Technique and results of interstitial laser coagulation

Abstract

By use of thermal "ablation" techniques to apply heat to the prostate from the urethra, the coagulation volume is limited by the limited penetration depth of suitable radiation sources, e.g., lasers, and by heat conduction. Secondarily, the coagulated tissue is removed by sloughing. Interstitial heat application was expected to overcome these problems. Our initial in vitro and animal studies using different light guides for interstitial Nd:YAG laser radiation showed that small, carbonized lesions were created by bare fibers, whereas large, homogeneous coagulation zones measuring up to 2 cm in diameter were produced by specially designed ITT (interstitial thermotherapy) fibers, which secondarily resulted in marked volume reduction by atrophy. Further experiments using such applicators resulted in an operation technique suitable for clinical routine in the treatment of symptomatic benign prostatic hyperplasia (BPH). These laser applicators are inserted into the prostate either transurethrally through a cystoscope under direct vision or percutaneously from the perineum under transrectal ultrasound guidance. The number of placements depends on the size and configuration of the gland. Radiation parameters were optimized for each system. To avoid charring, relatively low levels of laser power and long radiation periods (e.g., 7 W for 10 min) or power-formatting programs (e.g., stepwise reduction of power from 20 to 7 W for a total radiation time of 3 min) are applied. Beginning in July 1991, more than 350 unselected patients with BPH were treated with interstitial laser coagulation in our department, of whom 239 were followed for at least 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

“…The results for symptom reduction are comparable with those reported by others [4,8,10,17,22]. In a large study by Emberton et al [2] of > 3000 patients treated by TURP the AUA score decreased from a mean of 20.1 at baseline to 7.4 at 3 months.…”

“…ILC has documented efficacy and an acceptable frequency of side-effects [4][5][6][7]. In some aspects ILC seems to offer an advantage over TURP; blood loss is minimal and the risk of TUR syndrome is eliminated, as saline rather than glycine is used as the irrigant.…”

Interstitial laser coagulation for management of benign prostatic hyperplasia: Long‐term follow‐up

“…Muschter et al ., who first introduced this approach, reported significant improvement in clinical and voiding parameters with minimum morbidity. 1,2 We have previously reported that satisfactory results were obtained with ILC and that an improvement of symptoms lasted through 12 months. [3][4][5] To date, no long-term follow-up results after the ILC procedure have been reported.…”

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

“…The singular noncontact application technique described by Kabalin [12]was followed by contact irradiation of all surfaces of the prostatic urethra. ILCP was carried out as described by Muschter and Hofstetter [13]by introducing the ITT (Dornier ITT – light quide interstitial thermotherapy) fiber into chosen sites of prostatic lobes and irradiating them using a lower power (from 20 to 7.5 W) for 5 min. The duration of the two laser–therapy methods was similar and varied from 20 to 70 min depending on the size of the prostate, i.e.…”