Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Laser prostatic surgery: An update

  • 39 Accesses

  • 3 Citations

Abstract

This review presents an overview of the current state of the art of laser prostatic surgery. Several types of lasers have been used in the treatment of benign prostatic hyperplasia (BPH) over the past 15 years. Vaporization techniques have recently gained popularity and have been widely accepted by many urologists. Short-term results show that vaporization of a prostatic adenoma with higher-power potassium titanyl phosphate and holmium lasers is safe and effective in the treatment of symptomatic BPH. However, well designed randomized comparative trials with long-term follow-up are still needed. Holmium laser is a multi-purpose surgical tool and has multiple applications in urology. In the treatment of symptomatic BPH, holmium laser can be used in ablation, resection and enucleation of the prostate. Holmium laser enucleation of the prostate (HoLEP) is the most investigated laser procedure used in the treatment of symptomatic BPH. Several randomized controlled trails confirmed the safety, efficacy, and durability of HoLEP regardless of the prostate size.

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

References

  1. 1.

    Zani EL, Netto NR, Jr. Is the minimally invasive treatment as good as transurethral resection for benign prostatic hyperplasia? Int. Urol. Nephrol. 2007;39(1):161–8.

  2. 2.

    Malek RS, Nahen K. Photoselective vaporization of the prostate: KTP laser therapy of obstructive benign prostatic hyperplasia. AUA Update Series. 2004;23:153–9.

  3. 3.

    Te AE. The Next Generation in Laser Treatments and the Role of the GreenLight High-Performance System Laser. Rev. Urol. 2006;8 Suppl 3:S24–30.

  4. 4.

    Kuntz RM. Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur. Urol. 2006; Jun;49(6):961–9.

  5. 5.

    Te AE, Malloy TR, Stein BS, Ulchaker JC, Nseyo UO, Hai MA. et al. Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial. J. Urol. 2004; Oct;172(4 Pt 1):1404–8.

  6. 6.

    Volkan T, Ihsan TA, Yilmaz O, Emin O, Selcuk S, Koray K, et al. Short term outcomes of high power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate. Eur. Urol. 2005; Oct;48(4):608–13.

  7. 7.

    Hai MA, Malek RS. Photoselective vaporization of the prostate: Initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol. 2003; Mar;17(2):93–6.

  8. 8.

    Shingleton WB, Terrell F, Kolski J, May W, Renfroe DL, Fowler JE. Prostate specific antigen measurements after minimally invasive surgery of the prostate in men with benign prostatic hypertrophy. Prostate Cancer Prostatic Dis. 2000;3(3):200.

  9. 9.

    Sulser T, Reich O, Wyler S, Ruszat R, Casella R, Hofstetter A, et al. Photoselective KTP laser vaporization of the prostate: First experiences with 65 procedures. J. Endourol. 2004; Dec;18(10):976–81.

  10. 10.

    Sandhu JS, Ng C, Vanderbrink BA, Egan C, Kaplan SA, Te AE. High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates. Urology. 2004; Dec;64(6):1155–9.

  11. 11.

    Bachmann A, Ruszat R, Wyler S, Reich O, Seifert HH, Muller A, et al. Photoselective vaporization of the prostate: The basel experience after 108 procedures. Eur. Urol. 2005; Jun;47(6):798–804.

  12. 12.

    Reich O, Bachmann A, Siebels M, Hofstetter A, Stief CG, Sulser T. High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J. Urol. 2005; Jan;173(1):158–60.

  13. 13.

    Ahmed HU, Thwaini A, Shergill IS, Hammadeh MY, Arya M, Kaisary AV. Greenlight prostatectomy: A challenge to the gold standard? A review of KTP photoselective vaporization of the prostate. Surg. Laparosc. Endosc. Percutan. Tech. 2007; Jun;17(3):156–63.

  14. 14.

    Bachmann A, Schurch L, Ruszat R, Wyler SF, Seifert HH, Muller A, et al. Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): A prospective bi-centre study of perioperative morbidity and early functional outcome. Eur. Urol. 2005; Dec;48(6):965–71; discussion 972.

  15. 15.

    Bouchier Hayes DM, Anderson P, Van Appledom S, Bugeja P, Costello AJ. KTP laser versus transurethral resection: Early results of a randomized trial. J. Endourol. 2006; Aug;20(8):580–5.

  16. 16.

    Han D, Chung W, Kim JY, Jung BJ, Hong JH, Lee SW. Impact of 80 watt KTP photoselective laser vaporization prostatectomy versus transurethral resection of the prostate on erectile function: 12-month results of a prospective trial. J. Urol. 2007; Abstract 1840.

  17. 17.

    Rajbabu K, Chandrasekara SK, Barber NJ, Walsh K, Muir GH. Photoselective vaporization of the prostate with the potassium-titanyl-phosphate laser in men with prostates of>100 mL. BJU Int. 2007; Sep;100(3):593,8; discussion 598.

  18. 18.

    Ruszat R, Wyler S, Forster T, Reich O, Stief CG, Gasser TC, et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur. Urol. 2007; Apr;51(4):1031,8; discussion 1038-41.

  19. 19.

    Sandhu JS, Ng CK, Gonzalez RR, Kaplan SA, Te AE. Photoselective laser vaporization prostatectomy in men receiving anticoagulants. J. Endourol. 2005; Dec;19(10):1196–8.

  20. 20.

    Fu WJ, Hong BF, Wang XX, Yang Y, Cai W, Gao JP, et al. Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia. Asian J. Androl. 2006; May;8(3):367–71.

  21. 21.

    Ruszat R, Wyler S, Seifert HH, Reich O, Forster T, Sulser T, et al. Photoselective vaporization of the prostate: Subgroup analysis of men with refractory urinary retention. Eur. Urol. 2006; Nov;50(5):1040,9; discussion 1049.

  22. 22.

    Monoski MA, Gonzalez RR, Sandhu JS, Reddy B, Te AE. Urodynamic predictors of outcomes with photoselective laser vaporization prostatectomy in patients with benign prostatic hyperplasia and preoperative retention. Urology. 2006; Aug;68(2):312–7.

  23. 23.

    Malek RS, Kuntzman RS, Barrett DM. Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: Observations on long-term outcomes. J. Urol. 2005; Oct;174(4 Pt 1):1344–8.

  24. 24.

    Te AE, Malloy TR, Stein BS, Ulchaker JC, Nseyo UO, Hai MA. Impact of prostate-specific antigen level and prostate volume as predictors of efficacy in photoselective vaporization prostatectomy: Analysis and results of an ongoing prospective multicentre study at 3 years. BJU Int. 2006; Jun;97(6):1229–33.

  25. 25.

    Stovsky MD, Griffiths RI, Duff SB. A clinical outcomes and cost analysis comparing photoselective vaporization of the prostate to alternative minimally invasive therapies and transurethral prostate resection for the treatment of benign prostatic hyperplasia. J. Urol. 2006; Oct;176(4 Pt 1):1500–6.

  26. 26.

    Te AE. The development of laser prostatectomy. BJU Int. 2004; Feb;93(3):262–5.

  27. 27.

    Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology. 1996; Jan;47(1):48–51.

  28. 28.

    Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR. Combination holmium and Nd:YAG laser ablation of the prostate: Initial clinical experience. J. Endourol. 1995; Apr;9(2):151–3.

  29. 29.

    Gilling PJ, Cass CB, Cresswell MD, Malcolm AR, Fraundorfer MR. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J. Endourol. 1996; Oct;10(5):459–61.

  30. 30.

    Tan AH, Gilling PJ, Kennett KM, Fletcher H, Fraundorfer MR. Long-term results of high-power holmium laser vaporization (ablation) of the prostate. BJU Int. 2003; Nov;92(7):707–9.

  31. 31.

    Mottet N, Anidjar M, Bourdon O, Louis JF, Teillac P, Costa P, et al. Randomized comparison of transurethral electroresection and holmium: YAG laser vaporization for symptomatic benign prostatic hyperplasia. J. Endourol. 1999; Mar;13(2):127–30.

  32. 32.

    Tan AH, Gilling PJ. Holmium laser prostatectomy: Current techniques. Urology. 2002; Jul;60(1):152–6.

  33. 33.

    Kuntz RM, Lehrich K, Ahyai S. Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size? J. Endourol. 2004; Mar;18(2):183–8.

  34. 34.

    Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: An update on the early clinical experience. J. Endourol. 1998; Oct;12(5):457–9.

  35. 35.

    Hurle R, Vavassori I, Piccinelli A, Manzetti A, Valenti S, Vismara A. Holmium laser enucleation of the prostate combined with mechanical morcellation in 155 patients with benign prostatic hyperplasia. Urology. 2002; Sep;60(3):449–53.

  36. 36.

    Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of the prostate: A size-independent new “gold standard”. Urology. 2005; Nov;66(5 Suppl):108–13.

  37. 37.

    Tinmouth WW, Habib E, Kim SC, Kuo RL, Paterson RF, Terry CL, et al. Change in serum prostate specific antigen concentration after holmium laser enucleation of the prostate: A marker for completeness of adenoma resection? J. Endourol. 2005; Jun;19(5):550–4.

  38. 38.

    Shah HN, Mahajan AP, Hegde SS, Bansal MB. Perioperative complications of holmium laser enucleation of the prostate: Experience in the first 280 patients, and a review of literature. BJU Int. 2007; Jul;100(1):94–101.

  39. 39.

    Kuo RL, Paterson RF, Siqueira TM Jr. Watkins SL, Simmons GR, Steele RE, et al. Holmium laser enucleation of the prostate: Morbidity in a series of 206 patients. Urology. 2003; Jul;62(1):59–63.

  40. 40.

    Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, et al. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: Results at 2 years. Eur. Urol. 2006; Sep;50(3):569–73.

  41. 41.

    Rigatti L, Naspro R, Salonia A, Centemero A, Ghezzi M, Guazzoni G, et al. Urodynamics after TURP and HoLEP in urodynamically obstructed patients: Are there any differences at 1 year of follow-up? Urology. 2006; Jun;67(6):1193–8.

  42. 42.

    Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of>40 g. BJU Int. 2006; Jan;97(1):85–9.

  43. 43.

    Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: A randomized prospective trial in 200 patients. J. Urol. 2004; Sep;172(3):1012–6.

  44. 44.

    Tooher R, Sutherland P, Costello A, Gilling P, Rees G, Maddern G. A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J. Urol. 2004; May;171(5):1773–81.

  45. 45.

    Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J. Urol. 2003; Oct;170(4 Pt 1):1270–4.

  46. 46.

    Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: Results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J. Urol. 2004; Nov;172(5 Pt 1):1926–9.

  47. 47.

    Moody JA, Lingeman JE. Holmium laser enucleation for prostate adenoma greater than 100 gm.: Comparison to open prostatectomy. J. Urol. 2001; Feb;165(2):459–62.

  48. 48.

    Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.: A randomized prospective trial of 120 patients. J. Urol. 2002; Oct;168(4 Pt 1):1465–9.

  49. 49.

    Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates>70 g: 24-month follow-up. Eur. Urol. 2006; Sep;50(3):563–8.

  50. 50.

    Kuntz RM, Lehrich K, Ahyai S. Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J. Endourol. 2004; Mar;18(2):189–91.

  51. 51.

    Pedraza R, Samadi A, Eshghi M. Holmium laser enucleation of the prostate in critically ill patients with technique modification. J. Endourol. 2004; Oct;18(8):795–8.

  52. 52.

    Elzayat E, Habib E, Elhilali M. Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J. Urol. 2006; Apr;175(4):1428–32.

  53. 53.

    Peterson MD, Matlaga BR, Kim SC, Kuo RL, Soergel TM, Watkins SL, et al. Holmium laser enucleation of the prostate for men with urinary retention. J. Urol. 2005; Sep;174(3):998,1001; discussion 1001.

  54. 54.

    Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of prostate for patients in urinary retention. Urology. 2005; Oct;66(4):789–93.

  55. 55.

    Gilling PJ, Aho TF, Frampton CM, King CJ, Fraundorfer MR. Holmium laser enucleation of the prostate: Results at 6 years. Eur. Urol. 2007; Apr 23;[Epub ahead of print].

  56. 56.

    Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur. Urol. 2007; Aug 28;[Epub ahead of print].

  57. 57.

    El Hakim A, Elhilali MM. Holmium laser enucleation of the prostate can be taught: The first learning experience. BJU Int. 2002; Dec;90(9):863–9.

  58. 58.

    Salonia A, Suardi N, Naspro R, Mazzoccoli B, Zanni G, Gallina A, et al. Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: An inpatient cost analysis. Urology. 2006; Aug;68(2):302–6.

  59. 59.

    Fraundorfer MR, Gilling PJ, Kennett KM, Dunton NG. Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: Results of a randomized prospective study. Urology. 2001; Mar;57(3):454–8.

  60. 60.

    Fried NM, Murray KE. High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J. Endourol. 2005; Jan–Feb;19(1):25–31.

  61. 61.

    Fried NM. High-power laser vaporization of the canine prostate using a 110 W Thulium fiber laser at 1.91 microm. Lasers Surg. Med. 2005; Jan;36(1):52–6.

  62. 62.

    Bach T, Herrmann T, Ganzer R, Burchardt M, Gross A. RevoLix vaporesection of the prostate: Initial results of 54 patients with a 1-year follow-up. World Journal of Urology. 2007; Jun;25(3):257–62.

  63. 63.

    Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: A randomized prospective trial. Eur. Urol. 2007; Jun 4;[Epub ahead of print]

Download references

Author information

Correspondence to M. Elhilali.

About this article

Cite this article

Elhilali, M., Elzayat, E.A. Laser prostatic surgery: An update. Afr J Urol 14, 1–14 (2008). https://doi.org/10.1007/BF02994507

Download citation

Keywords

  • Laser
  • Holmium
  • KTP laser
  • Thulium
  • prostatic hyperplasia
  • prostatectomy