Der Diodenlaser

Abstract

Laser therapy of symptomatic benign prostatic hyperplasia (BPH) remains a challenge for most urologic surgeons. The main goal of laser surgery is to achieve a marked volume reduction and to decrease bladder outlet obstruction and lower urinary tract symptoms with minimal morbidity. Laser therapy encompasses a variety of techniques using different laser wavelengths, application systems, and surgical techniques to achieve contrasting tissue effects. In an in vitro animal model we compared the vaporization and coagulation effects of the potassium-titanyl-phosphate (KTP) laser, holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and diode laser (980 nm). In an in vitro model using isolated perfused porcine kidneys we investigated the vaporization, the coagulation effect, and the bleeding rate of the KTP, Ho:YAG, and diode lasers on five porcine kidneys each. The application of each laser type was standardized. The area of laser application was 1 cm x 1 cm. The KTP group received an application with 80 W, the Ho:YAG group an application with 10-30 W, and the diode group an application with 30, 60, and 100 W. Hemostasis was measured semiquantitatively. Ablation and coagulation were investigated macro- and microscopically. Concerning the ablation capacity, the diode laser is most effective (more than fivefold) compared to the KTP and Ho:YAG lasers but demonstrated a rather large coagulation zone of up to tenfold in comparison to the KTP and Ho:YAG lasers. Semiquantitatively, in terms of bleeding rate, all lasers were equivalent in this ex vivo model. Our very early and limited experience indicates that KTP (80 W) and Ho:YAG (30 W) laser application are equivalent in terms of tissue ablation capacity and coagulation in an experimental setting. The diode laser at 980 nm is superior in terms of ablation capacity but has a large coagulation zone. Concerning the bleeding rate all tested lasers are equivalent in this ex vivo model.