Contact Laser Vaporization Research Articles

A case of rapidly progressive prostate cancer with bone and lymph node metastasis after contact laser vaporization for benign prostatic hyperplasia

IntroductionProstate cancer is incidentally diagnosed in 6%–11% of benign prostatic hyperplasia surgeries.Case presentationA 79‐year‐old man was diagnosed with benign prostatic hyperplasia. The prostate volume was 54.5 mL, and the prostate‐specific antigen level was 7.121 ng/mL. Magnetic resonance imaging and prostate biopsy were not performed. He then underwent contact laser vaporization of the prostate. After 3 months, gross hematuria occurred, and the prostate‐specific antigen level was 62.495 ng/mL. Cystoscopy and magnetic resonance imaging revealed prostate cancer with bladder invasion. Prostate biopsy and transurethral resection were performed, revealing adenocarcinoma with a Gleason score of 5 + 5. The patient was diagnosed with prostate cancer T4N1M1b, and triplet therapy was initiated. After 6 months, the prostate‐specific antigen level was 0.037 ng/mL, and the metastases had shrunk.ConclusionVaporization for high‐grade prostate cancer can lead to rapid progression. Therefore, screening for prostate cancer before benign prostatic hyperplasia surgery is important.

Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia.

We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.

Efficacy and safety of Vibegron for the treatment of residual overactive bladder symptoms after laser vaporization of the prostate: A single-center prospective randomized controlled trial (VAPOR TRIAL).

This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization). This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks. Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5-78.5) years for the Vibegron group and 76.5 (71.0-81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was -3.66 (-4.99, -2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group. The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.

EXPERIENCES OF CONTACT LASER VAPORIZATION OF THE PROSTATE (CVP) FOR TREATING BENIGN PROSTATIC HYPERPLASIA IN THE LOCAL HOSPITAL

(Objective) We started contact laser vaporization of the prostate (CVP) for treating benign prostatic hyperplasia at our hospital in July 2019. Forty-five patients were treated with CVP from July 2019 to April 2021. (Methods) Patients were assessed preoperatively and at one and three months after CVP treatment by using the International Prostate Symptom Score (IPSS), quality of life index (QOL index), peak urinary flow rate (Qmax), and postvoid residual urine volume (PVR). (Results) IPSS, QOL index, Qmax, and PVR significantly improved three months after CVP (p<0.05). Regarding adverse events, five patients developed early external urinary meatus strictures, two had postoperative bleeding, and three had temporary urinary retention. (Conclusions) In our hospital, elderly patients and patients who cannot discontinue an antithrombotic drug were treated by CVP for benign prostatic hyperplasia relatively safely.

Endoscopic vaporization of benign prostatic hyperplasia using a contact 980 nm diode laser under antithrombotic therapy: A prospective survey.

To prospectively clarify whether endoscopic contact laser vaporization of the prostate (CVP) can be safely performed even in patients undergoing antithrombotic therapy. Fifty-five patients treated with CVP were enrolled. Patients were assigned to: (i) the antithrombotic therapy group (n=21, 38%); or (ii) control group without antithrombotic therapy (n=34, 62%). All patients in the antithrombotic therapy group continued all antithrombotic agents during the perioperative period and thereafter. No difference was noted in patient background between the two groups. In primary endpoints, decreases in the postoperative hemoglobin level were remarkable in the antithrombotic therapy group, while no serious effects were noted in either group. The control and antithrombotic therapy groups did not show a significant difference in the occurrence of catheter obstruction due to blood clots or serious hematuria following catheter removal. During follow-up, transurethral coagulation for hemostasis was needed only in the antithrombotic therapy group, with a frequency of transurethral coagulation of up to 14%. In secondary endpoints, no difference in the occurrence of perioperative or late-onset complications after surgery was noted between the two groups. Finally, no difference was noted in improvements in the International Prostate Symptom Score (IPSS), IPSS quality of life score, overactive bladder symptom score, maximum flow rate, or post-voiding residual urine volume between the two groups throughout the follow-up period. CVP can be performed safely and effectively in patients undergoing continuous antithrombotic therapy. However, the possibility of secondary bleeding after discharge in a subset of patients, such as those undergoing antithrombotic therapy, may be noted.

Photothermal Effect Induced by Contact Laser Vaporization of Porcine Prostate Tissues Using XCAVATOR Fiber

Photothermal Effect Induced by Contact Laser Vaporization of Porcine Prostate Tissues Using XCAVATOR Fiber

Prospective study of effectiveness and safety of contact laser vaporization of the prostate using the 980 nm high power diode laser for benign prostatic hyperplasia

Prospective study of effectiveness and safety of contact laser vaporization of the prostate using the 980 nm high power diode laser for benign prostatic hyperplasia

波長980 nmの高出力ダイオードレーザーを用いた前立腺肥大症に対する接触式レーザー前立腺蒸散術 (CVP) の初期経験

波長980 nmの高出力ダイオードレーザーを用いた前立腺肥大症に対する接触式レーザー前立腺蒸散術 (CVP) の初期経験

Early Experiences of Contact Laser Vaporization of the Prostate using the 980 nm High Power Diode Laser for Benign Prostatic Hyperplasia.

We report early experiences of contact laser vaporization of the prostate for symptomatic benign prostatic hyperplasia (BPH). A total of 80 patients recruited at four institutions in Japan from April 2013 through September 2014 underwent contact laser vaporization of the prostate using 980 nm high power diode laser with an end-firing fiber in the contact mode. Patients were followed prospectively at 1 day, 2, 4, 8, 12, and 24 weeks, postoperatively per protocol, and at 1 and 2 years post-protocol. Of 76 eligible patients, 64 (84.2%) achieved more than 50% decrease in International Prostate Symptom Score at 24 weeks (95% confidence interval: 74.0-91.6%), clearing the pre-fixed non-inferiority efficacy level to transurethral resection of the prostate (65%). Symptom scores, maximum flow rate, post-void residual urine, and prostate volume showed significant improvements at 12 and 24 weeks after the surgery. Perioperative complications included transient urinary retention (n = 20), retrograde ejaculation (5), bladder neck contracture (4), urethral stricture (3), stone in prostatic bed (3), bladder stone (2), bladder perforation (1), bladder deformity (1), and transient urgency incontinence (1). Urinary retention and bladder neck contracture occurred almost exclusively at one institution. Improved symptom scores, maximum flow rate, and post-void residual urine observed at 24 weeks remained virtually unchanged at 1 and 2 years. Early experience of contact laser vaporization in Japan showed efficacy comparable to transurethral resection of the prostate as a surgical procedure for BPH at 24 weeks. Long-term efficacy of the procedure remains uncertain.

New laser treatment approaches for benign prostatic hyperplasia

The recent introduction of higher power 100 W holmium:yttrium-aluminum-garnet (Ho:YAG) and 80 W potassium titanyl phosphate lasers for rapid incision and vaporization of the prostate has resulted in renewed interest in the use of lasers for treatment of benign prostatic hyperplasia (BPH). Although long-term studies are still lacking, short-term results demonstrate that these procedures are at least as safe and effective in relieving BPH symptoms as transurethral resection of the prostate and may provide reduced morbidity. Other laser techniques, such as interstitial laser coagulation and contact laser vaporization of the prostate, have lost popularity due to complications with increased catheterization time, irritative symptoms, and infection rates. Although Ho:YAG laser enucleation of the prostate is more difficult to learn and a slower procedure than potassium titanyl phosphate laser vaporization, the Ho:YAG laser is currently the most proven laser technique for BPH treatment. This article reviews the latest developments in laser treatment of BPH over the past 2 years and provides a view toward the future of lasers in the treatment of BPH.

Lasers in the treatment of benign prostatic hyperplasia: an update

Few of the original laser-based procedures from the early 1990s have withstood the test of time while some, such as holmium laser prostatectomy, have been significantly modified. New additions to the fold, such as the high-powered potassium-titanyl-phosphate (KTP) laser, use old techniques and disposables but a higher level of energy than previously. In the 12 months since September 2003, a number of important articles have appeared concerning laser prostatectomy, the subject of this review. Holmium laser enucleation of the prostate has been shown to result in greater relief of bladder outflow obstruction than transurethral resection of the prostate, which is a first for an endoscopic procedure. Durability beyond 4 years has also been confirmed. Concerns regarding the histology of the retrieved tissue and the learning curve have been clarified. Early results for 'photoselective' (KTP) vaporization of the prostate have been published confirming the lack of short-term morbidity. Its use on an outpatient basis has been tested in a small number of patients, and canine studies have confirmed less bleeding than with transurethral resection but inferior efficiency. Interstitial laser coagulation has been reviewed unfavourably and the results with contact laser vaporization have been variable. New studies of holmium laser enucleation have confirmed its efficacy and durability, though training and company support remain problematic and its acceptance has been slow. The KTP laser is beginning to accumulate some support in the literature though its 'honeymoon phase' is still in evidence. Randomized studies are needed. Interstitial laser coagulation and contact laser vaporization appear to be in decline.

HOLMIUM LASER ENUCLEATION VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE: RESULTS FROM A 2-CENTER, PROSPECTIVE, RANDOMIZED TRIAL IN PATIENTS WITH OBSTRUCTIVE BENIGN PROSTATIC HYPERPLASIA

To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia. From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup. At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room +/- SD was significantly longer than for TURP (74 +/- 19.5 vs 57 +/- 15 minutes, p < 0.05), while catheterization time (31 +/- 13 vs 57.78 +/- 17.5 minutes, p < 0.001 and hospital stay (59 +/- 19.9 vs 85.8 +/- 18.9 hours, p < 0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected. HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

Long-term follow-up of laser treatment for lower urinary tract symptoms suggestive of bladder outlet obstruction

Objectives. The long-term results of different laser technologies in the management of lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) are not well known. We studied the durability of the effect of laser prostatectomy and tried to identify the factors predictive of treatment outcome. Methods. Between December 1992 and November 1996, 190 patients underwent laser prostatectomy because of LUTS suggestive of BOO. One hundred seven patients received visual laser ablation of the prostate (VLAP), 30 received contact laser vaporization (CLV), and 53 received interstitial laser coagulation (ILC). The baseline evaluation included the International Prostate Symptom Score (IPSS), uroflowmetry (maximum urinary flow rate), postvoid residual urine (PVR), prostate volume measurement, and urodynamic investigation. Patients were followed up until April 1999. Kaplan-Meier plots were constructed to calculate the risk of retreatment, and the log-rank test was used to evaluate the predictive value of clinical parameters for treatment failure. Results. The median follow-up in the VLAP group was 53 months; the retreatment rate was 14% (95% confidence interval [CI] 6% to 22%). The corresponding numbers for the CLV and ILC groups were 47 months and 14% (95% CI 1% to 26%) and 34 months and 41% (95% CI 23% to 60%), respectively. A high PVR and a high grade of obstruction in the VLAP group, and a younger age in the ILC group, were associated with increased retreatment risk. Conclusions. VLAP and CLV have a durable effect, as demonstrated by their low retreatment rate. ILC is a less aggressive procedure, at the expense of a high retreatment rate. Patient selection for VLAP can be based on the grade of obstruction and PVR.

The Oxford Laser Prostate Trial: a double‐blind randomized controlled trial of contact vaporization of the prostate against transurethral resection; preliminary results

To compare the results of contact laser vaporization and transurethral resection of the prostate (TURP) in a double-blind randomized controlled clinical trial. The study comprised 148 patients with clinical benign prostatic hypertrophy (BPH) who were recruited and allocated randomly to undergo either TURP (72 patients) or laser ablation of the prostate (76 patients). The outcome was assessed using the American Urological Association (AUA -7) symptom score after 1 and 3 months as the primary measure and by urinary flow rates, haematological factors and the duration of hospital stay and length of catheterization. With 90% statistical power, the results at 3 months showed no clinical or statistical difference between the treatments in change in AUA symptom score. A lower blood loss, hospital stay and duration of catheterization significantly favoured the laser treatment, although the failure rate of trial without catheter and the rate of re-operation were higher after laser treatment. These early data are encouraging for this technique, although the outcome after one year requires evaluation before advocating the widespread uptake of this method.

Contact laser vaporization of the prostate: sidefire technique.

With the development of contact sidefiring fibers, urologists have gained a valuable tool to deliver laser energy more precisely into prostatic tissue. Contact laser prostatectomy can now be viewed as a well-established procedure that offers several distinct advantages over conventional methods such as transurethral resection of the prostate. The results of experimental and clinical studies are presented, supporting the value of this new modality.