Abstract
Purpose
To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications.
Methods
A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios. Settings were compared for the reported laser types, and common settings and preventive measures were identified.
Results
Twenty-two experts completed the survey with a mean filling time of 12.9 min. Ho:YAG, Thulium fiber laser (TFL), continuous wave (cw) Tm:YAG, pulsed Tm:YAG and Greenlight™ lasers are used by 73% (16/22), 50% (11/22), 23% (5/22), 13.6% (3/22) and 9.1% (2/22) of experts, respectively. All experts use anatomical enucleation of the prostate (EEP), preferentially in one- or two-lobe technique. Laser settings differ significantly between laser types, with median laser power for apical/main gland EEP of 75/94 W, 60/60 W, 100/100 W, 100/100 W, and 80/80 W for Ho:YAG, TFL, cwTm:YAG, pulsed Tm:YAG and Greenlight™ lasers, respectively (p = 0.02 and p = 0.005). However, power settings within the same laser source are similar. Pulse shapes for main gland EEP significantly differ between lasers with long and pulse shape modified (e.g., Moses, Virtual Basket) modes preferred for Ho:YAG and short pulse modes for TFL (p = 0.031).
Conclusion
Ho:YAG lasers no longer seem to be the mainstay of EEP. TFL lasers are generally used in pulsed mode though clinical applicability for quasi-continuous settings has recently been demonstrated. One and two-lobe techniques are beneficial regarding operative time and are used by most experts.
Similar content being viewed by others
References
Enikeev D, Taratkin M, Azilgareeva C, Glybochko P (2020) Knowing the inside of a laser. Arch Esp Urol 73(8):665–674
Huang SW, Tsai CY, Tseng CS, Shih MC, Yeh YC, Chien KL et al (2019) Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ (Clin Res Ed) 367:l5919. https://doi.org/10.1136/bmj.l5919
Enikeev D, Taratkin M (2023) Thulium fiber laser: bringing lasers to a whole new level. Eur Urol Open Sci 48:31–33. https://doi.org/10.1016/j.euros.2022.07.007
Enikeev D, Taratkin M, Babaevskaya D, Morozov A, Petov V, Sukhanov R et al (2022) Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 40(8):2047–2053. https://doi.org/10.1007/s00345-022-04046-8
Hartung FO, Kowalewski KF, von Hardenberg J, Worst TS, Kriegmair MC, Nuhn P et al (2022) Holmium versus Thulium laser enucleation of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol Focus 8(2):545–554. https://doi.org/10.1016/j.euf.2021.03.024
Perri D, Mazzoleni F, Besana U, Pacchetti A, Morini E, Berti L et al (2023) Pulsed-wave vs continuous-wave Thulium fiber laser enucleation of the prostate (ThuFLEP): a comparison of perioperative outcomes. Urology. https://doi.org/10.1016/j.urology.2023.05.013
Huusmann S, Lafos M, Meyenburg I, Muschter R, Teichmann HO, Herrmann T (2021) Tissue effects of a newly developed diode pumped pulsed Thulium:YAG laser compared to continuous wave Thulium:YAG and pulsed Holmium:YAG laser. World J Urol 39(9):3503–3508. https://doi.org/10.1007/s00345-021-03634-4
Large T, Nottingham C, Stoughton C, Williams J Jr, Krambeck A (2020) Comparative study of Holmium laser enucleation of the prostate with MOSES enabled pulsed laser modulation. Urology 136:196–201. https://doi.org/10.1016/j.urology.2019.11.029
Nevo A, Faraj KS, Cheney SM, Moore JP, Stern KL, Borofsky M et al (2021) Holmium laser enucleation of the prostate using Moses 2.0 vs non-Moses: a randomised controlled trial. BJU Int 127(5):553–559. https://doi.org/10.1111/bju.15265
Nottingham CU, Large T, Agarwal DK, Rivera ME, Krambeck AE (2021) Comparison of newly optimized Moses technology vs standard Holmium:YAG for endoscopic laser enucleation of the prostate. J Endourol 35(9):1393–1399. https://doi.org/10.1089/end.2020.0996
Pang KH, Ortner G, Yuan Y, Biyani CS, Tokas T (2022) Complications and functional outcomes of endoscopic enucleation of the prostate: a systematic review and meta-analysis of randomised-controlled studies. Cent Eur J Urol 75(4):357–386. https://doi.org/10.5173/ceju.2022.174
Ramadhani MZ, Klo** YP, Rahman IA, Yogiswara N, Renaldo J, Wirjopranoto S (2022) Comparative efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) using Moses technology and standard HoLEP: a systematic review, meta-analysis, and meta-regression. Ann Med Surg (2012) 81:104280. https://doi.org/10.1016/j.amsu.2022.104280
Socarrás MR, Del Álamo JF, Espósito F, Elbers JR, Monsalve DC, Rivas JG et al (2023) En Bloc enucleation with early apical release technique using MOSES (En Bloc MoLEP) vs. classic En Bloc HoLEP: a single arm study comparing intra- and postoperative outcomes. World J Urol 41(1):159–165. https://doi.org/10.1007/s00345-022-04205-x
Taratkin M, Azilgareeva C, Cacciamani GE, Enikeev D (2022) Thulium fiber laser in urology: physics made simple. Curr Opin Urol 32(2):166–172. https://doi.org/10.1097/mou.0000000000000967
Ortner G, Rice P, Nagele U, Herrmann TRW, Somani BK, Tokas T (2023) Tissue thermal effect during lithotripsy and tissue ablation in endourology: a systematic review of experimental studies comparing Holmium and Thulium lasers. World J Urol 41(1):1–12. https://doi.org/10.1007/s00345-022-04242-6
Barco-Castillo C, Plata M, Zuluaga L, Santander J, Trujillo CG, Caicedo JI et al (2020) Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement. Neurourol Urodyn 39(1):303–309. https://doi.org/10.1002/nau.24195
Knapp GL, Chalasani V, Woo HH (2017) Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W greenlight lithium triborate laser. BJU Int 119(Suppl 5):33–38. https://doi.org/10.1111/bju.13822
Elshal AM, El-Nahas AR, Ghazy M, Nabeeh H, Laymon M, Soltan M et al (2018) Low-power vs high-power Holmium laser enucleation of the prostate: critical assessment through randomized trial. Urology 121:58–65. https://doi.org/10.1016/j.urology.2018.07.010
Pirola GM, Castellani D, Maggi M, Lim EJ, Chan VWS, Naselli A et al (2022) Does power setting impact surgical outcomes of Holmium laser enucleation of the prostate? A systematic review and meta-analysis. Cent Eur J Urol 75(2):153–161. https://doi.org/10.5173/ceju.2022.0104
Gkolezakis V, Somani BK, Tokas T (2023) Low- vs. high-power laser for Holmium laser enucleation of prostate. J Clin Med. https://doi.org/10.3390/jcm12052084
Scoffone CM, Cracco CM (2020) Prostate enucleation, better with low or high-power Holmium laser? A systematic review. Arch Esp Urol 73(8):745–752
Tuccio A, Grosso AA, Sessa F, Salvi M, Tellini R, Cocci A et al (2021) En-bloc Holmium laser enucleation of the prostate with early apical release: are we ready for a new paradigm? J Endourol 35(11):1675–1683. https://doi.org/10.1089/end.2020.1189
Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Hennenberg M et al (2023) Efficacy, efficiency, and safety of en-bloc vs three-lobe enucleation of the prostate: a propensity score-matched analysis. Urology 175:48–55. https://doi.org/10.1016/j.urology.2023.02.014
Rücker F, Lehrich K, Böhme A, Zacharias M, Ahyai SA, Hansen J (2021) A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe. World J Urol 39(7):2337–2345. https://doi.org/10.1007/s00345-021-03598-5
Ortner G, Pang KH, Yuan Y, Herrmann TRW, Biyani CS, Tokas T (2023) Peri- and post-operative outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP): a systematic review and meta-analysis. World J Urol. https://doi.org/10.1007/s00345-023-04308-z
Press B, Ghiraldi E, Kim DD, Nair H, Johnson K, Kellner D (2022) “En-Bloc” enucleation with early apical release compared to standard Holmium laser enucleation of the prostate: a retrospective pilot study during the initial learning curve of a single surgeon. Urology 165:275–279. https://doi.org/10.1016/j.urology.2022.01.011
Gauhar V, Gilling P, Pirola GM, Chan VW, Lim EJ, Maggi M et al (2022) Does MOSES technology enhance the efficiency and outcomes of standard Holmium laser enucleation of the prostate? Results of a systematic review and meta-analysis of comparative studies. Eur Urol Focus 8(5):1362–1369. https://doi.org/10.1016/j.euf.2022.01.013
Li K, Meng C, Li J, Gan L, Peng L, Li Y et al (2023) Efficiency and clinical outcomes of Moses technology for Holmium laser enucleation of the prostate: an evidence-based analysis. Prostate 83(1):3–15. https://doi.org/10.1002/pros.24438
Ortner G, Nagele U, Herrmann TRW, Tokas T (2022) Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review. World J Urol 40(3):697–708. https://doi.org/10.1007/s00345-021-03769-4
Tokas T, Ortner G, Herrmann TRW, Nagele U (2021) Relevance of intravesical pressures during transurethral procedures. World J Urol 39(6):1747–1756. https://doi.org/10.1007/s00345-020-03401-x
Funding
None.
Author information
Authors and Affiliations
Contributions
GO and TT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TT, GO. Acquisition of data: GO, TT, SG, BKS, AN, CMS, CG, IKG, TB, FGS, FCAF, AK, GB, KL, EL, PK, JBR, AM, DE, LT, NB, PG, JRO, AP, SA, CN, ASG, UN, TH. Analysis and interpretation: GO, TT. Drafting of the manuscript: GO, TT. Critical revision of the manuscript: TT, BKS, SG, TH, UN, ASG. Statistical analysis: GO. Obtaining funding: None. Administrative, technical or material support: GO, TT, UN, TH. Supervision: TT.
Corresponding author
Ethics declarations
Conflict of interest
Gernot Ortner certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Karin Lehrich: Consultant Boston scientific, Coloplast, Olympus. Udo Nagele: Consultant Karl Storz, Baxter, Boston Scientific, Optimed, Storz medical, B + K. Javier Romero Otero: Member of advisory board for BPH for Coloplast, Olympus, Jena. Naeem Bhojani: Consultant Boston Scientific, Olympus, Procept Biorobotics, Amy Krambeck: Consultant Boston scientific, Storz Medical, Richard Wolf, Sonomotion Viruoso, Uriprene. Panagiotis Kallidonis: Consultant Cook Medical, EMS.
Research involving human participants and/or animals
This work does not involve human participants and/or animals.
Informed consent
No patients were included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ortner, G., Güven, S., Somani, B.K. et al. Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 41, 3277–3285 (2023). https://doi.org/10.1007/s00345-023-04565-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-023-04565-y