Complications of laser prostatectomy: a review of recent data.
BACKGROUND
Laser techniques for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE) have emerged as an alternative to transurethral resection of the prostate (TURP) and open prostatectomy (OP).


METHODS
A Medline search over the past 4 years was performed to assess the safety, intra- and postoperative morbidity of various laser techniques.


RESULTS
Data on holmium laser enucleation of the prostate (HoLEP) show the highest grade of evidence with two meta-analyses available and prove the low intra- and postoperative morbidity with reproducible long-term results. Photoselective vaporization of the prostate (PVP) with the Greenlightlaser (potassium titanyl phosphate, KTP or lithium borate, LBO) is characterized by excellent haemostatic properties in patients with or without oral anticoagulation. Long-term results show a reoperation rate comparable with TURP; however, there is a lack of randomized trials. Various types of diode lasers with different wavelengths are available for laser vaporization; despite their favourable haemostatic properties, a higher invasion depth seems to result in necrosis of the tissue leading to a higher rate of reoperation. Thulium-laser resection of the prostate shows promising intra- and postoperative morbidity, but data are limited and initial results need to be confirmed in large-scale trials.


CONCLUSIONS
In summary, HoLEP- and KTP-, or LBO-laser vaporization of the prostate are the most mature techniques of laser prostatectomy and treatment alternatives to TURP and OP, whereas the clinical value and durability of procedures with diode laser systems and the thulium laser need to be confirmed in high-quality prospective RCTs.
Rieken
Malte
M
Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. mrieken@uhbs.ch
Ebinger Mundorff
Nicole
N
Bonkat
Gernot
G
Wyler
Stephen
S
Bachmann
Alexander
A
D006801:Humans; D053685:Laser Therapy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods