Treating cervico-urethral obstructions with laser diode: initial clinical experience.

BACKGROUND: The first laser employment for the treatment of the cervico-urethral obstructions (CUO) dates back to the early ’90s. This study begins with the analysis of laser basics in Medicine and has the purpose to weigh pros and cons (and limits as well) of laser use in CUO due to Benign Prostatic Hyperplasia (BPH). That is an ageing man’s typical disease and there is a huge need of minimally in- vasive treatments, because people affected by this kind of illness suffer very often from comorbidities, and that could make traditional surgery quite risky. AIM OF THE STUDY: The target of this study is the in vivo experimentation of a brand new laser diode, crated to be specifically used in BPH, and to verify its efficacy and safety. MATERIALS AND METHODS: The subject of the study is the whole laser diode supply, with its double-band laser source (980 nm + 1470 nm), which gains a 140 W-power and is equipped with Water-Free optical fibers of different kinds of tip. We have tested a conical tip fiber on a standard 24-26 F-resectoscope instead of a standard diathermic loop. The conic fiber optimizes the energy on the treated tissue. We recruited 14 patients with CUO caused by BPH, 56 to 70 years old, with a prostatic volume between 33 and 53 cc, and we treated them with laser surgery using the power of 100-110 W. We considered the operative time, the intra-surgery complications and the specific side effects such as hematuria, pain, catheter removal time and the presence or not of acute urinary retention, in order to evaluate the efficacy and safety of this new technique. RESULTS: The possibility of using the same resectoscope as the one used in transurethral resection of prostate (TURP) made everything more comfortable and easy because of the immediate feeling with the new instrument and the actual time of Light Vaporization between 30 and 40 minutes, which is more or less the same time of a standard TURP procedure. CONCLUSIONS: The idea of a double-band-emitting laser used with conical tip fibers appears to be a great solution in the BPH treatment: it uses the principle of low power density plasma in order to treat bigger prostatic tissue areas but never going in depth. In our clinical results, the efficacy of the double- band-emitting laser source (1470 nm + 980 nm) appears to be similar, but even potentially greater, to the actual surgical laser options (such as HoLEP with Ho:YAG laser and PVP with KTP laser), and it is also similar to traditional TURP.