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N22 The diode laser: The new laser system for the transurethral vaporization of prostate – preliminary experience

      Introduction and Objectives

      The transurethral resection of prostate(TUR-P) and the open adenomectomy still remain the “gold standards” in the treatment of BPH. In the last decade, the laser technologies began to be used in the treatment of BPH. The KTP laser (vaporization) and the holmium laser (enucleation) achieved the established status in this sphere. The diode laser (980/1470 nm), which has only been used in urology for a short time, offers simultaneous absorption in water and hemoglobin, due to which it combines high ablative and homeostatic properties. The objectives of the study is evaluation of the efficiency of the transurethral vaporization of prostate in patients with BPH with the use of a diode laser that emits two wavelengths simultaneously (980 and 1470 nm).

      Material and Methods

      15 procedures of the transurethral vaporization of prostate with the diode laser were performed in patients with BPH. The patients were between 53 and 85 years old (av. 70). The volume of the prostate ranged from 40 ml to 93 ml (av. 58 ml). In the IPSS (International Prostatic Symptoms Score) the average number of points was 30 (15 to 35 pnt). The maximum urethral flow (Q max) from 5.1–9.1 ml/s (av. 7.7 ml/s). The average residual volume after micturition was 185 ml. (0–425 ml). The PSA value varied within the limits from 0.54 ng/ml to 3.74 ng/ml (av. 1.9 ng/ml). The average hematocrit values and levels of hemoglobin measured before the procedure amounted to respectively 0.400 L/L and 8.74 mmol/L. The patients were examined within a week after the procedure and then in the first, sixth and twelfth month after the procedure.

      Results

      The average time of the procedure was 40 min (21–119 min). The energy used for the procedure varied within the limits of 90 kJ–247 kJ (av. 157 kJ). None of the patients needed blood transfusion. The levels of hematocrit and hemoglobin did not differ substantially from those before the procedure and amounted respectively to 0.391 L/L and 8.71 mmol/L. No ion disorders were observed in any patients after the procedure. The hospitalization after the procedure lasted for 2 days in case of all the patients. All patients had the Foley catheter removed within one day after the procedure. One patient required reinsertion of the catheter because of the acute retention of urine. There were intensive cases of irritation syndromes in most of the patients during the first two weeks which lasted for the average of 4 weeks after the procedure (from 2 to 10 weeks). One patient mentioned erection disorders which appeared after the procedure and lasted for the whole observation period. All patients reported full continence of their urine after the procedure

      Conclusions

      Our initial results of the research in progress suggest that the vaporization of the prostate with the use of the diode laser is a safe and effective procedure for treating patients with BPH.