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Interstitial Laser Ablation of the Prostate

  • Rolf Muschter
Part of the Recent Advances in Endourology book series (ENDOUROLOGY, volume 2)

Summary

Interstitial laser therapy or coagulation (ILC) is a minimally invasive procedure for the treatment of benign prostatic hyperplasia (BPH). The objective of ILC is to achieve a marked volume reduction and, consecutively, decrease urethral obstruction and obstructive and irritative symptoms. To induce shrinking of the adenoma while preserving surrounding tissues, coagulation necrosis is generated well inside the adenoma. not at its urethral surface. The result is secondary atrophy and regression of the prostate lobes, not sloughing of necrotic tissue. This potentially avoids all problems related to tissue sloughing, such as irritative symptoms or an increased risk of urinary tract infections. In interstitial laser coagulation the applicator can be inserted as deeply and as often as necessary to coagulate any amount of tissue. Several experimental and clinical studies have been published, demonstrating the desired effects and excellent clinical results. For ILC, a Nd: YAG or diode laser is used in combination with specially designed fibers. In vitro experiments were initially done with constant power and later with stepwise reduced power and various radiation times in order to evaluate the maximal achievable lesion size without tissue carbonization in the shortest possible treatment time. The treatment volumes depended on the length of of the applicator and could be more than 7 ml. To achieve short radiation times but to avoid charring, stepwise reduced powers were favorable. These were repeatedly optimized and tested in vivo in the canine prostate. Lesion diameters of up to 20 mm were achieved. For increasing treatment safety, an optical feedback system was developed. For clinical use, interstitial applicators are inserted into the bulky tissue transurethrally through a cystoscope under direct vision. The number of fiber placements depends on the size and configuration of the gland. The most advanced radiation techniques which are currently used are based on temperature feedback controlled radiation cycles. Several studies indicated the effectiveness of interstitial laser coagulation of BPH regarding all of the three characteristics of the disease: symptoms, obstruction, and enlargement. All studies reported marked improvements in AUA score, peak flow rate, residual urine volume, and prostate volume. Pressure-flow studies demonstrated a sufficient decrease of the intravesical/detrusor pressure, urethral opening pressure. and the urethral resistance. Long-term results demonstrating sustained success for up to 3 years were reported in a series of 394 patients. Complications were rare. Prograde ejaculation was maintained in approximately 90% of the ILC patients. Urinary drainage, however, frequently was required in the postoperative period. ILC is suitable to debulk even large prostates and to treat highly obstructive patients. Therefore, ILC can be seen as a true alternative to transurethral resection of the prostate with certain advantages, such as almost no serious morbidity, and with certain disadvantages, such as the need for postoperative catheterization. ILC, however, can be done under local anesthesia and does not require hospitalization.

Keywords

Benign Prostatic Hyperplasia Prostate Volume Urethral Stricture Residual Urine Volume Peak Flow Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bown SG (1983) Phototherapy of tumors. World J Surg 7: 700–709PubMedCrossRefGoogle Scholar
  2. 2.
    McPhee MS, Thorndyke CW, Thomas G, Tulip J, Chapman D, Lakey WH (1984) Interstitial applications of laser irradiation in hematoporphyrin derivative-photosensitized Dunning R3327 prostate cancers. Lasers Surg Med 4: 93–98PubMedCrossRefGoogle Scholar
  3. 3.
    Bown SG (1991) New approaches to local destruction of tumours—interstitial laser hyperthermia and photodynamic therapy. In: Svaasand LO (ed) Future trends in biomedical applications of lasers. SPIE Proc 1525: 325–330Google Scholar
  4. 4.
    Camps JL Jr, Powers SK, Beckman WC Jr, Brown T, Weissman RM (1985) Photo-dynamic therapy of prostate cancer: an in vitro study. J Urol 134: 1222–1226PubMedGoogle Scholar
  5. 5.
    Littrup PJ, Lee F, Borlaza GS, Sacknoff EJ, Torp-Pedersen S, Gray JM (1988) Percutaneous ablation of canine prostate using transrectal ultrasound guidance. Invest Radiol 23: 734–739PubMedCrossRefGoogle Scholar
  6. 6.
    McNicholas TA, Charig C, Steger AC, Bown SG (1988) Interstitial laser coagulation of the prostate: an experimental study. Lasers Med Sci 3, Abstracts Issue, abstr 446Google Scholar
  7. 7.
    McNicholas TA, Steger AC, Bown SG, O’Donoghue N (1991) Interstitial laser coagulation of the prostate: experimental studies. In: Watson GM, Steiner RW, Pietrafitta JJ (eds) Lasers in urology, laparoscopy, and general surgery. SPIE Proc 1421: 30–35Google Scholar
  8. 8.
    McNicholas TA, Pope AJ, Timoney A, Lynch MJ, Parkinson MC, O’Donoghue N (1992) Hyperthermia of the prostate by interstitial laser coagulation. J Urol 147: 345AGoogle Scholar
  9. 9.
    McNicholas TA, Pope AJ, Timoney A, Lynch MJ, Parkinson MC, O’Donoghue N (1992) Interstitial laser coagulation of the prostate: experimental and clinical studies. J Urol 147: 210AGoogle Scholar
  10. 10.
    Hofstetter A (1991) Interstitielle Thermokoagulation (ITK) von Prostatatumoren. Lasermedizin 7: 179Google Scholar
  11. 11.
    Muschter R, Hofstetter A, Hessel S, Keiditsch E, Rothenberger K-H, Schneede P, Frank F (1992) Hi-tech of the prostate: interstitial laser coagulation of benign pro-static hypertrophy. In: Anderson RR (ed) Laser surgery: advanced characterization, therapeutics, and systems, III. SPIE Proc 1643: 25–34Google Scholar
  12. 12.
    Muschter R, De La Rosette JJMCH, Whitfield H, Pellerin J-P, Madersbacher S, Gillatt D (1996) Initial human clinical experience with diode laser interstitial treatment of benign prostatic hyperplasia. Urology 48: 223–228PubMedCrossRefGoogle Scholar
  13. 13.
    Muschter R, Hofstetter A (1995) Technique and results of interstitial laser coagulation. World J Urol 13: 109–114PubMedCrossRefGoogle Scholar
  14. 14.
    Muschter R, Sroka R, Perlmutter AP, Schneede P, Hofstetter A (1996) High power interstitial laser coagulation of benign prostatic hyperplasia. J Endourol 10, Suppl 1:S 197Google Scholar
  15. 15.
    De La Rosette JJMCH, Muschter R, Lopez MA (1996) Interstitial laser coagulation in the treatment of BPH using a tissue adaptive laser system. J Endourol 10, Suppl 1:S 93Google Scholar
  16. 16.
    Roggan A, Handke A, Miller K, Müller G (1994) Laser induced interstitial thermotherapy of benign prostatic hyperplasia—basic investigations and first clinical results. Minimal Invasive Med 5: 55–63Google Scholar
  17. 17.
    Handke A, Roggan A, Andreesen R, Miller K (1994) Laserinduzierte interstitielle Thermotherapie (LITT) bei BPH. Urologe [A] 33, Suppl S 81Google Scholar
  18. 18.
    Johnson DE, Cromeens DM, Price RE (1994) Interstitial laser prostatectomy. Lasers Surg Med 14: 299–305PubMedCrossRefGoogle Scholar
  19. 19.
    McNicholas T, Alsudani M (1996) Interstitial laser coagulation therapy for benign pro-static hyperplasia. SPIE Proc 2671: 300–308CrossRefGoogle Scholar
  20. 20.
    Muschter R, Hofstetter A, Hessel S, Keiditsch E, Schneede P (1992) Interstitial laser prostatectomy—experimental and first clinical results. J Urol 147: 346AGoogle Scholar
  21. 21.
    Muschter R, Hessel S, Hofstetter A, Keiditsch E, Rothenberger K-H, Schneede P, Frank F (1993) Die interstitielle Laserkoagulation der benignen Prostatahyperplasie. Urologe [A] 32: 273–281Google Scholar
  22. 22.
    Muschter R, Perlmutter AP (1994) The optimization of laser prostatectomy. Part II. Other lasing techniques. Urology 44: 856–861CrossRefGoogle Scholar
  23. 23.
    Muschter R, Perlmutter AP, Anson K, Jahnen P, Vargas Stüve JC, Razvi HA, Sroka R, Hofstetter A, Vaughan ED Jr (1995) Diode lasers for interstitial laser coagulation of the prostate. In: Anderson RR (ed) Lasers in surgery: advanced characterization, therapeutics, and systems. V. SPIE Proc 2395: 77–82Google Scholar
  24. 24.
    Henkel TO, Niedergethmann M, Alken P (1995) Laser-induced interstitial thermotherapy (LITT): in vitro and in vivo studies. J Endourol 9, Suppl 1:S 56Google Scholar
  25. 25.
    Muschter R, Hessel S, Jahnen P, Yalavac H, Hofstetter A (1995) Evaluation of different laser wavelengths and application systems for LITT. In: Müller G, Roggan A (eds) Laser-induced interstitial thermotherapy. SPIE Press, Bellingham, pp 212–223Google Scholar
  26. 26.
    Muschter R, Hofstetter A, Anson K, Perlmutter AP, Vaughan ED Jr (1995) Nd: YAG and diode lasers for interstitial laser coagulation of benign prostatic hyperplasia: experimental and clinical evaluation. J Urol 153: 229AGoogle Scholar
  27. 27.
    Muschter R, Perlmutter AP, Anson K, Sroka R, Vargas Stüve JC, Jahnen P, Yalavac H, Razvi HA, Vaughan ED Jr, Hofstetter AG (1995) Experimentelle Untersuchungen zur Eignung von Halbleiterlasern für die interstitielle Laserkoagulation der Prostata—Erste Ergebnisse. Lasermedizin 11: 150–156Google Scholar
  28. 28.
    Sroka R, Muschter R, Perlmutter AP (1997) Interstitial holmium:YAG laser application: a new procedure for prostatic tissue ablation. J Urol 157, Suppl 41Google Scholar
  29. 29.
    Hessel St, Frank F (1990) Technical prerequisites for interstitial thermotherapy using the Nd:YAG laser. In: Katzir A (ed) Optical fibers in medicine. V. SPIE Proc 1201: 233–238Google Scholar
  30. 30.
    Bhatta KM, Perlmutter A, Cho G, Morrison PR, Silverman SG, Jolesz FA, Loughlin KR (1996) A new technique of subsurface and interstitial laser therapy using a diode laser (wavelength = 1000nm) and a catheter delivery device. J Urol 155: 310AGoogle Scholar
  31. 31.
    Slatkine M, Mead D, Konwitz E, Johnson ED (1994) A neodymium: YAG fiber delivery system for interstitial photothermal therapy. In: Watson GM, Steiner RW, Johnson DE (eds) Lasers in urology. SPIE Proc 2129: 56–66Google Scholar
  32. 32.
    Sroka R, Perlmutter AP, Martin T, Muschter R (1996) LITT on canine prostates: an in-vivo study to compare the effects of different wavelengths. SPIE Proc 2671: 335–338CrossRefGoogle Scholar
  33. 33.
    Muschter R, Hofstetter A (1994) Erfahrungen mit der interstitiellen Laserkoagulation in der Therapie der benignen Prostatahyperplasie. Lasermedizin 10: 133–139Google Scholar
  34. 34.
    Muschter R, Schneede P, Müller-Lisse U, Fink HU, Perlmutter AP, Sroka R, Hofstetter AP (1997) Interstitial Nd:YAG laser therapy of the prostate: long-term results and new developments. J Urol 157, Suppl 42Google Scholar
  35. 35.
    Lopez M, Vargas JC, Muschter R, Perlmutter AP (1997) The size of prostatic interstitial laser lesions can be controlled by temperature. J Urol 157. Suppl 41Google Scholar
  36. 36.
    De La Rosette JJMCH, Muschter R, Lopez MA, Gillatt D (1997) Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode-laser system with temperature feedback. Br J Urol 80: 433–438PubMedCrossRefGoogle Scholar
  37. 37.
    Arai Y, Ishitoya S, Okubo K, Suzuki Y (1996) Transurethral interstitial laser coagulation for benign prostatic hyperplasia: treatment outcome and quality of life. Br J Urol 77: 93–98CrossRefGoogle Scholar
  38. 38.
    Martov AG, Kilchukov ZI (1996) Interstitial laser-indused coagulation of BPH: 6 months follow-up. J Endourol 10. Suppl 1:S 191Google Scholar
  39. 39.
    Meagher M (1996) Interstitial laser prostatectomy. J Endourol 10, Suppl 1:S 192Google Scholar
  40. 40.
    Orovan WL, Whelan JP (1994) Neodymium YAG laser treatment of BPH using interstitial thermotherapy: a transurethral approach. J Urol 151: 230AGoogle Scholar
  41. 41.
    Schettini M, Diana M, Fortunato P, Mauro M, Vincenzoni A, Tavani M, Gallucci M (1996) Results of interstitial laser coagulation of the prostate. J Endourol 10, Suppl 1:S 191Google Scholar
  42. 42.
    Henkel TO, Greschner M, Luppold T, Alken P (1995) Transurethral and transperineal interstitial laser therapy of BPH. In: Müller G, Roggan A (eds) Laser-induced interstitial thermotherapy. SPIE Press, Bellingham. pp 416–425Google Scholar
  43. 43.
    Horninger W, Janetschek G, Pointner J, Watson G, Bartsch G (1995) Are TULIP, interstitial laser and contact laser superior to TURP? J Urol 153: 413AGoogle Scholar
  44. 44.
    Heuck A, Müller-Lisse U, Muschter R, Schneede P, Scheidler J, Hofstetter A, Reiser M (1995) Einsatz der Magnetresonanz-Tomographie für die Darstellung der interstitiellen Laserkoagulation bei der benignen Prostatahyperplasie: Erste Erfahrungen. Lasermedizin 11: 27–33Google Scholar
  45. 45.
    Müller-Lisse UG, Heuck AF, Schneede P, Muschter R, Scheidler J, Hofstetter AG, Reiser MF (1996) Postoperative MRI in patients undergoing interstitial laser coagulation thermotherapy of benign prostatic hyperplasia. J Comput Assist Tomogr 20: 273–278CrossRefGoogle Scholar
  46. 46.
    Müller-Lisse U, Heuck A, Stehling MK, Frimberger M, Thoma M, Schneede P, Muschter R, Hofstetter A, Reiser M (1996) MRT-Monitoring vor, während und nach der laserinduzierten Thermotherapie der benignen Prostatahyperplasie. Erste klinische Erfahrungen. Radiologe 36: 722–731PubMedCrossRefGoogle Scholar
  47. 47.
    Muschter R, Ehsan A, Stepp HG, Hofstetter A (1995) Clinical results of LITT in the treatment of benign prostatic hyperplasia. In: Müller G, Roggan A (eds) Laser-induced interstitial thermotherapy. SPIE Press, Bellingham, pp 434–442Google Scholar
  48. 48.
    Whelan JP (1999) Interstitial laser coagulation of the prostate: transrectal ultrasound findings 3 months after treatment. J Urol 157. Suppl 435Google Scholar
  49. 49.
    Zhenghua G, Ciling C (1996) ITT combined with vaporized incision for treatment of BPH. J Endourol 10, Suppl 1:S 192Google Scholar
  50. 50.
    Muschter R, Hofstetter A (1995) Interstitial laser therapy outcomes in benign pro-static hyperplasia. J Endourol 9: 129–135PubMedCrossRefGoogle Scholar
  51. 51.
    Arai Y, Kanba T, Ishitoya S, Okubo K, Shichiri Y, Suzuki Y (1995) Interstitial laser coagulation for benign prostatic hyperplasia: preliminary clinical results. Int J Urol 2: 104–109PubMedCrossRefGoogle Scholar
  52. 52.
    Arai Y, Ishitoya S, Okubo K, Suzuki Y (1996) Interstitial laser coagulation for benign prostatic hyperplasia: 1-year follow-up and analysis of patient profile linked to clinical response. J Urol 155: 319AGoogle Scholar
  53. 53.
    Zellner M, Muschter R (1994) Initiale urodynamische Ergebnisse nach interstitieller Laserkoagulation der Prostata bei benigner Hyperplasie. Lasermedizin 10: 141–144Google Scholar
  54. 54.
    Henkel TO, Greschner M, Luppold T, Rassweiler J, Alken P (1994) Perineal interstitial laser of the prostate (PILP). In: Bown SG, Escourrou J, Frank F, Geschwind HJ, Godlewski G, Laffitté F, Scherer HH (eds) Medical applications of lasers. II. SPIE Proc 2327: 293–295Google Scholar
  55. 55.
    Muschter R, Hofstetter A (1994) Laserbehandlung der benignen Prostatahyperplasie. Urologe [A] 33: 281–287Google Scholar
  56. 56.
    Muschter R, Ehsan A, Baumhackl D, Stepp HG (1995) Interstitielle Laserkoagulation versus transurethrale Resektion—Ergebnisse eines prospektiven Vergleichs. Urologe [A] 34, Suppl 1: S74Google Scholar
  57. 57.
    Muschter R (1996) Interstitial laser therapy. Curr Opin Urol 6: 33–38CrossRefGoogle Scholar
  58. 58.
    Muschter R, Hofstetter A (1997) Thermocoagulation au laser de l’adénome de la prostate par voie interstitielle. Ann Urol (Paris) 31: 27–37Google Scholar
  59. 59.
    Whitfield HN (1995) The use of an interstitial diode laser (indigo) in laser prostatectomy: a randomized, controlled, prospective study. J Endourol 9, Suppl 1:S 149Google Scholar
  60. 60.
    Whitfield HN (1996) A randomized prospective multicenter study evaluating the efficacy of interstitial laser coagulation. J Urol 155: 318AGoogle Scholar
  61. 61.
    De La Rosette JJMCH, Muschter R, Whitfield FIN, Gillatt DA, Vicente JR, Fay R, Barett D, Reese J, Block NL, Costello AJ (1996) Report of a prospective multicenter randomized study evaluating interstitial laser coagulation for BPH. J Endourol 10, Suppl 1:S 125Google Scholar
  62. 62.
    Fay R, Chan SL, Kahn R, Sharlip I, Altman R (1997) Initial results of a randomized trial comparing interstitial laser coagulation therapy to transurethral resection of the prostate. J Urol 157, Suppl 41Google Scholar

Copyright information

© The Japanese Society of Endourology and ESWL 2000

Authors and Affiliations

  • Rolf Muschter
    • 1
  1. 1.Department of UrologyGrosshadern University Hospital of Ludwig-Maximilians UniversityMunichGermany

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