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Published in: Current Urology Reports 4/2024

13-02-2024 | Laser

Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy

Authors: David C. Dalton, T. Max Shelton, Marcelino Rivera

Published in: Current Urology Reports | Issue 4/2024

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Abstract

Purpose of Review

Lasers have had a significant impact on the treatment of benign prostatic hypertrophy. This article attempts to distill the advancements in laser technology for the treatment of benign prostatic hypertrophy (BPH) into key and understandable points to help make this topic more accessible to urologists.

Recent Findings

The holmium:yttrium–aluminum-garnet (YAG) laser, one of the most significant lasers in the field of urology, has recently been improved with pulse modulating technology (Moses™ technology). New thulium:YAG technology allows both pulsed and continuous wave modes. The thulium fiber laser is one of the newer lasers to come to market and has been shown to have effective and safe outcomes. GreenLight™ lasers are predominantly used in photovaporization procedures and have also been studied extensively, although less in recent years.

Summary

The modern urologist is fortunate to have many high-quality lasers and a wide variety of surgical techniques to choose from when treating BPH. Understanding the basic laser principles and applications will help urologists to select the best treatment options for their patients with BPH.
Literature
2.
go back to reference •• Schembri M, Sahu J, Aboumarzouk O, Pietropaolo A, Somani BK. Thulium fiber laser: the new kid on the block. Turk J Urol. 2020;46(Supp. 1):S1–10. https://doi.org/10.5152/tud.2020.20093. This article is an excellent overview of TFL technology and its surgical applications. As the article is devoted entirely to TFL, it explores fiber laser science in more detail, allowing the reader to gain a better understanding of the technology.CrossRefPubMedPubMedCentral •• Schembri M, Sahu J, Aboumarzouk O, Pietropaolo A, Somani BK. Thulium fiber laser: the new kid on the block. Turk J Urol. 2020;46(Supp. 1):S1–10. https://​doi.​org/​10.​5152/​tud.​2020.​20093. This article is an excellent overview of TFL technology and its surgical applications. As the article is devoted entirely to TFL, it explores fiber laser science in more detail, allowing the reader to gain a better understanding of the technology.CrossRefPubMedPubMedCentral
11.
go back to reference Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Renaldo J, Wirjopranoto S. Comparative efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) using Moses technology and standard HoLEP: a systematic review, meta-analysis, and meta-regression. Ann Med Surg (Lond). 2022;12(81): 104280. https://doi.org/10.1016/j.amsu.2022.104280.CrossRef Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Renaldo J, Wirjopranoto S. Comparative efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) using Moses technology and standard HoLEP: a systematic review, meta-analysis, and meta-regression. Ann Med Surg (Lond). 2022;12(81): 104280. https://​doi.​org/​10.​1016/​j.​amsu.​2022.​104280.CrossRef
12.
go back to reference • Nevo A, Faraj KS, Cheney SM, Moore JP, Stern KL, Borofsky M, Gnessin E, Humphreys MR. Holmium laser enucleation of the prostate usingvs non-Moses: a randomised controlled trial. BJU Int. 2021;127(5):553–9. https://doi.org/10.1111/bju.15265. This is an excellent double-blinded, randomized control trial comparing MosesTM and MosesTM 2.0 technology. It highlights how advances in MosesTM technology translate to enucleation efficiency.CrossRefPubMed • Nevo A, Faraj KS, Cheney SM, Moore JP, Stern KL, Borofsky M, Gnessin E, Humphreys MR. Holmium laser enucleation of the prostate usingvs non-Moses: a randomised controlled trial. BJU Int. 2021;127(5):553–9. https://​doi.​org/​10.​1111/​bju.​15265. This is an excellent double-blinded, randomized control trial comparing MosesTM and MosesTM 2.0 technology. It highlights how advances in MosesTM technology translate to enucleation efficiency.CrossRefPubMed
13.
go back to reference Elmansy H, Zakaria AS, Hodhod A, Shabana W, Ahmad A, Oquendo F, Fathy M, Abbas L, Abdul Hadi R, Kelly R, Kotb A, Shahrour W. Holmium laser Xpeeda vaporization vs GreenLight XPS vaporization of the prostate for benign prostatic obstruction: 1-year results from a randomized controlled clinical study. J Endourol. 2023;37(6):706–12. https://doi.org/10.1089/end.2022.0727.CrossRefPubMed Elmansy H, Zakaria AS, Hodhod A, Shabana W, Ahmad A, Oquendo F, Fathy M, Abbas L, Abdul Hadi R, Kelly R, Kotb A, Shahrour W. Holmium laser Xpeeda vaporization vs GreenLight XPS vaporization of the prostate for benign prostatic obstruction: 1-year results from a randomized controlled clinical study. J Endourol. 2023;37(6):706–12. https://​doi.​org/​10.​1089/​end.​2022.​0727.CrossRefPubMed
17.
go back to reference Lerner LB, Rajender A. Laser prostate enucleation techniques. Can J Urol. 2015;22(51):53–9.PubMed Lerner LB, Rajender A. Laser prostate enucleation techniques. Can J Urol. 2015;22(51):53–9.PubMed
18.
go back to reference Xia SJ, Zhang YN, Lu J, Sun XW, Zhang J, Zhu YY, Li WG. Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia. Zhonghua Yi Xue Za Zhi. 2005;85(45):3225–8. Chinese.PubMed Xia SJ, Zhang YN, Lu J, Sun XW, Zhang J, Zhu YY, Li WG. Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia. Zhonghua Yi Xue Za Zhi. 2005;85(45):3225–8. Chinese.PubMed
19.
go back to reference Herrmann TR, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, Gross AJ. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010;28:45–51. https://doi.org/10.1007/s00345-009-0503-0.CrossRefPubMed Herrmann TR, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, Gross AJ. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010;28:45–51. https://​doi.​org/​10.​1007/​s00345-009-0503-0.CrossRefPubMed
21.
go back to reference Hashim H, Worthington J, Abrams P, Young G, Taylor H, Noble SM, Brookes ST, Cotterill N, Page T, Swami KS, Lane JA UNBLOCS Trial Group. Thulium laser transurethral vaporesection of the prostate versus transurethral resection of the prostate for men with lower urinary tract symptoms or urinary retention (UNBLOCS): a randomised controlled trial. Lancet. 2020;396(10243):50–61. https://doi.org/10.1016/S0140-6736(20)30537-7.CrossRef Hashim H, Worthington J, Abrams P, Young G, Taylor H, Noble SM, Brookes ST, Cotterill N, Page T, Swami KS, Lane JA UNBLOCS Trial Group. Thulium laser transurethral vaporesection of the prostate versus transurethral resection of the prostate for men with lower urinary tract symptoms or urinary retention (UNBLOCS): a randomised controlled trial. Lancet. 2020;396(10243):50–61. https://​doi.​org/​10.​1016/​S0140-6736(20)30537-7.CrossRef
22.
go back to reference Sharaf A. PD24-10 Evaluation of the learning curve for thulium laser transurethral varoresection of the prostate (ThuVARP). J Urol. 2016;195(4S): e515.CrossRef Sharaf A. PD24-10 Evaluation of the learning curve for thulium laser transurethral varoresection of the prostate (ThuVARP). J Urol. 2016;195(4S): e515.CrossRef
23.
go back to reference Deng Z, Sun M, Zhu Y, Zhuo J, Zhao F, Xia S, Han B, Herrmann TRW. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol. 2018;36(9):1355–64. https://doi.org/10.1007/s00345-018-2287-6.CrossRefPubMed Deng Z, Sun M, Zhu Y, Zhuo J, Zhao F, Xia S, Han B, Herrmann TRW. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol. 2018;36(9):1355–64. https://​doi.​org/​10.​1007/​s00345-018-2287-6.CrossRefPubMed
24.
go back to reference • Perri D, Mazzoleni F, Besana U, Pacchetti A, Morini E, Berti L, Calandriello M, Pastore AL, Romero-Otero J, Bruyere F, Sighinolfi MC, Rocco B, Micali S, Gozen AS, Liatsikos E, Roche JB, Bozzini G. Pulsed-wave vs continuous-wave thulium fiber laser enucleation of the prostate (ThuFLEP): a comparison of perioperative outcomes. Urol. 2023;178:120–4. https://doi.org/10.1016/j.urology.2023.05.013. This study assesses outcomes of prostate enucleation using the new TFL. It assesses the use of this laser in both pulsed and continuous wave modes, and the authors conclude that both settings are safe and effective.CrossRefPubMed • Perri D, Mazzoleni F, Besana U, Pacchetti A, Morini E, Berti L, Calandriello M, Pastore AL, Romero-Otero J, Bruyere F, Sighinolfi MC, Rocco B, Micali S, Gozen AS, Liatsikos E, Roche JB, Bozzini G. Pulsed-wave vs continuous-wave thulium fiber laser enucleation of the prostate (ThuFLEP): a comparison of perioperative outcomes. Urol. 2023;178:120–4. https://​doi.​org/​10.​1016/​j.​urology.​2023.​05.​013. This study assesses outcomes of prostate enucleation using the new TFL. It assesses the use of this laser in both pulsed and continuous wave modes, and the authors conclude that both settings are safe and effective.CrossRefPubMed
25.
go back to reference Castellani D, Di Rosa M, Gómez Sancha F, Rodríguez Socarrás M, Mahajan A, Taif Bendigeri M, Taratkin M, Enikeev D, Dellabella M, Gadzhiev N, Somani BK, Herrmann TRW, Gauhar V. Holmium laser with Moses technology (MoLEP) vs thulium fiber laser enucleation of the prostate (ThuFLEP) in a real-world setting. Mid-term outcomes from a multicenter propensity score analysis. World J Urol. 2023;41(11):2915–2923. https://doi.org/10.1007/s00345-023-04524-7. Castellani D, Di Rosa M, Gómez Sancha F, Rodríguez Socarrás M, Mahajan A, Taif Bendigeri M, Taratkin M, Enikeev D, Dellabella M, Gadzhiev N, Somani BK, Herrmann TRW, Gauhar V. Holmium laser with Moses technology (MoLEP) vs thulium fiber laser enucleation of the prostate (ThuFLEP) in a real-world setting. Mid-term outcomes from a multicenter propensity score analysis. World J Urol. 2023;41(11):2915–2923. https://​doi.​org/​10.​1007/​s00345-023-04524-7.
27.
go back to reference Zorn KC, Liberman D. GreenLight 180W XPS photovaporization of the prostate: how I do it. Can J Urol. 2011;18(5):5918–26.PubMed Zorn KC, Liberman D. GreenLight 180W XPS photovaporization of the prostate: how I do it. Can J Urol. 2011;18(5):5918–26.PubMed
28.
go back to reference Corsi N, Nguyen DD, Arezki A, Sadri I, Law K, Bouhadana D, Deyirmendjian C, Bhojani N, Elterman DS, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Chughtai B, Zorn KC. Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database. World J Urol. 2023;41(2):529–36. https://doi.org/10.1007/s00345-022-04260-4.CrossRefPubMed Corsi N, Nguyen DD, Arezki A, Sadri I, Law K, Bouhadana D, Deyirmendjian C, Bhojani N, Elterman DS, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Chughtai B, Zorn KC. Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database. World J Urol. 2023;41(2):529–36. https://​doi.​org/​10.​1007/​s00345-022-04260-4.CrossRefPubMed
29.
go back to reference • Nguyen DD, Misraï V, Bach T, Bhojani N, Lingeman JE, Elterman DS, Zorn KC. Operative time comparison of aquablation, Greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol. 2020;38(12):3227–33. https://doi.org/10.1007/s00345-020-03137-8. This interesting study compares operative times for various surgical techniques used to treat BPH. In regard to laser technology, it demonstrates that surgical technique plays a role in operative efficiency.CrossRefPubMed • Nguyen DD, Misraï V, Bach T, Bhojani N, Lingeman JE, Elterman DS, Zorn KC. Operative time comparison of aquablation, Greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol. 2020;38(12):3227–33. https://​doi.​org/​10.​1007/​s00345-020-03137-8This interesting study compares operative times for various surgical techniques used to treat BPH. In regard to laser technology, it demonstrates that surgical technique plays a role in operative efficiency.CrossRefPubMed
30.
go back to reference Gasmi A, Khene ZE, Guérin S, Bensalah K, Peyronnet B, Mathieu R, Roupret M, Rijo E, Pradère B, Misrai V. Propensity-score analysis comparing perioperative and functional outcomes between XPS 180 W-photovaporization and GreenLight laser enucleation of the prostate: reasons to discard vaporization and move to enucleation. World J Urol. 2021;39(7):2269–76. https://doi.org/10.1007/s00345-021-03590-z.CrossRefPubMed Gasmi A, Khene ZE, Guérin S, Bensalah K, Peyronnet B, Mathieu R, Roupret M, Rijo E, Pradère B, Misrai V. Propensity-score analysis comparing perioperative and functional outcomes between XPS 180 W-photovaporization and GreenLight laser enucleation of the prostate: reasons to discard vaporization and move to enucleation. World J Urol. 2021;39(7):2269–76. https://​doi.​org/​10.​1007/​s00345-021-03590-z.CrossRefPubMed
31.
32.
35.
go back to reference • He G, Shu Y, Wang B, Du C, Chen J, Wen J. Comparison of Diode Laser (980 nm) Enucleation vs Holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia: a randomized controlled trial with 12-month follow-up. J Endourol. 2019;33(10):843–9. https://doi.org/10.1089/end.2019.0341. An excellent randomized control trial comparing the new 980 nm diode laser technology to Holmium in prostate enucleation procedures.CrossRefPubMed • He G, Shu Y, Wang B, Du C, Chen J, Wen J. Comparison of Diode Laser (980 nm) Enucleation vs Holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia: a randomized controlled trial with 12-month follow-up. J Endourol. 2019;33(10):843–9. https://​doi.​org/​10.​1089/​end.​2019.​0341. An excellent randomized control trial comparing the new 980 nm diode laser technology to Holmium in prostate enucleation procedures.CrossRefPubMed
36.
go back to reference Chun SS, Razvi HA, Denstedt JD. Laser prostatectomy with the Holmium: YAG laser. Tech Urol. 1995;1(4):217–21.PubMed Chun SS, Razvi HA, Denstedt JD. Laser prostatectomy with the Holmium: YAG laser. Tech Urol. 1995;1(4):217–21.PubMed
Metadata
Title
Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy
Authors
David C. Dalton
T. Max Shelton
Marcelino Rivera
Publication date
13-02-2024
Publisher
Springer US
Published in
Current Urology Reports / Issue 4/2024
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-024-01197-6