Lasers in BPH Treatment

For the last few years, different types of laser and different wavelengths have been proposed as candidates to be considered real alternative to the TUR.

Diode Laser (980nm)

Preliminary results suggest that prostate vaporization using 980 nm diode laser with output power up to 120 W, is effective and associated to minimal morbidity. It enjoy following advantages:

1. Highest absortion in water and haemoglobin from the same wavelength

2. Selective light vaporization (SLV)-combines perfectly non-contact vaporization and coagulation

3. Ability to work in continuous and pulsed mode to allow efficent removal in all tissue types

4. Optical penetration depth of the 980 nm is higher than for the KTP or Ho: YAG lasers

Nd: YAG laser

(1064 nm wavelength) has a low coefficient of absorption in the tissue and achieves a deep tissue penetration; it produces a necrosis by deferred coagulation, without appreciating immediate ablative effects. It has ben given up in the treatment of the BPH due to Its morbidity and low efficiency.

Holmium: YAG laser

(2140 nm wavelength) has a high absorption in prostatic tissue, which carries a high density of energy and a minimal depth penetration, allowing the vaporization of the tissue. It has been used in the treatment of the BPH either by vaporizing the tissue (HoLap) or by performing an split of the adenoma and carry out the enucleation of the gland (HoLep) . The first procedure needs a lot of time to be carried out and for the second one is necessary a long learning curve, facts that have limited the widespread of both techniques.

The KTP laser

(532 nm wavelength) allows a good hemostasy due to the high affinity for the hemoglobin as well as the prostate vaporization; on the contrary, the water absorption is minimal and this circumstance causes the procedure to be also slow . Nevertheless, given that the technique needs a minor learning curve, its low morbidity and the published good medium-term results, have spred its use. On the contrary, the costs and the long time needed to vaporize a suitable quantity of tissue, the reason why some authors consider it only for glands of small size, have restricted its application.

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