Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group

• Published in: World journal of urology Vol. 41; no. 11; pp. 3277 - 3285
• Main Authors: Ortner, Gernot, Güven, Selcuk, Somani, Bhaskar Kumar, Nicklas, Andre, Scoffone, Cesare Marco, Gracco, Cecilia, Goumas, Ioannis Kartalas, Bach, Thorsten, Sancha, Fernando Gómez, Figueredo, Felipe C. A., Krambeck, Amy, Bozzini, Giorgio, Lehrich, Karin, Liatsikos, Evangelos, Kallidonis, Panagiotis, Roche, Jean Baptiste, Miernik, Arkadiusz, Enikeev, Dmitry, Tunc, Lutfi, Bhojani, Naeem, Gilling, Peter, Otero, Javier Romero, Porreca, Angelo, Ahyai, Sasha, Netsch, Christopher, Gözen, Ali Serdar, Nagele, Udo, Herrmann, Thomas R. W., Tokas, Theodoros
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2023; Springer Nature B.V
• Subjects: Enucleation; Humans; Hypertrophy; Hypertrophy - drug therapy; Hypertrophy - surgery; Laser Therapy - methods; Lasers; Lasers, Solid-State - therapeutic use; Lithotripsy, Laser - methods; Male; Medicine; Medicine & Public Health; Nephrology; Oncology; Prostate; Prostatic Hyperplasia - drug therapy; Prostatic Hyperplasia - surgery; Surveys; Thulium - therapeutic use; Topic Paper; Urology; Prostat hypertrophy; Survey; Prostat hyperplasia; Settings; Laser
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04565-y

Purpose To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications. Methods A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios. Settings were compared for the reported laser types, and common settings and preventive measures were identified. Results Twenty-two experts completed the survey with a mean filling time of 12.9 min. Ho:YAG, Thulium fiber laser (TFL), continuous wave (cw) Tm:YAG, pulsed Tm:YAG and Greenlight™ lasers are used by 73% (16/22), 50% (11/22), 23% (5/22), 13.6% (3/22) and 9.1% (2/22) of experts, respectively. All experts use anatomical enucleation of the prostate (EEP), preferentially in one- or two-lobe technique. Laser settings differ significantly between laser types, with median laser power for apical/main gland EEP of 75/94 W, 60/60 W, 100/100 W, 100/100 W, and 80/80 W for Ho:YAG, TFL, cwTm:YAG, pulsed Tm:YAG and Greenlight™ lasers, respectively ( p  = 0.02 and p  = 0.005). However, power settings within the same laser source are similar. Pulse shapes for main gland EEP significantly differ between lasers with long and pulse shape modified (e.g., Moses, Virtual Basket) modes preferred for Ho:YAG and short pulse modes for TFL ( p  = 0.031). Conclusion Ho:YAG lasers no longer seem to be the mainstay of EEP. TFL lasers are generally used in pulsed mode though clinical applicability for quasi-continuous settings has recently been demonstrated. One and two-lobe techniques are beneficial regarding operative time and are used by most experts.