Chapter 12 - Thulium Laser Prostatectomy

Abstract

The high-power thulium laser was first introduced in 2005 for the treatment of benign prostatic hyperplasia (BPH) (Barbalat et al., 2016). The thulium laser has several properties that confer some theoretical advantages over other lasers used for the treatment of BPH. In ex-vivo animal studies comparing the potassium-titanyl-phosphate and thulium lasers, similar hemostatic properties were observed with a shallower coagulation zone for thulium lasers (Wendt-Nordahl et al., 2008). Thulium vapoenucleation, thulium laser resection - tangerine technique, thulium laser enucleation, and thulium vaporization are techniques for thulium laser prostatectomy that have been described. Studies using the 70–150-W thulium laser systems demonstrated good efficacy of these procedures with low morbidity and few complications in prostates of small to medium sizes (Gross et al., 2013). More recent studies show safety and efficacy in treatment of large prostates and in patients taking oral anticoagulation (Wei et al., 2014; Macchione et al., 2013; Pearce et al., 2016). Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP) (Barbalat et al., 2016). In general, thulium laser prostatectomy appears to have longer operative times, but shorter catheterization times, shorter hospital stay, and lower transfusion rates compared to standard and bipolar TURP. Outcomes of HoLEP and thulium enucleation techniques appear to be similar. Overall, thulium laser prostatectomy appears to be very safe and effective with low morbidity (Gilling, 2013).