Diode laser treatment of human prostates

Objectives
Laser-assisted vaporization of prostate tissue by means of the KTP laser is in clinical use. Alternative laser sources are available but are lacking clinical experience. In this study, the capability, feasibility, and post-operative outcome of vaporization of prostate by means of a diode laser were investigated.

Methods
The light (λ=1470 nm, 50 W) of a diode laser was fed into a side-fire fiber introduced through a 24F continuous-flow cystoscope and thus transmitted to prostate tissue. Normal saline was used for irrigation with additive of 1% ethanol for observation of TUR syndrome. The study includes 10 men suffering from bladder outlet obstruction due to benign prostatic hyperplasia (BPH) (prostate volume range: 35–78 ml). The prostatic lobes were vaporized within the prostatic capsule. Depending on the vaporized tissue the exposure time was in the range of 1220–4000 s (mean: 2397±757 s) during which a mean of 121±38 kJ (range: 61–200 kJ) of energy was delivered. Post-operative outcome and voiding were evaluated during a follow-up of 6 months.

Results
During surgery no significant blood loss or any fluid absorption occurred. Catheters were removed in the mean after 50 h (range: 18–168 h). All patients excepted two, were satisfied with their voiding outcome. After removing the catheter the mean peak urine flow rate significantly (p=0.05) increased from 8.9±2.9 ml/s pre-operatively to 15.7±5 ml/s post-operatively. No evidence of urgency, dysuria, hematuria, or incontinence was observed. Two patients required re-catheterization and consecutive TURP. After 1 month as well as after 6-month follow-up, 8/10 patients are still satisfied with the outcome.

Conclusion
This first and limited experience showed that 50 W-1470 nm-diode-laser vaporization prostatectomy is feasible and appears to be safe and effective for quickly relieving bladder outlet obstruction due to BPH. Long-term efficacy and durability should be evaluated in a randomized clinical trial with long-term follow-up.

www.gigaalaser.com