Contact Laser Vaporization Techniques for Benign Prostatic Hyperplasia

Abstract

Contact laser applications for the relief of bladder outlet obstruction caused by an enlarged prostate are different from the noncontact Nd:YAG laser methods. The noncontact techniques rely on coagulation necrosis or high power-density vaporization. The pure contact Nd:YAG laser allows cutting, coagulation, and vaporization of tissue with minimal penetration beyond the contact surface. In the contact laser prostatectomy technique, the laser probe directly touches and vaporizes the prostatic tissue. This results in immediate removal of the obstructing tissue, in a manner similar to the standard electrosurgical transurethral resection (TURP), and offers the patient the potential for decreased catheter time and a more rapid resolution of symptoms. Our initial experience suggests that the contact technique (contact laser ablation of the prostate or CLAP) may be better suited for the smaller prostate gland (i.e., less than 20-30 g). For prostates larger than 30 g, a newly described procedure known as coagulation and hemostatic resection of the prostate (CHRP) can be used. This method combines initial noncontact coagulation of the prostate with vaporization of a channel. The goal of CHRP is to allow more rapid removal of the catheter with a continued improvement in urine flow secondary to the coagulation effects. The contact laser is specifically designed to vaporize tissue such as the prostate and allows immediate observation of a TUR defect. Improvements in the delivery system and in the size of the contact laser probes have made CLAP a useful modality for the treatment of symptomatic benign prostatic hyperplasia.

Treatment of a Benign Prostatic Hyperplasia by Nd:YAG Laser – Own Experience

“…VLAP can be performed using a noncontact technique [7, 8]causing deep coagulation necrosis, and by contact surface vaporization [9, 10]. …”

Rotoresect for bloodless transurethral resection of the prostate: a 4‐year follow‐up

“…The use of TURP is justified as it is 90% effective in removing infravesical obstruction and symptoms [1] but the significant morbidity rate of ≈ 10% has provoked the development of alternative minimally invasive procedures [3]. In particular, the popular and attractive laser technique led to reports of improved morbidity and initially high success rates for BPH [13]. However, the high costs and unpredictable outcome with this method have dampened the initial enthusiasm.…”

Visual Laser Ablation of the Prostate (VLAP) with Bare Fiber in Conjunction with Laser Bladder Neck Incision in The Treatment of Patients with Benign Prostatic Hyperplasia (BPH)

“…Nd:YAG 1063 nm wavelength is suited to thermal ablation of the prostate. 10,11 Its wavelength is poorly absorbed by water and penetrates deeply into adenomaheating target tissue faster than its thermal relaxation time. Deep tissue coagulative necrosis occurs and deeper still, thrombosis of the prostatic arteries.…”