Benign prostate enlargement is usually treated using TURP (ransurethral resection of the prostate). An alternative to this is resection, i.e. tissue removal, using laser light.
Here you will find further information as well as selected specialists and centers for laser resection of the prostate.
Prostatic hyperplasia can often be treated with medication. If this is not sufficient, surgical removal of prostate tissue is necessary. This involves removing glandular tissue from the inner area of the prostate. With good results, this leads to
In most cases, the operation is minimally invasive. No skin incisions are necessary. Instead, an instrument is inserted through the urethra.
The worldwide standard surgical procedure is transurethral resection of the prostate (TURP). Numerous randomized studies have demonstrated the good long-term results of TURP. However, there are procedural risks associated with TURP, such as the washing in of irrigation solution and/or blood loss.
Various laser procedures have also been developed as an alternative to TURP. The aim was to provide a gentler treatment compared to TURP.
Laser is a high-energy, focused beam of light that generates heat in the tissue on contact. This local heat burns or vaporizes tissue and can thus cut or vaporize prostate tissue (vaporization). The type of tissue effect depends on the energy and wavelength of the laser light used.
Laser procedures have been used in the treatment of prostate hyperplasia for almost 30 years.
In principle, the acquisition costs for the necessary laser technology are relatively high. The laser fibers required for use on the patient are disposable instruments in the GREENLIGHT laser. They make every procedure of this type significantly more expensive compared to TURP. In principle, nothing changes for the patient, regardless of which procedure is used.
Different types of lasers have a gentle effect. However, they are less effective when removing proliferating prostate tissue.
Here you can see the prostate laser resection as a camera image © RFBSIP | AdobeStock
Procedures used today are
These procedures differ in the wavelength and energy of the laser light used. In other words, in their energy effect in the tissue and their penetration depth.
The HOLMIUM:YAG laser has not proven to be a good instrument for vaporization (tissue evaporation). This laser is therefore used for so-called laser enucleation of the prostate.
The laser is located in the instrument inserted into the urethra. Doctors use it to cut out the inner parts of the prostate. These parts of the prostate are then shredded in the bladder and flushed out. The principle of the operation is to remove as much as possible of the internal parts of the prostate that have grown.
The aim is the same as with TURP, although in principle the blood loss is less with HOLMIUM resection. Controlled comparative studies have shown good results that are not inferior to those of TURP.
The application of this technique is complex. As a result, this method has not become widespread.
GREENLIGHT laser resection uses the potassium titanyl phosphate (KTP):YAG laser exclusively to vaporize the internal prostate tissue.
Technically, it is a frequency-doubled Nd:YAG laser (wavelength 532 nm) using a KTP crystal. This wavelength lies in the visible, green range of the color spectrum. This is why the laser is also called a GREENLIGHT laser.
The laser provides superficial tissue destruction of tissue with a good blood supply. Only a small amount of blood escapes. This property results from the low penetration depth into the tissue and the high absorption of the laser energy, primarily by the red blood pigment (haemoglobin).
This procedure is therefore also known as "photoselective". Tissue is removed step by step under visual control.
The GREENLIGHT lasers have been upgraded from an initial 60 W output (with long operating times) to 120 W in the meantime. This has led to more efficient and faster tissue ablation.
The advantage is very low blood loss, so that high-risk patients in particular can be treated with it.
Controlled comparative studies have also shown comparable results to TURP.
Another procedure uses the so-called continuous wave laser. It has a wavelength of 2 micrometers (2 micron continuous wave laser). This wavelength is comparable to that of the holmium laser. With the CW laser, the infrared light radiation is very strongly absorbed by the cell water in the tissue.
The penetration depth into the tissue is only 0.5 mm and the absorbed energy is converted into heat. This vaporizes the prostate tissue, leaving a relatively thin layer of overcooked tissue.
This laser is therefore also used for vaporization with minimal blood loss.
Laser procedures are associated with low blood loss. This is a fundamental advantage compared to TURP. However, this is not of fundamental importance for every patient: With the average TURP, blood loss is low and can be tolerated. Blood loss is even less with the GREENLIGHT laser than with HOLMIUM resection.
Irrigation fluid is used in all prostate surgery procedures. Another advantage of laser procedures is that less irrigation fluid enters the patient's circulation. For patients with cardiovascular disease, the ingestion of large quantities of the irrigation solution can be dangerous.
When the tissue is removed with the GREENLIGHT laser, a superficial layer of dead tissue remains. It is gradually shed during the healing process. This takes several weeks. During this phase, there may be noticeable symptoms when urinating, but these then subside.
With TURP and the HOLMIUM laser, the tissue is removed with clear incision margins. This is why the healing phase is shorter here.
Tissue removal using vaporization procedures is less complete than with TURP. This can lead to the surgical result being insufficient in terms of improving bladder function. Secondary surgery is then required.
Another possible disadvantage of GREENLIGHT laser resection is the vaporization of the tissue. This means that no tissue remains for examination by a pathologist. However, this is possible with HOLMIUM resection and TURP.
The lack of examination options is a disadvantage in cases where prostate cancer is suspected.
Compared to TURP, the two laser procedures mentioned are less invasive. The term "invasive" essentially means "burdensome" and "fraught with complications".
The laser procedures have a significantly lower risk of bleeding and bleeding in. They therefore have a lower risk of complications. This is particularly important for patient groups who
On the other hand, the healing phase after GREENLIGHT resection usually takes longer. The term "burdensome" must therefore be put into perspective.
Scientific studies have shown that HOLMIUM enucleation and GREENLIGHT laser resection are effective procedures. Nevertheless, there are differences:
Individual studies have predominantly reported that HoLEP is highly effective. In direct comparative studies, patients treated with HoLEP had
than patients treated with TURP in the same study.
In a total of three available direct comparative studies
was determined.
Only a few studies comparing the THULIUM laser with TURP are available to date.
The decision for one of the laser surgical procedures depends largely on the size of the prostate.
The advantages of the GREENLIGHT laser are most evident in small and medium-sized prostate glands.
The HOLMIUM procedure is particularly advantageous for very large prostates, but unsuitable for small ones.
In addition, the doctor must always consider the
in order to be able to make a sensible recommendation.
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