AB016. Which laser works best for benign prostatic hyperplasia?

Abstract: For decades, transurethral resection of the prostate (TUR-P) has been considered the “gold standard” surgical procedure for men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The GreenLight (GL) laser has a wavelength of 532 nm the range of visible green light. The emitted energy is mostly absorbed by hemoglobin, thus heating the intracellular fluid in the well vascularized prostatic tissue which leads to vaporization. Since about half of men over the age of 60 often have lower LUTS due to BPH with prolonged life expectancy worldwide, more symptomatic BPH patients will require surgical interventions. The incidence of cardiovascular, stroke, and lung diseases also increases with age, the number of BPH patients at high risk for these diseases will increase accordingly. Gu et al. concluded that age has little effect on the efficacy and safety of GL HPS™ laser. Series of a total of 188 BPH patients at high cardiovascular risk and on long-term anticoagulation underwent 120-W GL laser vaporization of the BPH showed that no patient required blood transfusion, and none revealed any evidence of intraoperative fluid absorption leading to serum electrolyte abnormalities. Severe intraoperative and postoperative complications were not occurred. Disadvantage of previous KTP laser is limited volume reduction in large size prostate and may be insufficient to maintain long-lasting good functional results. Brunken et al. reported that GL laser enucleation of the prostate volume ≥50 cc. The results showed that all patients were able to void properly and during follow-up, none of the patients needed further interventions or hospital treatment. A multicenter randomized controlled trial at Europe compared GL laser with monopolar TUR-P with a total of randomized 139 patients. The results for IPSS variation were not different between two group in prostate volume ≥70 cc. The authors concluded that GL laser seems an acceptable alternative to TUR-P with close results on LUTS improvement in the short term and GL laser is associated with a reduced hospital stay with less postoperative irrigation and hematuria. Based on recently reported series, GL laser were not influenced by the size of prostate, the use of anticoagulant, the intake of 5-ARI for BPH management, a history of AUR. GL laser can be applied to the patients of large size of prostate, or difficult to stop the use of anticoagulant.

Keywords: Benign prostatic hyperplasia (BPH); GreenLight laser (GL laser); anticoagulant