The Holmium Laser for the Treatment of Benign Prostatic Hyperplasia: A Brief Review

At a wavelength of 2140 nm, the holmium:YAG (Ho:YAG) laser can be used for incision, ablation and resection of prostatic tissue. This laser has revolutionised the surgical management of benign prostatic hyperplasia (BPH) in our institution. Five different techniques have been utilised in evolving the current techniques using the Ho:YAG laser either alone or in combination with neodymium:YAG (Nd:YAG laser for the surgical management of BPH. The clinical outcome of 664 patients undergoing these procedures is presented. Enucleation of the prostatic adenoma using the holmium laser energy is the most common procedure presently performed at our institution for the surgical management of BPH. A mechanical tissue morcellator appears to be the most efficient way to remove prostatic tissue, once enucleated, from within the bladder. Paper received 24 February 1998; accepted after revision 30 June 1998.     

A 4-year follow-up of a randomized prospective study comparing transurethral electrovaporization of the prostate with neodymium: YAG laser therapy for treating benign prostatic hyperplasia

OBJECTIVE: To compare the safety, efficacy and durability of neodymium (Nd):YAG laser prostatectomy with transurethral electrovaporization of the prostate (TUVP) for treating benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: From March 1995 to March 1997, 180 patients with bladder outlet obstruction secondary to BPH were randomized equally either to Nd:YAG laser therapy or TUVP. Laser therapy combined two different techniques, side-fire coagulation of the lateral lobes and contact vaporization of the median lobe. Before treatment the two groups had a comparable International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and prostate and adenoma volume. In all, 62 and 78 patients completed the 1, 2, 3 and 4-year follow-up from the laser and TUVP groups, respectively. RESULTS: At each follow-up, the IPSS, QoL, Qmax and PVR were significantly better and more durable in the TUVP than in the laser group. In the TUVP and laser groups respectively, at the 4-year follow-up the mean value of the IPSS was 3.7 vs 11.9, the QoL 1.3 vs 3.1, the Qmax 21.4 vs 13.6 mL/s and the PVR 25.1 vs 64.6 mL (all P < 0.001). The mean prostate and adenoma volume were significantly lower after TUVP than after laser therapy (P < 0.001) at the 1- and 4-year follow-up, with final values of 27.9 vs 35.9 and 11.7 vs 20 mL (both P < 0.001) for the TUVP and laser groups, respectively. Retrograde ejaculation was significantly more common after TUVP (63%) than after laser therapy (18%; P < 0.001). Impotence was reported in 8% of men after TUVP and in none after laser therapy (P = 0.040). The re-operation rate was 12% after TUVP and 38% after laser treatment (P < 0.001). CONCLUSION: These 4-year follow-up results confirm that TUVP is significantly more effective and durable than the Nd:YAG laser for treating BPH. Residual obstructing adenoma was the main cause of failure in the laser group, which reflects the inadequacy of laser therapy for removing the adenoma.     

经尿道接触式激光治疗前列腺增生216例报告

目的：探讨接触式激光治疗前列腺增生症（ＢＰＨ）的有效性。方法：１９９５年７月～１９９８年７月采用ＮＤ：ＹＡＧ接触式激光治疗ＢＰＨ２１６例。激光输出功率５０Ｗ,治疗时间５～１５ｍｉｎ。结果：随访３个月～３年,２０１例一次治疗成功,１３全钎２次激光治疗,２例改行开放性手术治愈。结论：激光手术虽然不能取代开放性手术,但其具有适应证宽、安全性高、易于掌握、患者痛苦小等优点,近期疗效肯定,易被老年患者接受。     

Low-power v high-power KTP laser: improved method of laser ablation of prostate

BACKGROUND AND OBJECTIVE: Current treatment technique for laser prostatectomy involve Nd:YAG wavelength at 60 to 80 W. Use of the KTP wavelength in addition to Nd:YAG allows for vaporization of more tissue, decreasing the amount undergoing coagulation necrosis. In this study, we compared 20 W and 40 W of KTP laser energy in conjunction with the Nd:YAG wavelength for the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND MATERIALS: A total of 50 consecutive patients underwent laser ablation of the prostate, with 38 patients (Group I) receiving treatment with 20 W of the KTP and 60 W of the Nd:YAG wavelengths. The other 12 patients (Group II) underwent treatment with 40 W of KTP and 60 W of Nd:YAG laser energy. The patients had an initial evaluation consisting of American Urological Association (AUA) Symptom Score, uroflowmetry, transrectal ultrasonography for prostate volume measurement, and assay of prostate specific antigen (PSA) serum level. The patients were seen in follow-up at 1, 3, and 6 months. RESULTS: The mean symptom score decreased from 23.4 to 8.9 from Group I and from 18.2 to 3.5 for Group II at the 6-month follow-up. The mean peak urinary flow rate increased from 8.4 to 15.4 mL/sec Group I and from 8.3 to 16.5 mL/sec in Group II at the 6-month follow-up. CONCLUSIONS: The patients treated with the 40 W of KTP laser energy experienced a more rapid and sustained improvement in symptom score than those treated at 20 W. The improvement in peak urinary flow rate was approximately the same in the two groups.     

Long-Term Results with a Multiple Synchronized-Pulse 1064 nm Nd:YAG Laser for the Treatment of Leg Venulectasias and Reticular Veins

BACKGROUND: The long-pulsed Nd:YAG (1064 nm) laser has been shown to be effective in the treatment of blue venulectasias and reticular veins. OBJECTIVE: The present study examined the clinical efficacy and long-term follow-up (12 months) of patients treated with the 1064 nm Nd:YAG laser technology. METHODS: Twenty-five female patients (mean age 37.6 years, Fitzpatrick skin types II-V) were treated with up to three treatment sessions at 6-week intervals on a 5 cm2 surface area of vessels utilizing the 1064 nm Nd:YAG laser with a circulating cooling device. Treatment parameters were vessel size 0.2-2.0 mm treated with a double pulse of 7 msec at 120 J/cm2 and vessel size 2.0-4.0 mm treated with a single pulse of 14 msec, fluence 130 J/cm2, with a spot size of 6 mm. Improvement was judged by double-blinded observer evaluation, macrophotographic imaging, optical chromatography, and a patient evaluation scale. RESULTS: Sixty-four percent of patients treated in the present study achieved 75% or greater clearing of vessels after a maximum of three treatment sessions. Optical chromatography revealed statistically significant decreased chromophore intensity (mean blueness reduction index of 41.2b-). Sixty-four percent of patients were greatly satisfied with the results of the laser treatment. Two patients manifested vessel recurrence when examined at 6 and 12 months, respectively. CONCLUSION: The 1064 nm Nd:YAG laser can produce effective long-term photosclerosis of blue venulectasia and reticular veins. The potential for recurrence should be recognized by the vascular laser surgeon.     

Transurethral Visual Laser Ablation of the Prostate for Benign Prostatic Hyperplasia Using a KTP/YAG Laser

Background :
Transurethral visual laser ablation of the prostate (VLAP) has been established as an alternative method for the treatment of benign prostatic hyperplasia (BPH). However, most VLAP procedures utilize only a neodymium:yttrium-aluminum-gamet (Nd:YAC) laser. Since a potassiumtitenyl-phosphate (KTP) laser offers limited tissue penetration, KTP can be safely utilized to excise part of the obstructing prostatic tissue. This study assessed the interaction between KTP vaporization and YAG coagulative ablation to determine the safety and efficacy of VLAP utilizing a combined KTP/YAG treatment.
Methods :
Forty patients with bladder outlet obstruction secondary to BPH were treated with VLAP using a KTP/YAG laser. The laser light was delivered by an angle delivery device.
Results :
Most cases demonstrated a significant improvement in routine subjective and objective parameters (AUA symptom score, peak flow rate, average flow rate, and amount of residual urine). No significant complications relating to this procedure were reported, however, 4 patients experienced postoperative acute urinary retention.
Conclusion :
KTP/YAG laser ablation of the prostate is safe and effective for the treatment of BPH.     

Quality of life changes following KTP/Nd:YAG laser treatment of the prostate and TURP.

OBJECTIVE: To compare health-related quality of life (HRQL) changes in patients receiving hybrid KTP/Nd:YAG laser treatment of the prostate with TURP. PATIENTS AND METHODS: Patients complaining of symptomatic benign prostatic enlargement were studied. Their symptoms (IPSS), disease-specific (BPH Impact Index (BPHII)) and generic HRQL (Short Form-36 (SF-36)) was evaluated before and at 6 weeks, 6 months and 1 year following treatment. RESULTS: 204 patients were randomized into the study. Patients in both groups reported an improvement in IPSS and BPHII at each postoperative assessment, but there were significant differences between the two groups at the 6-week stage in favor of the TURP group. At 6 weeks, patients in the laser group reported significantly worse scores in the SF-36 domains of bodily pain, social function and role emotional when compared to the TURP group. These differences disappeared at both the 6-month and 1-year follow-up assessments. CONCLUSIONS: Although hybrid KTP/Nd:YAG laser treatment and TURP differed in the way they affected patients in the early postoperative period, at 1 year, patients reported similar improvements in symptoms and enjoyed a similar disease-specific and generic HRQL.     

Transurethral holmium laser resection of the prostate

PURPOSE: We evaluated the efficacy of the holmium:YAG laser for transurethral endoscopic prostatectomy for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We treated 103 patients with BPH with holmium:YAG laser resection of the prostate. A high power holmium laser generating a maximum of 60 or 81 W. was used in a pulsed mode, applying energy directly to prostatic tissue via a forward firing 550 micron. fiber transurethrally under direct vision. Treatment outcome was evaluated by the International Prostate Symptom Score, quality of life score, maximum flow rate and post-void residual urine volume. We also compared holmium laser surgery and transurethral resection of the prostate for operative factors, such as surgical duration, bleeding volume and catheterization time. RESULTS: Average symptom score, quality of life score, peak flow rate and post-void residual significantly improved at 1 week, 1 month and 3 months postoperatively, with improvement maintained up to 36 months postoperatively in the holmium:YAG group. Intraoperative bleeding volume was significantly lower and catheterization time was significantly shorter for holmium:YAG than for transurethral prostatic resection. Use of the holmium laser caused no complications. CONCLUSIONS: Because of its effectiveness and safety holmium:YAG resection is a viable potential surgical alternative for symptomatic BPH. The holmium:YAG laser has been verified to be useful for many purposes in urology.     

Treatment of Hori's Nevus with the Q-Switched Nd:YAG Laser

BACKGROUND: Hori's nevus is an acquired pigmented lesion involving bilateral blue-brown facial macules. There has been a dearth of reported treatment modalities for this condition. OBJECTIVE: The purpose of this study was to evaluate the efficacy of the Q-switched Nd:YAG laser for the treatment of Hori's nevus. METHODS: The Q-switched Nd:YAG laser was used to treat Hori's nevus in 66 Asian patients. Patients were treated up to seven times. The follow-up time after the final treatment ranged from 3 to 44 months. RESULTS: Twenty six percent of patients showed good to excellent clearing after one to two treatments. Fifty percent of patients who underwent more than two treatments received good to excellent results. CONCLUSION: The Q-switched Nd:YAG laser can be used to treat Hori's nevus. Results are not as good as those seen with nevus of Ota.     

经尿道前列腺汽化电切联合钬激光碎石治疗前列腺增生合并膀胱结石

目的探讨前列腺汽化电切(TUVP)和钬激光同期治疗前列腺增生合并膀胱结石的疗效及安全性。方法总结24例前列腺增生合并膀胱结石患者,应用钬激光经尿道膀胱镜粉碎膀胱结石并同期行TUVP的临床资料。结果24例患者中,膀胱结石均一次碎石成功,碎石后行TUVP,无膀胱结石残留、膀胱穿孔及水中毒发生,手术时间62~160min,平均手术时间88 min,切除前列腺质量20~120 g,平均38 g,术后平均拔除尿管时间3~6 d,平均4.75 d,平均住院时间10 d,所有患者术后均排尿通畅,无尿失禁。结论TUVP和钬激光同期治疗前列腺增生合并膀胱结石是一种安全有效的治疗方法,具有损伤小、结石清除率高、并发症少等优点。     

Comparative evaluation of the effects of Nd:YAG and Er:YAG laser in dentin hypersensitivity treatment

Dentin hypersensitivity (DH) is one of the most common complications that affect patients after periodontal therapy. So far, many investigators have successfully used different types of laser on DH treatment. The aim of this study was to evaluate the comparative effect of Nd:YAG laser and Er:YAG laser on human teeth desensitization. A group of nine patients with a total of 63 chronic hypersensitive teeth were selected. Each one of them should at least have three hypersensitive teeth. These teeth were randomly allocated into three groups. Group 1, Nd:YAG laser (1 W, 15 Hz, 60 s, two times); group 2, Er:YAG laser (100 mJ, 3 Hz, 60 s, two times); and group 3 serves as control group without any treatment. Assessment of pain was performed by a visual analysing scale (VAS) after stimulation of sensitive tooth by using the sharp tip of an explorer. This test was performed before treatment, immediately after that and at 1-, 3- and 6-month intervals after treatment by one blinded examiner. Analysis of VAS score between the three groups at the time of treatment did not show any significant difference (p = 0.506). However, by using repeated-measurement analysis of variance test, significant differences were seen in the three groups between before-treatment VAS score and after treatment (p < 0.0005). This statistically significant difference in the control group demonstrated a placebo effect. However, the effect of using Nd:YAG and Er:YAG lasers was stronger than this placebo effect, so that after removing the effect of the placebo, differences immediately after, 1, 3 and 6 months post treatment between all three groups still were statistically highly significant (p < 0.0005). Compared to the Er:YAG laser group, using Nd:YAG laser resulted in a significant reduction of VAS score at each follow-up examination (p < 0.0005). Although using Nd:YAG and Er:YAG laser in desensitization of hypersensitive teeth showed a placebo effect limited to a short time, results of this study demonstrated that both of these lasers have an acceptable therapeutic effect. The observed effects seemed to last for at least 6 months. It was concluded that Nd:YAG laser is more effective than Er:YAG laser in reduction of patients’ pain.     

In-situ irradiation of keloid scars with Nd:YAG laser

In-situ coagulation of keloid with Nd:YAG laser irradiation was carried out in in a cohort study of 17 patients, each with one keloid scar situated on either the sternum (six), abdomen (seven), shoulder (two), hip (one), or ear lobe (one). The duration of scarring was three to 17 years and size varied from 3-8 cm long. One to two doses of laser irradiation was required for complete coagulation. At three months, 10 (58.8%) keloids had completely healed; but in seven (41.1%), 25-50% of residual keloid persisted. Intralesional triamcinolone injection, once in four patients and twice in three patients, produced complete resolution in all seven patients. At 18 months to five years follow-up, 14 patients remain keloid-free but in three keloid recurred and was re-treated with laser coagulation with complete resolution. The treatment was carried out as an outpatient procedure under local anaesthesia. There were no complications. The results of this initial study suggest that Nd:YAG laser irradiation coagulation is effective treatment for keloid scarring.     

接触与非接触式激光经尿道前列腺切除术(附51例报告)

为探讨并发症少、死亡率低的治疗前列腺增生症（BPH）的更有效方法，采用接触与非接触式激光联合治疗BPH51例。术中先以接触式激光将5、7点间腺体切除，再以非接触式侧射探头高功率（60W）照射树叶腺体致组织塌陷，扩大排尿通道。11例腺体较大、组织炭化重者加用经尿道前列腺切除术（TURP）。结果51例中，48例成功，3例因腺体≥80ml改行开放手术。术后随访1～12个月，平均6.6个月，平均最大尿流率17．2±4．4ml／s，IPSS平均递减8.5分。认为接触与非接触式激光联合经尿道前列腺切除术安全有效，适用于具有前列腺增生梗阻、刺激症状重的高危患者，腺体较大及中叶凸向膀胱2cm者，单独使用激光效果不佳，可在激光气化、凝固腺体基础上酌加TURP。腺体≥80ml或中叶凸向膀胱＞3cm者，不适宜腔内治疗。     

FURTHER EVALUATION OF TRANSURETHRAL LASER ABLATION OF THE PROSTATE IN PATIENTS TREATED WITH ANTICOAGULANT THERAPY

Transurethral Nd: YAG laser ablation of the prostate gland was used to treat benign prostatic hyperplasia (BPH) in 20 patients on Warfarin anticoagulant therapy, and in two patients with abnormal coagulation parameters secondary to haematologic disorders. Preliminary results for the first 10 of these patients has been reported previously. The mean pre-operative international normalized ratio (INR) was 2.6 (range 1.19 to 5.25) and the mean prostate volume was 56cc (13.6–112cc). All patients had significant subjective and objective indicators of prostatic obstruction and six patients were in urinary retention. Postoperative improvement in symptom score, maximum flow rate and post-void residual was noted in 82% of patients at 3 months, 89% at 6 months and 75% at 1 year. Two patients have required revision laser or transurethral resection of the prostate (TURP) for persistent obstruction. while one patient required revision TURP for intractable haematuria. Three patients developed haematuria requiring transfusion while four patients had mild haematuria requiring no intervention. Laser ablation of the prostate can be used successfully and safely to treat prostatic obstruction in patients with abnormal coagulation parameters, or in those who are fully anticoagulated. Anticoagulation can be maintained during surgery in this group unlike TURP where pre-operative reversal is necessary with reinstitution of therapy several days postoperatively. Other authors report at least a 50% blood transfusion rate in this group. Laser prostatectomy appears the more appealing surgical option in these patients.     

Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

Purpose

To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH).

Methods

Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software.

Results

Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma.

Conclusions

TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation “gold standard” of surgery for large BPH.

     

Carcinoma of penis treated with neodymium YAG laser

Sixteen men with squamous cell carcinoma of the penis were treated primarily with the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Five patients had TIS, 9 had T1 tumors, and 2 had T2 carcinoma. All patients had refused traditional therapy of partial penectomy and gave informed consent as to the investigational nature of the Nd:YAG laser photoradiation therapy. Circumcisions and deep tissue biopsies were performed on all patients prior to tumoricidal neodymium photoradiation treatment. The patients were followed from twelve to thirty-six months. At follow-up, 5 patients with TIS had no evidence of recurrent cancer. Of the 9 patients with T1 squamous cell carcinoma of the penis, 6 (67%) were tumor-free at a mean follow-up of twenty-six months. The 2 men with T2 carcinoma of the penis had reduction of the tumor mass but were not cured. The obvious advantage of the Nd:YAG laser in treating carcinoma of the penis is preservation of the penis eliminating disfiguring amputation.     

Comparative study of transurethral laser prostatectomy versus transurethral electroresection for benign prostatic hyperplasia

BACKGROUND: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). Recently, less invasive transurethral laser prostatectomy, such as visual laser ablation (VLAP) or interstitial laser coagulation (ILCP), have been developed. Herein, we investigated the efficacy of VLAP and ILCP compared to TURP. METHODS: A total of 80 patients with BPH were treated: 20 patients by VLAP, 30 patients by ILCP and 30 patients by TURP. All patients were followed up for 12 months after their operations. Treatment outcomes were evaluated by four different criteria: (i) the International Prostatic Symptom Score (I-PSS), (ii) the maximum flow rate (Qmax), (iii) postvoided residual urine volume before treatment and one, three, six and 12 months after treatment, and (iv) prostatic volume before operation and three and six months postoperatively. RESULTS: The I-PSS, Qmax and residual urine volume were significantly improved compared to baseline levels and the improvement continued for 12 months in the three groups: for I-PSS (P<0.001 in the VLAP group and P<0.0001 in the ILCP and TURP groups), Qmax (P<0.001 in the VLAP and ILCP groups, and P<0.0001 in the TURP group), residual urine volume (P<0.01 in the VLAP group and P<0.0001 in the ILCP and TURP groups). Significant reduction of the prostatic volume was recorded only in the ILCP and TURP groups (P<0.001). CONCLUSION: Visual laser ablation and ILCP can be good alternative treatments for BPH. Visual laser ablation provides good outcomes in patients with small-sized BPH and with risk factors such as heart disease or anticoagulation therapy.     

Holmium: YAG Laser Resection of the Prostate Versus Visual Laser Ablation of the Prostate and Transurethral Ultrasound-Guided Laser Induced Prostatectomy: A Retrospective Comparative Study

Background:
Transurethral resection of the prostate (TUR-P) is the gold standard for treating symptomatic benign prostatic hyperplasia (BPH) despite some perioperative morbidity. As a minimally-invasive alternative to TUR-P, a neodymium:YAG laser, and more recently a holmium:YAG laser, have been used in transurethral surgery for BPH. In order to assess the safety and efficacy of various BPH treatments, the outcome in patients treated with transurethral ultrasound-guided laser induced prostatectomy (TULIP), visual laser ablation of the prostate (VLAP) and holmium:YAG laser resection of the prostate (HoLRP) were retrospectively compared.
Methods:
From May 1995 to August 1996, 60 patients with symptomatic BPH underwent TULIP (n=20), VLAP (n=20), and HoLRP (n=20). All patients were evaluated preoperatively and at 1 and 3 months postoperatively by the International Prostate Symptom Score (IPSS), the IPSS quality-of-life score (QOL), maximum flow rate (MFR), prostate volume, and residual urine volume.
Results:
The preoperative mean IPSS was 18.5, 19.3, and 19.6 and the mean MFR was 6.3, 6.9, and 6.1mL/sec in the TULIP, VLAP, and HoLRP groups, respectively. At 1 month after surgery, the mean IPSS was 10.2, 9.5, and 4.7 and the mean MFR was 9.6, 1 3.4, and 1 8.7mL/sec while at 3 months the mean IPSS was 6.2, 6.1, and 3.6 and the mean MFR was 14.1, 1 6.0, and 21.5 mL/sec in patients treated with TULIP, VLAP, and HoLRP, respectively. No serious complication occurred in any patient.
Conclusion: Although HoLRP requires expertise, it appears to be a promising treatment modality for BPH.     

Lasers in clinical urology: state of the art and new horizons

We present an overview of current and emerging lasers for Urology. We begin with an overview of the Holmium:YAG laser. The Ho:YAG laser is the gold standard lithotripsy modality for endoscopic lithotripsy, and compares favorably to standard electrocautery transurethral resection of the prostate for benign prostatic hyperplasia (BPH). Available laser technologies currently being studied include the frequency doubled double-pulse Nd:Yag (FREDDY) and high-powered potassium-titanyl-phosphate (KTP) lasers. The FREDDY laser presents an affordable and safe option for intracorporeal lithotripsy, but it does not fragment all stone compositions, and does not have soft tissue applications. The high power KTP laser shows promise in the ablative treatment of BPH. Initial experiments with the Erbium:YAG laser show it has improved efficiency of lithotripsy and more precise ablative and incisional properties compared to Ho:YAG, but the lack of adequate optical fibers limits its use in Urology. Thulium:YAG fiber lasers have also demonstrated tissue ablative and incision properties comparable to Ho:YAG. Lastly, compact size, portability, and low maintenance schedules of fiber lasers may allow them to shape the way lasers are used by urologists in the future.     

Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study

The objective of this study was to evaluate the microbiological and clinical outcomes following nonsurgical treatment by either scaling and root planing, combination of Nd:YAG and Er:YAG lasers, or by Er:YAG laser treatment alone. The study involved 60 patients with generalized chronic periodontitis, randomly assigned into one of three treatment groups of 20 patients. The first group received scaling and root planing by hand instruments (SRP group), the second group received Er:YAG laser treatment alone (Er group), and the third group received combined treatment with Nd:YAG and Er:YAG lasers (NdErNd group). Microbiological samples, taken from the periodontal pockets at baseline and 6 months after treatments, were assessed with PET Plus tests. The combined NdErNd laser (93.0%), followed closely by Er:YAG laser (84.9%), treatment resulted in the highest reduction of all bacteria count after 6 months, whereas SRP (46.2%) failed to reduce Treponema denticola, Peptostreptococcus micros, and Capnocytophaga gingivalis. Full-mouth plaque and bleeding on probing scores dropped after 6 months and were the lowest in both laser groups. The combination of NdErNd resulted in higher probing pocket depth reduction and gain of clinical attachment level (1.99?±?0.23 mm) compared to SRP (0.86?±?0.13 mm) or Er:YAG laser alone (0.93?±?0.20 mm) in 4–6 mm-deep pockets. Within their limits, the present results provide support for the combination of Nd:YAG and Er:YAG lasers to additionally improve the microbiological and clinical outcomes of nonsurgical periodontal therapy in patients with moderate to severe chronic periodontitis.