Investig Clin Urol.  2018 Nov;59(6):392-398. 10.4111/icu.2018.59.6.392.

Outcome of 980 nm diode laser vaporization for benign prostatic hyperplasia: A prospective study

• Mithani MH
• Khalid SE
• Khan SA
• Sharif I
• Awan AS
• Mithani S
• Majeed I

• KMID: 2424294
• DOI: http://doi.org/10.4111/icu.2018.59.6.392

Abstract

PURPOSE
To evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser.
MATERIALS AND METHODS
A prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery.
RESULTS
The mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p < 0.001) in IPSS 7.04±1.69 (−18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (−112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs.
CONCLUSIONS
PVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.

Keyword

Lasers; Prostatic hyperplasia; Semiconductor diode lasers; Treatment outcome; Vaporization

MeSH Terms

Burns
Dysuria
Humans
Lasers, Semiconductor*
Operative Time
Pakistan
Prospective Studies*
Prostate
Prostatic Hyperplasia*
Treatment Outcome
Urinary Bladder Neck Obstruction
Urination
Volatilization*

Reference

1. Simforoosh N, Abdi H, Kashi AH, Zare S, Tabibi A, Danesh A, et al. Open prostatectomy versus transurethral resection of the prostate, where are we standing in the new era? A randomized controlled trial. Urol J. 2010; 7:262–269. PMID: 21170857.

2. Garraway WM, Collins GN, Lee RJ. High prevalence of benign prostatic hypertrophy in the community. Lancet. 1991; 338:469–471. PMID: 1714529.

3. Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990; 17:241–246. PMID: 1700403.

4. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006; 50:969–979. discussion 980. PMID: 16469429.

5. Kaplan SA. AUA guidelines and their impact on the management of BPH: an update. Rev Urol. 2004; 6(Suppl 9):S46–S52. PMID: 16985925.

6. European Association of Urology. Management of Male LUTS, including BPO. EAU Guidelines. 2012; 40–59.

7. Muschter R. Lasertherapie der benignen prostatahyperplasie. Aktuelle Urol. 2008; 39:359–366. PMID: 18798125.

8. Lee NG, Xue H, Lerner LB. Trends and attitudes in surgical management of benign prostatic hyperplasia. Can J Urol. 2012; 19:6170–6175. PMID: 22512959.

9. Kuntz RM. Laser treatment of benign prostatic hyperplasia. World J Urol. 2007; 25:241–247. PMID: 17530259.

10. Reich O, Bachmann A, Siebels M, Hofstetter A, Stief CG, Sulser T. High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J Urol. 2005; 173:158–160. PMID: 15592063.

11. Rieken M, Bachmann A. Laser treatment of benign prostate enlargement--which laser for which prostate? Nat Rev Urol. 2014; 11:142–152. PMID: 24595121.

12. Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, et al. 980-nm Diode laser: a novel laser technology for vaporization of the prostate. Eur Urol. 2007; 52:1723–1728. PMID: 17611013.

13. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004; 46:547–554. PMID: 15474261.

14. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008; 180:246–249. PMID: 18499179.

15. Seitz M, Reich O, Karl A, Bachmann A, Gratzke C, Steinbrecher V, et al. Diode laser treatment of human prostates - clinical 6-month experience. Med Laser Appl. 2008; 22:232–237.

16. Reich O, Seitz M, Gratzke C, Schlenker B, Bachmann A, Stief C. [Benign prostatic syndrome (BPS). Ablative treatments]. Urologe A. 2006; 45:769–780. quiz 781-2. PMID: 16788796.

17. Bach T, Muschter R, Sroka R, Gravas S, Skolarikos A, Herrmann TR, et al. Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol. 2012; 61:317–325. PMID: 22033173.

18. Teichmann HO, Herrmann TR, Bach T. Technical aspects of lasers in urology. World J Urol. 2007; 25:221–225. PMID: 17534625.

19. Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg. 2007; 94:1201–1208. PMID: 17729384.

20. Ruszat R, Wyler S, Forster T, Reich O, Stief CG, Gasser TC, et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol. 2007; 51:1031–1038. discussion 1038-41. PMID: 16945475.

21. Kang SH, Choi YS, Kim SJ, Cho HJ, Hong SH, Lee JY, et al. Long-term follow-up results of photoselective vaporization of the prostate with the 120 W greenlight HPS laser for treatment of benign prostatic hyperplasia. Korean J Urol. 2011; 52:260–264. PMID: 21556212.

22. Ruszat R, Seitz M, Wyler SF, Müller G, Rieken M, Bonkat G, et al. Prospective single-centre comparison of 120-W diode-pumped solid-state high-intensity system laser vaporization of the prostate and 200-W high-intensive diode-laser ablation of the prostate for treating benign prostatic hyperplasia. BJU Int. 2009; 104:820–825. PMID: 19239441.

23. Shaker HS, Shoeb MS, Yassin MM, Shaker SH. Quartz head contact laser fiber: a novel fiber for laser ablation of the prostate using the 980 nm high power Diode laser. J Urol. 2012; 187:575–579. PMID: 22177175.

24. Leonardi R. Preliminary results on selective light vaporization with the side-firing 980 nm Diode laser in benign prostatic hyperplasia: an ejaculation sparing technique. Prostate Cancer Prostatic Dis. 2009; 12:277–280. PMID: 19322136.

25. Yang KS, Seong YK, Kim IG, Han BH, Kong GS. Initial experiences with a 980 nm Diode laser for photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia. Korean J Urol. 2011; 52:752–756. PMID: 22195264.

26. Razzaghi MR, Mazloomfard MM, Mokhtarpour H, Moeini A. Diode laser (980 nm) vaporization in comparison with transurethral resection of the prostate for benign prostatic hyperplasia: randomized clinical trial with 2-year follow-up. Urology. 2014; 84:526–532. PMID: 25168526.

27. Cetinkaya M, Onem K, Rifaioglu MM, Yalcin V. 980-Nm Diode laser vaporization versus transurethral resection of the prostate for benign prostatic hyperplasia: randomized controlled study. Urol J. 2015; 12:2355–2361. PMID: 26571321.

28. Erol A, Cam K, Tekin A, Memik O, Coban S, Ozer Y. High power Diode laser vaporization of the prostate: preliminary results for benign prostatic hyperplasia. J Urol. 2009; 182:1078–1082. PMID: 19616811.

29. Xu A, Zou Y, Li B, Liu C, Zheng S, Li H, et al. A randomized trial comparing Diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia. J Endourol. 2013; 27:1254–1260. PMID: 23879477.

30. Lusuardi L, Myatt A, Sieberer M, Jeschke S, Zimmermann R, Janetschek G. Safety and efficacy of eraser laser enucleation of the prostate: preliminary report. J Urol. 2011; 186:1967–1971. PMID: 21944122.