Background/Aims/Objectives: To describe the depth of the laser coagulation zone in vivo based on histological examinations and the functional outcome of a 1,318-nm diode laser for enucleation in benign prostatic enlargement (BPE). Methods: A total of 20 patients with BPE were treated by laser Eraser® enucleation of the prostate (ELEP). Prostatic tissue wedges were evaluated to assess the depth of the ELEP coagulation zones. Additionally, patients were assessed preoperatively and 12 months postoperatively. Results: The coagulation zones were 0.36 ± 0.17 mm in epithelial tissue, 0.28 ± 0.15 mm in stromal tissue, and 0.25 ± 0.12 mm in mixed tissue. The coagulation area at the cutting edge completely sealed capillary vessels, reaching a depth of 0.35 ± 0.15 mm. The diameter of the coagulated vessels measured 1.75 ± 0.83 mm. Mean blood loss was 115.54 ± 93.12 ml, catheter time 1.35 ± 0.33 days, and hospital stay 1.89 ± 0.52 days. The International Prostate Symptom Score, maximal flow rate, and quality of life significantly improved 12 months after the procedure. Conclusions: ELEP is safe and effective for BPE treatment and yields good results at a follow-up of 1 year. Because of the limited penetration depth, damage to the urinary sphincter is not expected.

Keywords:
Prostate, Benign prostatic enlargement, Laser surgery, Diode laser
1.
Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS: EAU guidelines on laser technologies. Eur Urol 2012;61:783-795.
2.
Lusuardi L, Myatt A, Sieberer M, Jeschke S, Zimmermann R, Janetschek G: Safety and efficacy of Eraser laser enucleation of the prostate: preliminary report. J Urol 2011;186:1967-1971.
3.
Yang SS, Hsieh CH, Lee YS, Chang SJ: Diode laser (980 nm) enucleation of the prostate: a promising alternative to transurethral resection of the prostate. Lasers Med Sci 2013;28:353-360.
4.
Khoder WY, Sroka R, Siegert S, Stief CG, Becker AJ: Outcome of laser-assisted laparoscopic partial nephrectomy without ischaemia for peripheral renal tumours. World J Urol 2012;30:633-638.
5.
Rolle A, Koch R, Alpard SK, Zwischenberger JB: Lobe-sparing resection of multiple pulmonary metastases with a new 1318-nm Nd:YAG laser-first 100 patients. Ann Thorac Surg 2002;74:865-869.
6.
Ekengren J, Hahn RG: Blood loss during transurethral resection of the prostate as measured by the HemoCue photometer. Scand J Urol Nephrol 1993;27:501-507.
7.
Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J: Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 2011;107:1030-1043.
8.
Seitz M, Ruszat R, Bayer T, Tilki D, Bachmann A, Stief C, et al: Ex vivo and in vivo investigations of the novel 1,470 nm diode laser for potential treatment of benign prostatic enlargement. Lasers Med Sci 2009;24:419-424.
9.
Rieken M, Kang HW, Koullick E, Ruth GR, Bachmann A: Laser vaporization of the prostate in vivo: experience with the 150-W 980-nm diode laser in living canines. Lasers Surg Med 2010;42:736-742.
10.
Seitz M, Bayer T, Ruszat R, Tilki D, Bachmann A, Gratzke C, et al: Preliminary evaluation of a novel side-fire diode laser emitting light at 940 nm, for the potential treatment of benign prostatic hyperplasia: ex-vivo and in-vivo investigations. BJU Int 2009;103:770-775.
11.
Bachmann A, Woo HH, Wyler S: Laser prostatectomy of lower urinary tract symptoms due to benign prostate enlargement: a critical review of evidence. Curr Opin Urol 2012;22:22-33.
12.
Bach T, Netsch C, Haecker A, et al: Thulium:Yag laser enucleation (vapoenucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 2010;28:39-43.
13.
Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, Haecker A: Systemic evaluation of recently introduced 2-lm continuous-wave thulium laser for vaporesection of the prostate. J Endourol 2008;22:1041-1045.
14.
Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR: Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol 1995;9:151-153.
15.
Montorsi F, Naspro R, Salonia A, et al: Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2008;179:S87-S90.
16.
Gupta N, Sivaramakrishna, Kumar R, et al: Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g. BJU Int 2006;97:85-89.
17.
Vavassori I, Hurle R, Vismara A, et al: Holmium laser enucleation of the prostate combined with mechanical morcellation: two years of experience with 196 patients. J Endourol 2004;18:109-112.
18.
Tan AH, Gilling PJ: Holmium laser prostatectomy: current techniques. Urology 2002;60:152-156.
19.
Hermann EL, Nagele U, Traxer O, Merseburger AS: Guidelines on Lasers and Technologies. European Association of Urology, 2011.
20.
Rieken M WS, Müller G, et al: Laser vaporization of the prostate: intermediate-term follow-up with the 200 W high-intensity diode (HiDi) laser system. Eur Urol Suppl 2009;8:269, abstr 589.
21.
Chen CH, Chiang PH, Chuang YC, Lee WC, Chen YT, Lee WC: Preliminary results of prostate vaporization in the treatment of benign prostatic hyperplasia by using a 200-W high-intensity diode laser. Urology 2010;75:658-663.
22.
Erol A, Cam K, Tekin A, Memik O, Coban S, Ozer Y: High power diode laser vaporization of the prostate: preliminary results for benign prostatic hyperplasia. J Urol 2009;182:1078-1082.
23.
Rieken M, Bachmann A, Reich O: Re: High power diode laser vaporization of the prostate: preliminary results for benign prostatic hyperplasia. A Erol, K Cam, A Tekin, O Memik, S Coban, Y Ozer: J Urol 2009;182:1078-1082. J Urol 2010;183:828-829; author reply 9-30.
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2013
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