Lithium Triborate Laser Research Articles

2178 EARLY EXPERIENCE PHOTOSELECTIVE VAPORISATION OF THE PROSTATE USING THE 180W LITHIUM TRIBORATE AND COMPARISON WITH THE 120W LITHIUM TRIBORATE LASER

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122178 EARLY EXPERIENCE PHOTOSELECTIVE VAPORISATION OF THE PROSTATE USING THE 180W LITHIUM TRIBORATE AND COMPARISON WITH THE 120W LITHIUM TRIBORATE LASER Nicholas Campbell, Amanda Chung, Peter Yoon, Isaac Thangasamy, and Henry Woo Nicholas CampbellNicholas Campbell Sydney, Australia More articles by this author , Amanda ChungAmanda Chung Sydney, Australia More articles by this author , Peter YoonPeter Yoon Sydney, Australia More articles by this author , Isaac ThangasamyIsaac Thangasamy Sydney, Australia More articles by this author , and Henry WooHenry Woo Sydney, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2351AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is little information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the new highly powerful 180W lithium triborate (LBO) laser. The objective of this study was to report on initial outcomes of PVP with the 180W laser with the first 50 cases and to compare it the last 50 cases performed with the 120W LBO laser. METHODS A registry of all PVP cases performed by a single surgeon (HHW) has been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 and June 2011). The inclusion criteria were all men undergoing PVP for indications consistent with established guidelines for surgery for benign prostatic hyperplasia. Baseline patient variables for men treated with the 120W and 180W LBO laser were recorded preoperatively and compared to postoperative parameters at 3 months and perioperative data was also recorded. RESULTS The 180W cases had a larger mean TRUS prostate volume (80.5cc versus 59.4cc, p<0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (NS, p=0.22), lasering time 49.6 and 69.3 minutes (NS, p=0.30) and energy utilisation 477.6kJ and 377.9kJ (p<0.05) respectively. Complications did not significantly differ between the two lasers. Using the Clavien-Dindo classification there were 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser and with the 120 W LBO laser there were 4 grade 1 complications and 1 grade 2. CONCLUSIONS This study demonstrates that there is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The introduction of the more powerful 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times. Comparison of 180W versus 120W LBO Laser Perioperative Parameters 180W baseline 180W 3 month 120W baseline 120W 3 month IPSS 21 10 27 9 QL 4 2 4 2 Qmax (ml/s) 9 29 9 26 PVR (ml) 227 55 168 51 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e878 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Campbell Sydney, Australia More articles by this author Amanda Chung Sydney, Australia More articles by this author Peter Yoon Sydney, Australia More articles by this author Isaac Thangasamy Sydney, Australia More articles by this author Henry Woo Sydney, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Photoselective vaporization of the prostate using the 180W lithium triborate laser

Photoselective vaporization of the prostate (PVP) is widely used to treat benign prostatic obstruction (BPO), but there is little experience reported on the new more powerful 180W lithium triborate (LBO) laser. This study evaluates the safety and efficacy of using the 180W LBO laser to treat BPO by examining a multicentre Australian experience. Retrospective review of prospectively collected data on all men treated by 180W LBO laser PVP by eight urologists across six Australian hospitals, from July 2011 to August 2011, was performed. Perioperative and functional outcomes were examined at baseline and 3 months. Of the 85 men (median age 70 years, prostate volume 51 cm(3)) identified, 27% (23/85) were in urinary retention and 44% (37/85) were taking antiplatelet/anticoagulant medication. Median operating time was 46 min, laser time 27 min, energy use 211 kJ, post-operative duration of catheterization 15 h and hospitalization 22 h. Functional outcomes from baseline to 3 months, respectively, were for IPSS 25-7; QoL 5-2; Qmax 7.7-18.4; and PVR 147-38. All improvements were statistically significant (P < 0.01). Thirty-eight percent (32/85) of patients experienced at least one adverse event. Most adverse events were low Clavien-Dindo grade I-II. There were five grade III, two grade IV and no grade V adverse events. Sixty per cent (51/85) of men were able to be discharged home voiding successfully without a catheter within 24-h post-PVP. Our early multicentre Australian experience indicates the 180W LBO laser PVP is an efficacious and safe treatment for BPO.

Mini-Photoselective Vaporization of the Prostate for Difficult Intermittent Self-Catheterization

Bladder neck incision or transurethral incision of the prostate is a procedure described for men with bladder outflow obstruction associated with a gland size of less than 30 ml. We report a case of a man with detrusor dysfunction who was having increasing difficulty performing clean intermittent self-catheterization of the bladder. The successful use of the 120 W lithium triborate laser to perform a "mini-photoselective vaporization of the prostate" ("mini-PVP") enabled discharge of the patient on the same day as well as resolution of the patient's difficulties in performing self-catheterization. Mini-PVP has proven to be a simple and effective approach to resolution of a prostate configuration impeding the process of clean intermittent self-catheterization.

Sexual function outcome following photoselective vaporisation of the prostate

There is little reported on sexual functional outcome following photoselective vaporisation of the prostate using the 120 W lithium triborate laser. The objective of this study was to evaluate changes in sexual function at 3 and 12 months following PVP. The primary outcome measures were changes in voiding parameters and changes in erectile function in the international index of erectile function (IIEF-5). Change in erectile function was defined as mild (<5 IIEF points) or major (≥5 points). Results found that 75% of men had an IIEF-5 < 17 at baseline. At 3 months, the mean post-operative IIEF-5 score was unchanged compared to baseline (P = 0.13). A major decline in erectile function was seen in 12.4 and 24% of men at 3 and 12 months, respectively, and a major improvement in erectile function was seen in 8.3 and 6% at 3 and 12 months, respectively. There was no correlation in change in erectile function with urinary function, quality of life and loss of emission on orgasm. Loss of emission on orgasm was reported in 65% of respondents. Significant changes in erectile function are observed following PVP although a cause and effect relationship remains unclear.

Editorial Comment

Bleeding, intraoperative or postoperative, is one of the biggest ways to ruin a urologist's day. So, to think of operating on a man's prostate when he is actively taking coumadin “is ridiculous.” That answer would have been the most common response from most of our speciality doctors just a few years ago. This article reproduces results that vaporization of the prostate, now with 120 W lithium Triborate Laser, can be performed safely on patients actively taking coumadin. While this is not my standard care practice, I find it reassuring that in the situation that a man is unable to discontinue his coumadin; this procedure remains a safe option. My standard care practice is to discontinue anticoagulants, such as coumadin, 5 days before prostate laser vaporization, if medically cleared to do so. However, if the patient must remain anticoagulated, I discuss the increased potential bleeding risks of a surgical procedure while on coumadin, and only then, perform the surgery. Photoselective Vaporization of the Prostate with the 120-W Lithium Triborate Laser in Men Taking CoumadinUrologyVol. 78Issue 1PreviewTo specifically evaluate perioperative morbidity associated with men who were taking coumadin and continued on this medication at therapeutic levels for the purposes of the prostate (PVP). Increasing numbers of men are taking coumadin for medical comorbidity and this creates clinical concerns for urologists treating such men with benign prostatic obstruction. Photoselective vaporization of the PVP has been shown to be an effective treatment for men receiving anticoagulation treatment, although previously published studies have evaluated a mix of men on aspirin, coumadin, or clopidogrel. Full-Text PDF ReplyUrologyVol. 78Issue 1PreviewThe ability to treat men with photoselective vaporization of the prostate while on Coumadin makes a great deal sense. We understand well the physics of the laser tissue interaction whereby the 532-nm wavelength is absorbed by human tissue with such efficiency to effect vaporization and to then create beyond this an effective thin layer of coagulation. Our reported experience comes off the back of experience with the 80-W KTP laser, which was the predecessor to the 120-W LBO laser. We became “comfortable” with the ability to perform PVP with the 80-W KTP laser and became convinced that we could not tell whether a man was on Coumadin or not on the basis of intraoperative surgical appearances. Full-Text PDF

Lithium Triborate Laser Vaporization of the Prostate Using the 120 W, High Performance System Laser: High Performance All the Way?

Technical modifications of the 120 W lithium-triborate laser have been implemented to increase power output, and prevent laser fiber degradation and loss of power output during laser vaporization of the prostate. However, visible alterations at the fiber tip and the subjective impression of decreasing ablative effectiveness during lithium-triborate laser vaporization indicate that delivering constantly high laser power remains a relevant problem. Thus, we evaluated the extent of laser fiber degradation and loss of power output during 120 W lithium-triborate laser vaporization of the prostate. We investigated 46 laser fibers during routine 120 W lithium-triborate laser vaporization in 35 patients with prostatic bladder outflow obstruction. Laser beam power was measured at baseline and after the application of each 25 kJ during laser vaporization. Fiber tips were microscopically examined after the procedure. Mild to moderate degradation at the emission window occurred in all fibers, associated with a loss of power output. A steep decrease to a median power output of 57.3% of baseline was detected after applying the first 25 kJ. Median power output at the end of the defined 275 kJ lifespan of the fibers was 48.8%. Despite technical refinements of the 120 W lithium-triborate laser fiber degradation and significantly decreased power output are still detectable during the procedure. Laser fibers are not fully appropriate for the high power delivery of the new system. There is still potential for further improvement in the laser performance.

Photoselective Vaporization of the Prostate with the 120-W Lithium Triborate Laser in Men Taking Coumadin

To specifically evaluate perioperative morbidity associated with men who were taking coumadin and continued on this medication at therapeutic levels for the purposes of the prostate (PVP). Increasing numbers of men are taking coumadin for medical comorbidity and this creates clinical concerns for urologists treating such men with benign prostatic obstruction. Photoselective vaporization of the PVP has been shown to be an effective treatment for men receiving anticoagulation treatment, although previously published studies have evaluated a mix of men on aspirin, coumadin, or clopidogrel. From a prospective database of men treated with the 120-W lithium triborate (LBO) laser from November 2006 to July 2010, 43 men were identified to have been on coumadin during their PVP. The mean age was 73.4 years (range, 55-90) and mean prostate size was 75.3 mL (range, 20-227). Perioperative morbidity and early functional outcomes were examined. No men required a blood transfusion, although 2 of 43 (4.7%) men had prolonged catheterization for bleeding. No patient required discontinuation of the coumadin during the perioperative period. Urinary tract infection occurred in 4 (9.3%) and recatheterization in 6 (14%). Apart from 3 outliers, the mean postoperative length of stay was 21.6 hours. At 3 months, improvements in International Prostate Symptom Score, peak urinary flow rate, and postvoid residual were similar to previously reported series of men not taking an anticoagulant. PVP in this high-risk group of patients has low perioperative morbidity and is associated with good early functional outcomes.

Photoselective vaporization for prostatic obstruction with the 120‐W lithium triborate laser: 1‐year clinical outcomes

There are few reports of the clinical outcomes of photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) using the 120-W lithium triborate (LBO) laser. The present study evaluates clinical outcomes of 76 men treated with the 120-W LBO laser by an experienced PVP surgeon with 12 months follow up. The International Prostate Symptom Score (IPSS), peak flow rate (Qmax) and post-void residual (PVR) were examined at baseline and at 3 and 12 months. These parameters at baseline and 12 months were 20 ± 7.0, 7.6 ± 3.5 mL/s, 155 ± 155 mL and 8.1 ± 6.1, 22.5 ± 10.3 mL/s, 59 ± 87 mL, respectively. Clinically, meaningful improvements in IPSS, Qmax and PVR were observed at 3 months and sustained at 12 months. There were few adverse events, with only 5.3% of patients requiring recatheterization. Clinical outcome at 12 months was similar to that at 3 months and to other published series.

Photoselective Vaporisation of the Prostate in Men Unfit For Transurethral Resection of the Prostate - Case Report

Transurethral resection of the prostate (TURP) is the gold standard treatment for bladder outlet obstruction. However, newer modalities, such as photoselective vaporisation of the prostate (PVP) have some significant advantages over TURP. Men who are candidates for transurethral resection of the prostate are suitable candidates PVP. The converse is not necessarily true. Patients who have an absolute requirement for anticoagulation can still be treated with PVP. We present a case study of two men at our centre with refractory urinary retention were considered unfit for TURP; both sought treatment with PVP. These men had an American Society of Anaesthesiology (ASA) Score of 4 and were also fully anti-coagulated with coumadin. Treatment was performed with the 120W lithium triborate laser. Both men successfully re-established urethral voiding and have maintained a good clinical outcome at over 2 years. This case report demonstrates that PVP may be performed safely and efficaciously in men despite medical co-morbidities, and whilst anti-coagulated.

Photoselective Vaporization Prostatectomy: Experience With a Novel 180 W 532 nm Lithium Triborate Laser and Fiber Delivery System in Living Dogs

We studied vaporization parameters, and anatomical and histopathological outcomes of photoselective vaporization of the prostate with the novel GreenLight™ XPS™ 180 W, 532 nm lithium triborate laser and MoXy™ fiber in a survival model of living dogs. We compared these findings with those of the existing GreenLight HPS™ 120 W 532 nm lithium triborate laser photoselective vaporization of the prostate in living dogs. Eight dogs underwent antegrade photoselective vaporization of the prostate with the 180 W laser delivered through a new 750 μm (vs the existing 600 μm core diameter), 50% larger, spot sized, side firing fiber. Four dogs were sacrificed 3 hours and 8 weeks postoperatively, respectively. We recorded laser energy and time. Prostates were sectioned, measured and histologically analyzed after hematoxylin and eosin, triphenyltetrazolium chloride or Gomori trichrome staining and compared with a normal control. Photoselective vaporization of the prostate with the 180 W laser bloodlessly created a 76% larger cavity (mean 11.8 vs 6.7 cm(3), p = 0.014), vaporized tissue at a 77% higher rate (mean 2.3 vs 1.3 cm(3) per minute, p = 0.03) and did so in 37% less time per volume vaporized (0.5 vs 0.8 minutes per cm(3), p = 0.003). Hematoxylin and eosin, and triphenyltetrazolium chloride staining histologically revealed a 33% thicker mean coagulation zone vs that of 120 W laser photoselective vaporization of the prostate (2.0 ± 0.4 vs 1.5 ± 0.3 mm, p <0.005). In prostates healed for 8 weeks postoperatively hematoxylin and eosin, and Gomori trichrome staining showed re-epithelialized cavities with negligible submucosal fibrosis compared with a normal prostate. GreenLight XPS 180 W 532 nm lithium triborate laser photoselective vaporization of the prostate with the MoXy fiber has a significantly higher vaporization rate and speed with a deeper hemostatic coagulation zone but favorable tissue interaction and healing equal to those of HPS 120 W laser photoselective vaporization of the prostate in dogs.

Photoselective vaporization of the prostate using the 120‐W lithium triborate laser in enlarged prostates (&gt;120 cc)

OBJECTIVE • To evaluate experience with high power LBO laser for large prostates • Prospective database of 288 men treated with PVP from November 2006-2009 • 33 men identified to have transrectal ultrasound measured prostate size >120 cc • All but 9 men not in urinary retention or on anticoagulant medications • Average ASA Score 2.25 (range 1-4) with 11 having an ASA Score of 3 or more • Mean operating time and laser time 109 and 86 minutes respectively • IPSS, QoL and Qmax changes from baseline to 3 months for those not in retention were 24 to 8.6, 5.0 to 1.8 and 7.5 mL/s to 19.6 mL/s respectively • Post void residual in these men fell from a mean of 235 mL to 88 mL • Average fall in PSA was 38% for 22 men with paired PSA data • Post operative urinary retention in 4 men resolved. 2 late onset clot urinary retention • Early results demonstrate PVP to be safe and efficacious on early follow up in a high risk group of patients with significantly enlarged prostates, anticoagulation and urinary retention.

Quantitative Evaluation of High Power Effect on 532 nm Laser Vaporization of Bovine Prostate In Vitro

We investigated the effect of 120 to 200 W high power levels on in vitro vaporization of bovine prostate using a custom-made 532 nm lithium triborate laser system. Light (532 nm) delivered through a newly designed 750 microm core diameter side firing prototype fiber vaporized 114 bovine prostate tissue specimens in saline at 20C using a 2-dimensional scanning system. Various conditions were tested, including 120 to 200 W power, 1 to 5 mm working distance and 2 to 8 mm per second treatment speed. Regardless of treatment speed 180 W was the optimal power to maximize tissue vaporization efficiency by removing 80% more tissue than at 120 W. At 120 and 180 W laser light vaporized tissue more efficiently at a 4 mm per second treatment speed and vaporized equally efficiently at up to 3 mm working distance. At the slowest treatment speed the mean thickness of the coagulation zone at 180 W was 20% thicker than at 120 W (1.31 vs 1.09 mm) but still thin, comparable to previous findings of 1 to 2 mm. In vitro the 532 nm lithium triborate laser showed that 180 W is the optimal power to maximize tissue vaporization efficiency with enhanced coagulation characteristics. These desirable outcomes must be validated in vivo.

120 W Lithium Triborate Laser for Photoselective Vaporization of the Prostate: Comparison with 80 W Potassium-Titanyl-Phosphate Laser in an Ex-Vivo Model

To evaluate the ablative and hemostatic properties of the recently introduced 120 W lithium triborate (LBO) 532 nm laser and compare the results against the conventional 80 W potassium-titanyl-phosphate (KTP) laser. The ex-vivo model of the isolated blood-perfused porcine kidney was used to determine the ablation capacity, hemostatic properties, and coagulation depth of the GreenLight HPS laser system (American Medical System, Minnetonka, MN) that used an output power of 120 W. The results were compared with the KTP laser that used output power levels of 30 W, 50 W, and 80 W. Unperfused kidneys were weighed before and after 10 minutes of laser ablation in an area of 3 x 3 cm; the weight difference marked the amount of removed tissue. Bleeding was determined by the weight difference of a swab before and after it was placed on the bleeding surface for 60 seconds after ablating a surface area of 9 cm(2) on blood-perfused kidneys. With a tissue removal of 7.01 +/- 1.83 g after 10 minutes of laser ablation at 120 W, the LBO laser offered a significantly higher ablation capacity compared with 3.99 +/- 0.48 g reached with the conventional KTP laser at 80 W in the same time interval (P < 0.05). The bleeding rate was also significantly increased using the LBO at 120 W compared with the conventional device at 80 W (0.65 +/- 0.26 g/min vs 0.21 +/- 0.07 g/min; P < 0.05). The corresponding depths of the coagulation zones were 835 +/- 73 microm and 667 +/- 64 microm (P < 0.05), respectively. The 120 W LBO laser offers a significantly higher tissue ablation capacity compared with the conventional 80 W KTP laser. Because the increased efficacy of the device is accompanied by a higher bleeding rate and a slightly deeper coagulation zone, the user has to select the appropriate output power levels carefully for a safe and efficient treatment. Nevertheless, the bleeding rate compared with previous studies of transurethral resection of the prostate is significantly reduced.

Advanced Laser Techniques for Filler-Induced Complications

The increasing use of injectable fillers has been increasing the occurrence of disfiguring anaerobic infection or granulomas. This study presents two types of laser-assisted evacuation of filler material and inflammatory and necrotic tissue that were used to treat disfiguring facial nodules after different types of gel fillers. Infectious lesions after hydrogels were drained using a lithium triborate laser at 532 nm, with subsequent removal of infected gel and pus (laser assisted evacuation). Granuloma after gels containing microparticles were treated using an 808-nm diode laser using intralesional laser technique. The latter melted and liquefied the organic and synthetic components of the granulomas, facilitating subsequent evacuation. Both lasers had an easily controllable thin laser beam, which enabled the physician to control tissue damage and minimize discomfort and pain. All 20 patients experienced reduction or complete resolution, the latter increasing with repeated treatments. Laser-assisted treatment offers a successful solution for patients who have been suffering from disfiguring nodules from injected fillers-often for many years. The procedure broadens the range of treatment options in cases of untoward reactions to fillers, in line with surgical removal but with lower morbidity and less cosmetic disfigurement.

Greenlight Photoselective 120-Watt 532-nm Lithium Triborate Laser Vaporization Prostatectomy in Living Canines

Efficiency, anatomic, and histopathologic outcomes of GreenLight HPS 120-W, 532-nm lithium triborate (LBO) laser photoselective vaporization of the prostate (PVP) in a survival model of living canines were studied and compared with the outcomes of the only benchmarked survival study of 60-W 532-nm potassium-titanyl-phosphate (KTP) laser PVP in living canines. Twelve dogs underwent anterograde PVP with the 120-W LBO laser and, 4 each, were euthanized 3 hours (acute), 3 days (early), or 8 weeks (chronic) postoperatively. Laser energy and time were recorded. Prostates were sectioned, measured, and histologically analyzed after hematoxylin and eosin (H&E), triphenyltetrazolium chloride (TTC), or Gomori trichrome (GT) staining and compared with a normal control. LBO laser PVP at 120 W acutely created a 6.7 +/- 3.2 cm(3) cavity, hemostatically, and vaporized tissue 160% more efficiently (mean 1.3 cm(3)/min vs 0.5 cm(3)/min), 500% faster (mean 4.9 vs 29.1 min), and needed 121% less energy (mean 28.8 vs 63.6 kJ) than the 60-W KTP laser. Histologic staining with H&E and TTC demonstrated a coagulation zone of 1.5 +/- 0.3 mm for the 120-W LBO laser, comparable to the 1 to 2 mm for the 60-W KTP laser. H&E- and GT-stained, healed prostates at 8-weeks postoperatively showed reepithelialized cavities with minimal submucosal fibrosis compared with an identically stained normal and the benchmarked KTP laser PVP-treated prostates. Our in vivo canine survival study demonstrates GreenLight HPS 120-W, 532-nm LBO laser PVP has substantially more vaporization efficiency and speed, with equally favorable tissue interaction and healing vis-à-vis those benchmarked for the 532-nm wavelength by KTP laser PVP.