Historical aspects of laser therapy for benign prostatic hyperplasia

The gold standard treatment of benign prostatic hyperplasia (BPH) has been the transurethral resection of the prostate (TURP). However, this procedure is associated with a number of complications, and other surgical therapies, including laser prostatectomy, have been developed to overcome these issues. Laser prostatectomy involves tissue coagulation or vaporization. Coagulation of the tissue results in debulking of the gland through sloughing of necrotic tissue, while vaporization results in an instantaneous debulking of prostatic tissue. The laser procedures developed over the past decade include visual laser ablation of the prostate using the neodymium:yttrium-aluminium-garnet laser. Clinical outcome with this procedure shows good results up to 3 yr. The same laser can be applied through direct insertion of the laser fibres into the prostate in a procedure termed interstitial laser coagulation. Holmium laser enucleation of the prostate is one of the most investigated of the laser procedures and is associated with a good outcome over a long follow-up period. one drawback is the high degree of training required to master the technicalities of the procedure. The latest addition to laser therapy for BPH is photoselective vaporization of the prostate. This procedure results in rapid vaporization of prostate tissue with good outcome up to 5 yr reported. The procedure can be applied to large glands, patients in retention, and those on anticoagulants. Clinical evidence now exists on the effectiveness of both the holmium and potassium-titanyl phosphate lasers, and these therapies now represent a valid clinical alternative to TURP. (c) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.