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Surgical Treatment: Lasers and Techniques

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Male LUTS/BPH Made Easy

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Abstract

Laser techniques for the treatment of benign prostate enlargement are established alternatives to TURP and OP. Currently, the most frequently used lasers are holmium (Ho):YAG, potassium titanyl phosphate or lithium triborate (GreenLight), thulium, and diode laser. Based on the wavelength of the laser and the resulting laser–tissue interaction enucleation, vaporization, vapoenucleation, and vaporesection are the main techniques. In recent years, high-level evidence could show the equal efficacy and superior safety of holmium laser enucleation of the prostate (HoLEP) to TURP and OP. Furthermore, photoselective vaporization of the prostate (PVP) demonstrated comparable efficacy and superior safety in comparison to TURP and OP in various randomized clinical trials (RCTs). Thulium and diode laser prostatectomy represent upcoming new techniques with promising results. Although, short- and intermediate-term results indicate comparable outcomes relative to TURP or HoLEP, long-term results are missing and more high-level evidence results are required. Diode lasers, primarily used for vaporization, are characterized by high intraoperative safety. Controversial data exist regarding postoperative complications and reoperation rate of diode lasers.

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References

  1. Abdel-Hakim AM, Habib EI, et al. Holmium laser enucleation of the prostate: initial report of the first 230 Egyptian cases performed in a single center. Urology. 2010;76(2):448–52.

    Article  PubMed  Google Scholar 

  2. Ahyai SA, Chun FK, et al. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy – which procedure is faster? J Urol. 2012;187(5):1608–13.

    Article  PubMed  Google Scholar 

  3. Ahyai SA, Gilling P, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384–97.

    Article  PubMed  Google Scholar 

  4. Ahyai SA, Lehrich K, et al. Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol. 2007;52(5):1456–63.

    Article  PubMed  Google Scholar 

  5. Al-Ansari A, Younes N, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol. 2010;58(3):349–55.

    Article  PubMed  Google Scholar 

  6. Alivizatos G, Skolarikos A. Should holmium laser enucleation be the new gold standard for bladder outlet obstruction caused by BPH? Nat Clin Pract Urol. 2008;5(7):358–9.

    Article  PubMed  Google Scholar 

  7. Bach T, Muschter R, et al. Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol. 2012;61(2):317–25.

    Article  PubMed  Google Scholar 

  8. Bach T, Netsch C, et al. Thulium:YAG vapoenucleation in large volume prostates. J Urol. 2011;186(6):2323–7.

    Article  PubMed  Google Scholar 

  9. Bach T, Xia SJ, et al. Thulium: YAG 2 mum cw laser prostatectomy: where do we stand? World J Urol. 2010;28(2):163–8.

    Article  PubMed  CAS  Google Scholar 

  10. Bachmann A, Muir GH, et al. 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol. 2012;61(3):600–7.

    Article  PubMed  Google Scholar 

  11. Bachmann A, Woo HH, et al. Laser prostatectomy of lower urinary tract symptoms due to benign prostate enlargement: a critical review of evidence. Curr Opin Urol. 2012;22(1):22–33.

    Article  PubMed  Google Scholar 

  12. Becker A, et al. Holmium laser enucleation of the prostate is safe in patients with prostate cancer and lower urinary tract symptoms – a retrospective feasibility study. J Endourol (in press).

    Google Scholar 

  13. Bouchier-Hayes DM, Van Appledorn S, et al. A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int. 2010;105(7):964–9.

    Article  PubMed  Google Scholar 

  14. Briganti A, Naspro R, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol. 2006;175(5):1817–21.

    Article  PubMed  Google Scholar 

  15. Capitan C, Blazquez C, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol. 2011;60(4):734–9.

    Article  PubMed  Google Scholar 

  16. Chen YB, Chen Q, et al. A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year follow-up. J Urol. 2013;189:217–22.

    Article  PubMed  Google Scholar 

  17. Chiang PH, Chen CH, et al. GreenLight HPS laser 120-W versus diode laser 200-W vaporization of the prostate: comparative clinical experience. Lasers Surg Med. 2010;42(7):624–9.

    Article  PubMed  Google Scholar 

  18. Chung DE, Wysock JS, et al. Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol. 2011;186(3):977–81.

    Article  PubMed  Google Scholar 

  19. Costello AJ, Johnson DE, et al. Nd:YAG laser ablation of the prostate as a treatment for benign prostatic hypertrophy. Lasers Surg Med. 1992;12(2):121–4.

    Article  PubMed  CAS  Google Scholar 

  20. Crain DS, Amling CL, et al. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer. J Urol. 2004;171(2 Pt 1):668–71.

    Article  PubMed  Google Scholar 

  21. Descazeaud A, Peyromaure M, et al. Predictive factors for progression in patients with clinical stage T1a prostate cancer in the PSA era. Eur Urol. 2008;53(2):355–61.

    Article  PubMed  Google Scholar 

  22. El-Hakim A, Elhilali MM. Holmium laser enucleation of the prostate can be taught: the first learning experience. BJU Int. 2002;90(9):863–9.

    Article  PubMed  CAS  Google Scholar 

  23. Elmansy H, Baazeem A, et al. Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial. J Urol. 2012;188(1):216–21.

    Article  PubMed  Google Scholar 

  24. Eltabey MA, Sherif H, et al. Holmium laser enucleation versus transurethral resection of the prostate. Can J Urol. 2010;17(6):5447–52.

    PubMed  Google Scholar 

  25. Elzayat E, Habib E, et al. Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol. 2006;175(4):1428–32.

    Article  PubMed  CAS  Google Scholar 

  26. Elzayat EA, Elhilali MM. Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol. 2007;52(5):1465–71.

    Article  PubMed  Google Scholar 

  27. Elzayat EA, Habib EI, et al. Holmium laser enucleation of the prostate: a size-independent new "gold standard". Urology. 2005;66(5 Suppl):108–13.

    Article  PubMed  Google Scholar 

  28. Erol A, Cam K, et al. High power diode laser vaporization of the prostate: preliminary results for benign prostatic hyperplasia. J Urol. 2009;182(3):1078–82.

    Article  PubMed  CAS  Google Scholar 

  29. Gilling PJ, Aho TF, et al. Holmium laser enucleation of the prostate: results at 6 years. Eur Urol. 2008;53(4):744–9.

    Article  PubMed  Google Scholar 

  30. Gilling PJ, Cass CB, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J Endourol. 1996;10(5):459–61.

    Article  PubMed  CAS  Google Scholar 

  31. Gilling PJ, Fraundorfer MR. Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol. 1998;8(1):11–5.

    Article  PubMed  CAS  Google Scholar 

  32. Gilling PJ, Kennett K, et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol. 1998;12(5):457–9.

    Article  PubMed  CAS  Google Scholar 

  33. Gilling PJ, Mackey M, et al. Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year follow-up. J Urol. 1999;162(5):1640–4.

    Article  PubMed  CAS  Google Scholar 

  34. Gilling PJ, Wilson LC, et al. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109(3):408–11.

    Article  PubMed  Google Scholar 

  35. Gomez Sancha F, Bachmann A, et al. Photoselective vaporization of the prostate (GreenLight PV): lessons learnt after 3500 procedures. Prostate Cancer Prostatic Dis. 2007;10(4):316–22.

    Article  PubMed  CAS  Google Scholar 

  36. Gross AJ, Netsch C, et al. Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution. Eur Urol. 2013;63(5):859–67.

    Article  PubMed  Google Scholar 

  37. Gupta N, Sivaramakrishna, et al. Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g. BJU Int. 2006;97(1):85–9.

    Article  PubMed  Google Scholar 

  38. Hai MA. Photoselective vaporization of prostate: five-year outcomes of entire clinic patient population. Urology. 2009;73(4):807–10.

    Article  PubMed  Google Scholar 

  39. Haraguchi T, Takenaka A, et al. The relationship between the reproducibility of holmium laser enucleation of the prostate and prostate size over the learning curve. Prostate Cancer Prostatic Dis. 2009;12(3):281–4.

    Article  PubMed  CAS  Google Scholar 

  40. Hauser S, Rogenhofer S, et al. Thulium laser (Revolix) vapoenucleation of the prostate is a safe procedure in patients with an increased risk of hemorrhage. Urol Int. 2012;88(4):390–4.

    Article  PubMed  Google Scholar 

  41. Hochreiter WW, Thalmann GN, et al. Holmium laser enucleation of the prostate combined with electrocautery resection: the mushroom technique. J Urol. 2002;168(4 Pt 1):1470–4.

    PubMed  Google Scholar 

  42. Hoffman RM, MacDonald R, et al. Laser prostatectomy versus transurethral resection for treating benign prostatic obstruction: a systematic review. J Urol. 2003;169(1):210–5.

    Article  PubMed  Google Scholar 

  43. Horasanli K, Silay MS, et al. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology. 2008;71(2):247–51.

    Article  PubMed  Google Scholar 

  44. Kuntz RM. Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur Urol. 2006;49(6):961–9.

    Article  PubMed  Google Scholar 

  45. Kuntz RM, Ahyai S, et al. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol. 2004;172(3):1012–6.

    Article  PubMed  Google Scholar 

  46. Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.: a randomized prospective trial of 120 patients. J Urol. 2002;168(4 Pt 1):1465–9.

    PubMed  Google Scholar 

  47. Kuntz RM, Lehrich K, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53(1):160–6.

    Article  PubMed  Google Scholar 

  48. Leliefeld HH, Stoevelaar HJ, et al. Sexual function before and after various treatments for symptomatic benign prostatic hyperplasia. BJU Int. 2002;89(3):208–13.

    Article  PubMed  CAS  Google Scholar 

  49. Lukacs B, Loeffler J, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol. 2012;61(6):1165–73.

    Article  PubMed  Google Scholar 

  50. Madersbacher S, Alivizatos G, 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;46(5):547–54.

    Article  PubMed  Google Scholar 

  51. Marszalek M, Ponholzer A, et al. Palliative transurethral resection of the prostate: functional outcome and impact on survival. BJU Int. 2007;99(1):56–9.

    Article  PubMed  CAS  Google Scholar 

  52. Mattioli S, Munoz R, et al. Treatment of benign prostatic hyperplasia with the Revolix laser. Arch Esp Urol. 2008;61(9):1037–43.

    PubMed  Google Scholar 

  53. Mavuduru RM, Mandal AK, et al. Comparison of HoLEP and TURP in terms of efficacy in the early postoperative period and perioperative morbidity. Urol Int. 2009;82(2):130–5.

    Article  PubMed  CAS  Google Scholar 

  54. McAllister WJ, Gilling PJ. Vaporization of the prostate. Curr Opin Urol. 2004;14(1):31–4.

    Article  PubMed  Google Scholar 

  55. Montorsi F, Naspro R, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004;172(5 Pt 1):1926–9.

    Article  PubMed  Google Scholar 

  56. Naspro R, Suardi N, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol. 2006;50(3):563–8.

    Article  PubMed  Google Scholar 

  57. Oelke M, Bachmann A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64:118–40.

    Article  PubMed  Google Scholar 

  58. Ou R, You M, et al. A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80 mL. Urology. 2010;76(4):958–61.

    Article  PubMed  Google Scholar 

  59. Peng B, Wang GC, et al. A comparative study of thulium laser resection of the prostate and bipolar transurethral plasmakinetic prostatectomy for treating benign prostatic hyperplasia. BJU Int. 2013;111(4):633–7.

    Article  PubMed  Google Scholar 

  60. Pereira-Correia JA, de Moraes Sousa KD, et al. GreenLight HPS 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110(8):1184–9.

    Article  PubMed  Google Scholar 

  61. Placer J, Gelabert-Mas A, et al. Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. Urology. 2009;73(5):1042–8.

    Article  PubMed  Google Scholar 

  62. Rassweiler J, Teber D, et al. Complications of transurethral resection of the prostate (TURP) – incidence, management, and prevention. Eur Urol. 2006;50(5):969–79; discussion 980.

    Article  PubMed  Google Scholar 

  63. Rieken M, Bonkat G, et al. The effect of increased maximum power output on perioperative and early postoperative outcome in photoselective vaporization of the prostate. Lasers Surg Med. 2013;45(1):28–33.

    Article  PubMed  Google Scholar 

  64. Rieken M, Kang HW, et al. Laser vaporization of the prostate in vivo: experience with the 150-W 980-nm diode laser in living canines. Lasers Surg Med. 2010;42(8):736–42.

    Article  PubMed  Google Scholar 

  65. Rigatti L, Naspro R, et al. Urodynamics after TURP and HoLEP in urodynamically obstructed patients: are there any differences at 1 year of follow-up? Urology. 2006;67(6):1193–8.

    Article  PubMed  Google Scholar 

  66. Rosen R, Altwein J, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44(6):637–49.

    Article  PubMed  Google Scholar 

  67. Ruszat R, Seitz M, et al. GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures. Eur Urol. 2008;54(4):893–901.

    Article  PubMed  Google Scholar 

  68. Ruszat R, Seitz M, et al. Prospective single-centre comparison of 120-W diode-pumped solid-state high-intensity system laser vaporization of the prostate and 200-W high-intensive diode-laser ablation of the prostate for treating benign prostatic hyperplasia. BJU Int. 2009;104(6):820–5.

    Article  PubMed  CAS  Google Scholar 

  69. Santos Garcia-Baquero A, Soler Martinez J, et al. Prostatic enucleation with holmium laser. Arch Esp Urol. 2008;61(9):1015–21.

    Article  PubMed  CAS  Google Scholar 

  70. Skolarikos A, Papachristou C, et al. Eighteen-month results of a randomized prospective study comparing transurethral photoselective vaporization with transvesical open enucleation for prostatic adenomas greater than 80 cc. J Endourol. 2008;22(10):2333–40.

    Article  PubMed  Google Scholar 

  71. Tan AH, Gilling PJ, et al. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003;170(4 Pt 1):1270–4.

    Article  PubMed  CAS  Google Scholar 

  72. Te AE. The development of laser prostatectomy. BJU Int. 2004;93(3):262–5.

    Article  PubMed  CAS  Google Scholar 

  73. Thangasamy IA, Chalasani V, et al. Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012. Eur Urol. 2012;62(2):315–23.

    Article  PubMed  Google Scholar 

  74. Tombal B, De Visccher L, et al. Assessing the risk of unsuspected prostate cancer in patients with benign prostatic hypertrophy: a 13-year retrospective study of the incidence and natural history of T1a-T1b prostate cancers. BJU Int. 1999;84(9):1015–20.

    Article  PubMed  CAS  Google Scholar 

  75. Tyson MD, Lerner LB. Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol. 2009;23(8):1343–6.

    Article  PubMed  Google Scholar 

  76. van Rij S, Gilling PJ. In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new ‘gold standard’. Curr Urol Rep. 2012;13(6):427–32.

    Article  PubMed  Google Scholar 

  77. Westenberg A, Gilling P, et al. Holmium laser resection of the prostate versus transurethral resection of the prostate: results of a randomized trial with 4-year minimum long-term follow-up. J Urol. 2004;172(2):616–9.

    Article  PubMed  Google Scholar 

  78. Wilson LC, Gilling PJ. From coagulation to enucleation: the use of lasers in surgery for benign prostatic hyperplasia. Nat Clin Pract Urol. 2005;2(9):443–8.

    Article  PubMed  Google Scholar 

  79. Woo HH. Photoselective vaporization of the prostate using the 120-W lithium triborate laser in enlarged prostates (>120 cc). BJU Int. 2011;108(6):860–3.

    PubMed  Google Scholar 

  80. Xia SJ, Zhu J, et al. The treatment of benign prostatic hyperplasia by means of transurethral holmium laser enucleation. Zhonghua Nan Ke Xue. 2003;9(4):257–9.

    PubMed  Google Scholar 

  81. Xia SJ, Zhuo J, et al. Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol. 2008;53(2):382–9.

    Article  PubMed  Google Scholar 

  82. Zhang F, Shao Q, et al. Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center. Urology. 2012;79(4):869–74.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University Medical Center Hamburg, Martinistraße 52, Hamburg, 20246, Germany

    Sascha A. Ahyai & Andreas Becker

  2. Department of Urology, University Hospital Basel, Spitalstr. 21, Basel, 4031, Switzerland

    Malte Rieken MD & Alexander Bachmann MD

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  1. Sascha A. Ahyai
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  2. Andreas Becker
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  3. Malte Rieken MD
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  4. Alexander Bachmann MD
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Correspondence to Andreas Becker .

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Editors and Affiliations

  1. Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust The Royal Hallamshire Hospital, Sheffield, United Kingdom

    Christopher R. Chapple

  2. Department of Urology, Sant'Andrea Hospital, Rome, Italy

    Andrea Tubaro

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Ahyai, S.A., Becker, A., Rieken, M., Bachmann, A. (2014). Surgical Treatment: Lasers and Techniques. In: Chapple, C., Tubaro, A. (eds) Male LUTS/BPH Made Easy. Springer, London. https://doi.org/10.1007/978-1-4471-4688-9_7

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