Skip to main content
SpringerLink
Log in

Laservaporisation der Prostata

Aktueller Stellenwert des Greenlight- und Diodenlasers

Laservaporization of the prostate

Current status of the greenlight and diode laser

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die Laservaporisation der Prostata hat sich in den letzten 10 Jahren als sichere und effektive Alternative zur TURP etabliert. Die photoselektive Vaporisation der Prostata (PVP) hat seit der Einführung des 532 nm 80-W-KTP-Lasers im Jahr 2002 maßgeblich zu dieser Entwicklung beigetragen. Ergebnisse prospektiv randomisierter Studien zu PVP und TURP mit einem maximalen Beobachtungszeitraum von 3 Jahren zeigen mehrheitlich vergleichbare funktionelle Resultate. Zahlreiche Kohortenstudien belegen zudem die sichere Anwendung der PVP bei Patienten unter oraler Antikoagulation sowie bei großem Prostatavolumen. Zur Laservaporisation der Prostata mit dem Diodenlaser stehen Systeme verschiedener Hersteller zur Verfügung, welche sich in maximaler Laserleistung und Wellenlänge unterschieden. Daher kann nicht von dem Diodenlaser per se gesprochen werden. Bisher fehlen zu Diodenlasern Resultate prospektiv randomisierter Studien im Vergleich mit TURP. In Kohortenstudien oder Vergleichsstudien zur PVP zeichnet sich der Diodenlaser v. a. durch eine ausgeprägte Hämostase aus. Bezüglich der funktionellen Resultate zeigt sich ein uneinheitliches Bild mit teilweise hohen Reoperationsraten.

Abstact

In the last decade laser vaporization of the prostate has emerged as a safe and effective alternative to transurethral resection of the prostate (TURP). This was facilitated in particular by the introduction of photoselective vaporization of the prostate (PVP) with a 532 nm 80 W KTP laser in 2002. Prospective randomized trials comparing PVP and TURP with a maximum follow-up of 3 years mostly demonstrated comparable functional results. Cohort studies showed a safe application of PVP in patients under oral anticoagulation and with large prostates. Systems from various manufacturers with different maximum power output and wavelengths are now available for diode laser vaporization of the prostate. Prospective randomized trials comparing diode lasers and TURP are not yet available. In cohort studies and comparative studies PVP diode lasers are characterized by excellent hemostatic properties but functional results vary greatly with some studies reporting high reoperation rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Arrighi HM, Metter EJ, Guess HA, Fozzard JL (1991) Natural history of benign prostatic hyperplasia and risk of prostatectomy. The Baltimore Longitudinal Study of Aging. Urology 38:4–8

    Article  PubMed  CAS  Google Scholar 

  2. Oelke M, Bachmann A, Descazeaud A et al (2012) Guidelines on the management of male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Uroweb 2. http://www.uroweb.org

  3. Costello AJ, Johnson DE, Bolton DM (1992) Nd:YAG laser ablation of the prostate as a treatment for benign prostatic hypertrophy. Lasers Surg Med 12:121–124

    Article  PubMed  CAS  Google Scholar 

  4. Kuntz RM (2006) Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur Urol 49:961–969

    Article  PubMed  Google Scholar 

  5. Hoffman RM, MacDonald R, Slaton JW, Wilt TJ (2003) Laser prostatectomy versus transurethral resection for treating benign prostatic obstruction: a systematic review. J Urol 169:210–215

    Article  PubMed  Google Scholar 

  6. Wilson LC, Gilling PJ (2005) From coagulation to enucleation: the use of lasers in surgery for benign prostatic hyperplasia. Nat Clin Pract Urol 2:443–448

    Article  PubMed  Google Scholar 

  7. McAllister WJ, Gilling PJ (2004) Vaporization of the prostate. Curr Opin Urol 14:31–34

    Article  PubMed  Google Scholar 

  8. Te AE (2004) The development of laser prostatectomy. BJU Int 93:262–265

    Article  PubMed  CAS  Google Scholar 

  9. Bachmann A, Muir GH, Collins EJ et al (2012) 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol 61:600–607

    Article  PubMed  Google Scholar 

  10. Al-Ansari A, Younes N, Sampige VP et al (2010) 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 58:349–355

    Article  PubMed  Google Scholar 

  11. Bouchier-Hayes DM, Van Appledorn S, Bugeja P et al (2010) 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 105:964–969

    Article  PubMed  Google Scholar 

  12. Capitán C, Blázquez C, Martin MD et al (2011) 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 60:734–739

    Article  PubMed  Google Scholar 

  13. Horasanli K, Silay MS, Altay B et al (2008) 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 71:247–251

    Article  PubMed  Google Scholar 

  14. Lukacs B, Loeffler J, Bruyère F et al (2012) 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 61:1165–1173

    Article  PubMed  Google Scholar 

  15. Pereira-Correia JA, Moraes Sousa KD de, Santos JBP et al (2012) 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 110(8):1184–1189

    Article  PubMed  Google Scholar 

  16. Thangasamy IA, Chalasani V, Bachmann A, Woo HH (2012) 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 62(2):315–323

    Article  PubMed  Google Scholar 

  17. Skolarikos A, Papachristou C, Athanasiadis G et al (2008) 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 22:2333–2340

    Article  PubMed  Google Scholar 

  18. Woo HH (2011) Photoselective vaporization of the prostate using the 120-W lithium triborate laser in enlarged prostates (> 120 cc). BJU Int 108:860–863

    PubMed  Google Scholar 

  19. Elmansy H, Baazeem A, Kotb A et al (2012) Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial. J Urol 188:216–221

    Article  PubMed  Google Scholar 

  20. Chung DE, Wysock JS, Lee RK et al (2011) Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol 186:977–981

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Bach T, Muschter R, Sroka R et al (2012) Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol 61:317–325

    Article  PubMed  Google Scholar 

  23. Ruszat R, Seitz M, Wyler SF et al (2009) 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 104:820–825

    Article  PubMed  CAS  Google Scholar 

  24. Chiang PH, Chen CH, Kang CH, Chuang YC (2010) GreenLight HPS laser 120-W versus diode laser 200-W vaporization of the prostate: comparative clinical experience. Lasers Surg Med 42:624–629

    Article  PubMed  Google Scholar 

  25. Rieken M, Kang HW, Koullick E et al (2010) Laser vaporization of the prostate in vivo: Experience with the 150-W 980-nm diode laser in living canines. Lasers Surg Med 42:736–742

    Article  PubMed  Google Scholar 

  26. Erol A, Cam K, Tekin A et al (2009) High power diode laser vaporization of the prostate: preliminary results for benign prostatic hyperplasia. J Urol 182:1078–1082

    Article  PubMed  CAS  Google Scholar 

  27. Yang KS, Seong YK, Kim IG et al (2011) Initial experiences with a 980 nm diode laser for photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia. Korean J Urol 52:752–756

    Article  PubMed  Google Scholar 

  28. Shaker HS, Shoeb MS, Yassin MM, Shaker SH (2012) Quartz head contact laser fiber: a novel fiber for laser ablation of the prostate using the 980 nm high power diode laser. J Urol 187:575–579

    Article  PubMed  Google Scholar 

  29. Seitz M, Sroka R, Gratzke C et al (2007) The diode laser: a novel side-firing approach for laser vaporisation of the human prostate – immediate efficacy and 1-year follow-up. Eur Urol 52:1717–1722

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: Prof. Dr. A. Bachmann ist im Medical Advisory Board von AMS und der Principal Investigator der RCT ‚‚Goliath’‘ XPS versus TURP Studie. Dr. M. Rieken gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Urologische Universitätsklinik Basel – Liestal, Universitätsspital Basel, Spitalstraße 21, CH-4031, Basel, Schweiz

    M. Rieken & A. Bachmann

  2. Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland

    C. Gratzke

Authors
  1. M. Rieken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Gratzke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Rieken.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rieken, M., Bachmann, A. & Gratzke, C. Laservaporisation der Prostata. Urologe 52, 339–344 (2013). https://doi.org/10.1007/s00120-012-3087-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-012-3087-z

Schlüsselwörter

Keywords

Search

Navigation