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Choices of Lasers

 

Laser Prostatectomy by vaporization or vapo-resection offers the advantage of virtually immediate relief of symptoms, minimal catheterization time, reduced operative and post-operative discomfort and minimal risk of complications. 

Note that some lasers such as Nd:YAG lasers or Diode lasers with wavelengths typically ranging from 980 nm to 1064 nm are designed to create coagulative necrosis in the prostatic tissue.  This approach provides gradually improving symptoms rather than immediate relief.  Treatment by coagulative necrosis requires catheterization for days or even weeks and can be attended by dysuria (or irritative symptoms).

Lasers with that can immediately remove tissue through vaporization are now considered the ideal surgical tools for treating PBH.  There are several laser wavelengths available that, to greater or lesser degrees, meet this criteria.  The most popular of these wavelengths are; Thulium, Holmium and KTP (sometimes referred to as; “green-light laser”).  Although each of these wavelengths can be used to vaporize prostatic tissue, there are important differences.

Holmium lasers can be technically more difficult to used due to their tendency to create a cloudy surgical field that can impair the surgeon’s vision.  The vaporizing effect of holmium lasers is not as efficient as that of other lasers and therefore the procedural time is longer.  Holmium lasers tend not to provide as effective bleeding control as other wavelengths and therefore post operative bleeding can be a risk.

The green light of KTP lasers is absorbed by blood.  Therefore KTP laser vaporize highly vascularized tissue quite well.  However, in poorly vascularized tissue the energy is transmitted into the tissue causing a coagulative necrosis that can result in unwanted post-operative symptoms.

The new thulium wavelength (such as that of the Cyber TM™ laser) is now considered by many to be the ideal wavelength for BPH surgery.  This laser vaporizes well vascularized or poorly vascularized tissue with equal efficiency. The thulium laser provides effective control of bleeding (hemostasis) without creating deep coagulative necrosis.  When using the thulium laser, the operative field of vision is kept clear for the surgeon so that he can easy see what he is doing.  Since the wavelength of the thulium laser is highly absorbed by water, there is much less risk that stray laser light will accidently damage untargeted tissues such as certain areas of the bladder that can be vulnerable to such problems during BPH surgery with other lasers.

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