Will lasers replace transurethral resection of the prostate for the treatment of BPH?

  • Ali Erol
  • Serhat Dönmezer
  • Erem Kaan Başok

Bull Urooncol 2013;12(4):255-262

During the last decade, KTP 532, Holmium:YAG, thulium and diode lasers have been increasingly used as an alternative to TURP. This review will focus on the current role of lasers for the surgical treatment of BPH.

Laser vaporization of the prostate has become more popular worldwide, due to its short learning curve. Since its introduction in 1996, there have been many clinical studies regarding KTP532. Although the first low power devices obtained good results, 180 watts XPS has recently been introduced to the market as well as more durable self cooling MoXY fibers for more efficient vaporization. Currently diode lasers are available up to 300 watts utilizing twister fiber which works in contact mode, contrary to the former side firing fibers. Laser vaporization is feasible under local anesthesia and in the patients on anticoagulant medications. The risk of missing incidental prostate cancers has always been a matter of debate, even if it is rare. Vaporization efficiency declines as the prostate gets larger, leading to more secondary operations in the future. Although enucleation with all the laser types at various wavelengths has been reported, Ho: YAG enucleation has the highest number of relevant clinical studies with longer follow-up. One of the advantages of Ho:YAG laser is the possibility of simultaneous lithotripsy. KTP 532 and HoYAG laser proved to be valid alternatives to TURP, although not superior, according to the large number of clinical trials. Thulium and diode lasers significantly improved the symptoms of BPH, however, long term comparative studies are warranted.

Keywords: laser prostatectomy, benign prostatic hyperplasia, transurethral resection of the prostate