While prostate transurethral resection (TURP) remains the benchmark technique for benign prostatic hyperplasia (BPH) surgery, laser treatment by photosensitive prostatic vaporization (PVP) is becoming increasingly common . Although performed in hospitals, this technique most often allows patients to return home on the day of surgery. More and more studies show little or no difference between laser and surgery in terms of efficacy on urinary disorders in men with BPH. However, a study conducted in 2014 showed a benefit of the laser against TURP in the short term: TURP requires more frequent blood transfusions, longer hospitalizations and more frequent post-operative complications (such as pneumonia or septic shock) , But which remain very rare.
It inserts in this endoscope a flexible and very thin laser fiber connected to a laser generator capable of generating high intensity light pulses.
These can be used to spray surplus prostatic tissue while cauterizing it to reduce bleeding. This technique makes it possible to uniformly widen the urethral canal (whose diameter was initially reduced) and thus to restore a more satisfactory urinary flow. It should be noted, however, that the vaporization of the tissues is also the main disadvantage of the PVP laser compared to the TURP because it prevents precisely controlling the tissues destroyed in order to detect possible cancer cells. The cauterization of blood vessels offers the non-negligible advantage of allowing patients treated with anticoagulants or platelet anti-aggregants to continue to take this type of medication.
Different types of lasers can be used. One of the most common is the KTP laser (potassium-titanyl-phosphate). This laser produces a visible green light which is selectively absorbed by the prostatic tissue because it is rich in hemoglobin. The energy thus trapped produces vapor bubbles that destroy the cells of the interior. Surgeons currently use KTP lasers two to three times more potent than those used 10 years ago when PVP appeared. These allow surgeons to work faster and reduce intervention times.
Recent analyzes have shown that PVP and TURP have comparable advantages. In a randomized study conducted in several European countries and published in 2014, results obtained in 289 men treated with these two techniques showed similar improvement in symptom scores six months after treatment. This study also found that PVP results in fewer complications or short-term problems than TURP, as well as shorter duration of catheter maintenance and hospitalization.
- Bachmann A, Tubaro A, Barber N, et al. An European Multicenter Randomized Noninferiority Trial Comparing 180-W GreenLight-XPS Laser Vaporization and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: 12-Months Results of the GOLIATH-study. Journal of Urology 2014; Electronic publication ahead of print. PMID: 25219699.
- Elshal AM, Elkoushy MA, El-Nahas AR, et al. Green Light Laser (XPS) Photoselective Vapo-Enucleation of the Prostate Versus Holmium Laser Enucleation of the Prostate for Treatment of Symptomatic Benign Pros-tate Hyperplasia: A Randomized Controlled Study. Journal of Urology 2014; Electronic publication ahead of print. PMID: 25261801.
- Malik RD, Wang CE, Lapin B, et al. Com-parison of Patients Undergoing Laser Vaporization of the Prostate Versus TURP Using the ACS-NSQIP Database. Prostate Cancer and Prostatic Diseases 2014; Publication électronique précédant une version papier. PMID: 25311768.