Abstract

The authors present a new application system for the laser resection and review their own experience in the development and clinical application of Holmium:YAG laser technology for prostatectomy. Their efforts had been to solve certain problems in the clinical application, e.g. the angle fiber/tissue in the apex area of the prostate and the movements of the shaft during the resection. Laser prostatectomy has been reported as a successful therapy for men with benign prostatic hyperplasia (BPH). Indications for the surgical treatment of BPH are refractory urinary retention, urinary tract infections, recurrent gross hematuria, bladder stones, renal insufficiency and large bladder diverticula due to BPH. Standard therapy of BPH are TURP (transurethral resection of the prostate) and open prostatectomy; these procedures are associated with a morbidity of 18% including blood loss and blood transfusion (2.9-19.6%) and transurethral resection syndrome in up to 2%. Since the mid-80's the Holmium laser has been under investigation for soft-tissue ablation, because the emitted wavelength is strongly absorbed by tissue due to its high content of water. The Holmium:YAG laser (2.140nm) has many applications in urology and can be delivered via a range of flexible low water content quartz fibers using endfiring or sidefiring techniques. The unique physical characteristics of the Holmiunv.YAG (Ho:YAG) laser makes it an effective tool to vaporize or incise tissue, including the prostate. In 1993, Gilling and Fraundorfer published a new technique of laser resection, the HoLRP. It combines the advantages of minimal perioperative morbidity, enjoyed with prior laser techniques, with the immediacy of intraoperative tissue removal and early postoperative voiding improvement. The Ho:YAG laser has been established as a new instrument for the performance of transurethral prostatectomy, which now has been demonstrated to be a safe and effective therapy for symptomatic BPH in extended clinical trials.

© 1999 Optical Society of America