Lasers in the treatment of benign prostatic hyperplasia: an update

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.