(2006)

Cited by (46)

Efficacy and Safety of 1470-nm Diode Laser Enucleation of the Prostate in Individuals With Benign Prostatic Hyperplasia Continuously Administered Oral Anticoagulants or Antiplatelet Drugs
2020, Urology
To evaluate the efficacy and safety of 1470-nm Diode Laser Enucleation of the Prostate (DiLEP) in patients with benign prostatic hyperplasia continuously receiving oral anticoagulants or antiplatelet drugs.
From January 2016 to June 2017, 144 patients were submitted to 1470-nm DiLEP, including 49 (34.0%) continuously administered anticoagulants or antiplatelet drugs per os due to cardiac and/or cerebrovascular diseases (group A), while 95 (66.0%) were not (group B). Evaluation was performed preoperatively, and at postoperative 3, 6, and 12 months, respectively. Patient baseline features, operative data, perioperative complications, and postsurgical outcomes were assessed.
Both groups had comparable preoperative parameters, except age (77.3 ± 7.5 vs 73.2 ± 8.8 years, P = .007). Meanwhile, surgical time, sodium decrease, catheterization duration, and hospital stay markedly differed between the 2 groups. In comparison with group B, group A patients had statistically higher blood loss (14.9 ± 7.3 g/L vs 10.2 ± 7.0 g/L, P < .001) and increased bladder irrigation time (21.1 ± 10.9 hours vs 16.1 ± 9.0 hours, P = .004). One case required blood transfusion in group A, because of moderate anemia preoperatively. Both groups showed similar blood transfusion and complication rates. International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual were markedly improved in both groups at 3-, 6-, and 12-month follow-up postoperatively compared with baseline values. However, no statistically significant differences were observed between the 2 groups in various assessment parameters at follow-up (P > .05).
These findings demonstrated that 1470-nm DiLEP is efficient and safe in benign prostatic hyperplasia cases receiving continuous oral anticoagulant or antiplatelet drugs. Anticoagulation therapy did not significantly influence the results and complication rates.
Surgical Treatment for LUTS/BPH: Laser Devices
2018, Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia: From Research to Bedside
The introduction of laser energy for the treatments of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) has dramatically changed the surgical landscape of surgery for BPO. Several laser devices are available and they differ according to the used laser energy source. Each laser has unique properties resulting in a variety of possible techniques, ranging from vaporization to resection and enucleation.
GreenLight 180-W XPS laser versus 120-W HPS laser for the treatment of benign prostate hyperplasia by a single experienced urologist
2016, Urological Science
This study aims to evaluate the operative efficacy and safety of the GreenLight 180-W XPS laser system in comparison to the GreenLight 120-W HPS system used by a single experienced surgeon for the treatment of bladder outlet obstruction caused by an enlarged prostate.
We retrospectively compared the patients undergoing GreenLight 180-W XPS (September 2014–September 2015) and GreenLight 120-W HPS (August 2008–September 2009) for lower urinary tract symptoms secondary to benign prostatic hyperplasia by a single experienced surgeon. The patient baseline characteristics, perioperative parameters, and complications were recorded. Prostate size and prostate-specific antigen were also assessed. Functional parameters, including International Prostate Symptom Score, maximum uroflow rate, postvoid residual, and quality of life score, were analyzed in different follow-up periods.
A total of 130 patients (65 in the HPS and 65 in the XPS group) were included in this study. Intraoperative lasing time was significantly shorter in the XPS group, but the postoperative length of catheterization and hospital stay were comparable in both groups. The number of fibers used during vaporization was significantly less, and only one case required two fibers for prostate vaporization in the XPS group (p = 0.03). During the follow-up period, there was statistically significant improvement compared with baseline in all functional parameters in each group. However, no significant difference was observed in these parameters between the two groups. The mean percentages of prostate volume reduction were 57% and 41% and those of prostate-specific antigen reduction were 60% and 49%, respectively, in the XPS and HPS groups. Complications were comparable between the two groups.
The 180-W XPS system displays a shorter lasing time, less laser fiber use, more volume reduction, and a comparable safety profile in comparison with the 120-W HPS system for the treatment of bladder outlet obstruction caused by an enlarged prostate.
Management of prostate enlargement with acute urinary retention: Diode laser vaporization in combination with bipolar transurethral resection of the prostate
2016, Urological Science
Citation Excerpt :
It is consistent with our findings. Diode laser vaporization showed good hemostatic property, but a large coagulation zone and tissue sloughing were noted in several studies.8,9,13,14 Necrotic tissues were highly associated with postoperative irritative symptoms.
Transurethral resection of prostate (TURP) has long been the gold standard for the management of benign prostate enlargement (BPE). Over the years, laser techniques have been developed as major alternative treatment for BPE. Retrospectively, we compared the preoperative status and surgical outcomes of conventional TURP with those of high-intensity diode laser vaporization in combination with bipolar TURP (DV + bTURP) in patients with BPE who are suffering from refractory acute urinary retention.
This is a retrospective chart review study. A total of 60 patients with BPE who were suffering from refractory acute urinary retention were enrolled between July 2011 and July 2013. Thirty-four patients were included in the TURP group and 26 in the DV + bTURP group. Perioperative parameters, including operation time, hemoglobin decrease, length of hospital stay, and time for catheter removal, were all recorded. Patients were followed postoperatively with peak flow rate measurement, international prostate symptom scores, and postvoid residual volume, and all adverse events were also recorded.
DV + bTURP was superior to TURP in terms of hospital stay (3.1 d vs. 4.2 d), catheter removal time (1.3 d vs. 3.2 d), hemoglobin reduction (0.8 g/dL vs. 2.5 g/dL), and fewer adverse events. However, it was inferior to TURP in terms of operation time (93.2 min vs. 68.5 min). Complications are also comparable. No significant differences were observed in peak flow rates, international prostate symptom score, and postvoid residual volume between the two procedures.
DV + bTURP is comparable with monopolar TURP for relieving acute urinary retention in men with BPE in terms of complications and functional outcomes. The combined technique can provide better intraoperative hemostasis and shorter catheterization time, with no significant postoperative irritative symptoms.
Laser transurethral resection of the prostate: Safety study of a novel system of photoselective vaporization with high power diode laser in prostates larger than 80 mL
2015, Actas Urologicas Espanolas
Presentar la viabilidad de la vaporización fotoselectiva de la próstata (VFP) con un nuevo sistema de resección de láser de diodo. El tratamiento quirúrgico de la hiperplasia prostática benigna (HPB) está en constante evolución. Las técnicas de láser se utilizan cada vez más en próstatas de gran tamaño.
Se realizó un estudio prospectivo para evaluar los datos operativos y los resultados de los pacientes con VFP utilizando láser de diodo de alta potencia (DAP) y una innovadora fibra con cabeza de cuarzo en forma de pala en los pacientes con próstata > 80 ml. Se describen los datos demográficos, tiempo quirúrgico, pérdida de hemoglobina, resultados operatorios (IPSS, calidad de vida [CdV], Qmáx, residuo posmiccional [RPM], IIEF-5 y micción diaria) y las complicaciones de la clasificación Clavien-Dindo.
Treinta y un pacientes fueron incluidos en el estudio. Dieciséis (51,6%) estaban en tratamiento antiplaquetario activo y 12 (38,7%) habían recibido anticoagulantes antes de la cirugía. Todos los casos fueron seguidos al menos 6 meses. No se produjeron complicaciones graves intraoperatorias ni postoperatorias. Tres pacientes (9,7%) tuvieron complicaciones leves según la clasificación Clavien-Dindo. Veintisiete (87,1%) fueron dados de alta en el primer día del postoperatorio sin catéter. Hubo mejoras significativas en el IPSS, CdV, Qmáx y RPM, tanto a los 3 como a los 6 meses (p < 0,0001), pero la función sexual según el IIEF-5 no mostró diferencias. La urgencia (de cualquier grado) aumentó a los 3 meses (48,4%; p = 0,002) y se redujo considerablemente a los 6 meses (9,7%, p < 0,0001).
Esta experiencia piloto con fibra en forma de pala y DAP es alentadora. Esto demuestra que la resección con láser es un procedimiento seguro, logrando excelentes resultados en cuanto a IPSS, CdV y Qmáx en próstatas grandes, incluso en pacientes de alto riesgo. Se necesita un seguimiento más prolongado, estudios controlados comparativos y aleatorios para generalizar estos resultados.
To present the feasibility of photoselective vaporization of the prostate (PVP) with of a new diode laser-resection system. Surgical treatment of benign prostatic hyperplasia (BPH) is constantly evolving. Laser techniques are increasingly used in prostates of large size.
A prospective study was performed to evaluate operative data and patient outcomes with PVP using high-power diode laser (HPD) and a novel quartz-head fiber with shovel shape in patients with prostate > 80 mL. Demographic data, operative time, hemoglobin loss, operative results (IPSS, quality of life (QoL), Qmax, post void residue (PVR), IIEF-5 and micturition diary) and complications following Clavien-Dindo classification are described.
Thirty-one patients were included in the study. Sixteen (51.6%) were on active antiplatelet treatment and 12 (38.7%) had received anticoagulants before surgery. All cases were followed at least 6 mo. No intraoperative or postoperative major complications occurred. Three patients (9.7%) had minor complications according to Clavien-Dindo classification. Twenty-seven (87.1%) were discharged on postoperative day one without catheter. There were significant improvements in IPSS, QoL, Qmax and PVR, both at 3 and 6 mo (P < .0001), but sexual function according to IIEF-5 showed no differences. Urgency (any grade) increased at 3 mo (48.4%; P = .002) and considerably decreased at 6 mo (9.7%; P < .0001).
This pilot experience with shovel shape fiber and HPD is encouraging. It shows that laser-resection is a safe procedure, achieving excellent results in terms of IPSS, QoL and Qmax in large prostates even in high-risk patients. Longer follow-up, comparative and randomized controlled studies are needed to widespread these results.
Diode laser vaporisation of the prostate vs. diode laser under cold irrigation: A randomised control trial
2014, Arab Journal of Urology
Citation Excerpt :
Few studies showed a significant improvement in urodynamic variables (Qmax and PVR). The reduction in PSA was used as a surrogate marker for the reduction of prostate volume in some studies [11–15]. The diode laser at a wavelength of 980 nm offers the highest simultaneous absorption of water and haemoglobin (Fig. 2), which is why it has the best tissue-ablative capacity.
To compare the perioperative morbidity and early follow-up after diode laser vaporisation of the prostate (LVP) and its modification, diode laser under cold irrigation (LUCI) in patients with symptomatic benign prostatic hyperplasia, as the main disadvantages of LVP are the postoperative pain, dysuria and storage urinary symptoms.
This was a single-centre prospective randomised control trial in which 100 patients were randomised to receive LVP (50) or LUCI (50) from June 2011 until July 2012. LUCI is similar to LVP except that it is done under normal irrigation with saline at 4 °C instead of saline at room temperature. The primary outcome measures were the International Prostate Symptom Score (IPSS), IPSS-Dysuria, a pain scale (PS), maximum flow rate (Q_max), a quality-of-life (QoL) score and the postvoid residual urine volume (PVR) after 1 month, then the IPSS, Q_max, QoL, and PVR at 3 and 12 months. Secondary outcomes included intraoperative surgical variables, e.g., the decline in core temperature, bleeding, peri- and postoperative morbidity.
The baseline characteristics of both groups were similar. For the primary outcome measures, there was a statistically significant difference between the groups in all variables except Q_max after 1 month, in favour of LUCI. The mean (SD) IPSS at 1 month in the LVP group was 8.97 (1.68), statistically significantly different from that after LUCI, of 6.89 (1.5) (P < 0.05). The mean IPSS-Dysuria at 1 month was also significantly, at −2.32 (0.91) for LVP and 3.54 (1.07) for LUCI (P < 0.05). The respective mean PS at 1 month was 7.84 (2.92) and 5.7 (2.1) (P < 0.05). The QoL and PVR at 1 month were also significantly different. Within the first month 17% of patients in the LVP group and 4% in the LUCI group complained of transient urgency or stress incontinence, and this difference was statistically significant (P < 0.05). There was no significant bleeding in either group. The mean operative time or applied energy of LVP was not statistically significant from that of LUCI, and there was no significant difference in the decline in core temperature between the groups (P > 0.05).
LUCI is a good modification for reducing the pain, dysuria and storage symptoms associated with LVP. The procedure appears to be safe, with no significant decrease in core temperature in either group.

View all citing articles on Scopus

View full text

Prostatic Diseases and Male Voiding DysfunctionPreliminary Results of Prostate Vaporization in the Treatment of Benign Prostatic Hyperplasia by Using a 200-W High-intensity Diode Laser

Objectives

Methods

Results

Conclusions

Section snippets

Study Population

Results

Comment

Conclusions

Eur Urol

Eur Urol

Eur Urol

J Urol

J Urol

J Urol

Eur Urol

Eur Urol

J Urol

Eur Urol

Eur Urol

Eur Urol

Eur Urol

Eur Urol

Prostatic Diseases and Male Voiding Dysfunction
Preliminary Results of Prostate Vaporization in the Treatment of Benign Prostatic Hyperplasia by Using a 200-W High-intensity Diode Laser