Endoscopic vaporesection of the prostate using the continuous-wave 2-microm thulium laser: outcome and demonstration of the surgical technique.
BACKGROUND
The potential of a new continuous-wave (CW) 70-W, 2.013-microm thulium-doped yttrium aluminium garnet (Tm:YAG) laser for the endoscopic treatment of benign prostatic hyperplasia (BPH) is investigated.


OBJECTIVE
The simultaneous combination of vaporisation and resection of prostatic tissue in a retrograde fashion is the main characteristic of this new laser technique. We provide a DVD that shows the main steps of this procedure.


METHODS
We retrospectively evaluated 56 nonconsecutive patients who were treated by thulium laser vaporesection of the prostate in our institution between 2005 and 2007.


METHODS
Vaporesection of the prostate is performed by moving the fibre semicircumferentially from the verumontanum towards the bladder neck, thereby undermining tissue and cutting chips.


METHODS
Blood loss, postvoiding residual urine (PVRU), maximum flow rate (Q(max)), and the International Prostate Symptom Score (IPSS) were measured as well as prostate volume and prostate-specific antigen (PSA). The duration of the procedure, need for postoperative irrigation, duration of catheterisation, and hospital stay were recorded.


CONCLUSIONS
The median procedure time was 60 min, postoperative irrigation was necessary in 19 out of 56 patients, and the median duration of catheterisation was 23 hr. At the day of discharge, the mean haemoglobin value decreased by 0.2mg/dl (p=0.13), the average Q(max) improved from 8.1 to 19.3 ml/s (p<0.001), and the PVRU decreased from 152 ml to 57 ml (p<0.05). The blood transfusion rate was 3.6%, and two patients needed a recatheterisation postoperatively (3.6%). After a median follow-up of 9 mo, the IPSS improved from 19.8 at baseline to 8.6 (p<0.001). Four patients had a repeat transurethral resection of the prostate (TURP) during the learning curve, but this was not necessary in any of the later patients. One patient developed a urethral stricture, and another developed a bladder neck contracture.


CONCLUSIONS
The thulium laser seems to be a suitable tool for the endoscopic treatment of BPH.
Szlauer
Roman
R
University Department of Urology and Andrology, Paracelsus Medical School, Landeskliniken Salzburg, Austria. r.szlauer@salk.at
Götschl
Robert
R
Razmaria
Aria
A
Paras
Ljiljana
L
Schmeller
Nikolaus T
NT
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011467:Prostate / Q000033:anatomy & histology; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013932:Thulium / Q000627:therapeutic use; D020728:Transurethral Resection of Prostate / Q000379:methods; D014463:Ultrasonography; D001743:Urinary Bladder / Q000473:pathology
D013932:Thulium