Contact Laser prostatectomy: a new standard

摘要

For the last 50 years, electrosurgical transurethral resection of the prostate (TURP) has been the 'gold standard' surgical treatment for male urinary outflow obstruction, despite its high morbidity rate. Recently, in an attempt to decrease the morbidity associated with electrosurgical TURP, the Nd:YAG laser has been widely used to treat outflow obstruction by coagulating prostatic tissue. Although morbidity due to post-operative bleeding is significantly decreased by the Nd:YAG laser, the need for an indwelling catheter for up to one week and dysuria lasting for up to two months have limited the acceptance of this approach. More recently, contact laser prostatectomy, utilizing patented Wavelength Conversion $+TM$/ Effect (WCE) technology, has demonstrated a significant reduction in morbidity compared with TURP and provides immediate symptom improvement and catheter removal typically within 24 hours. With WCE surface treatments on large round probes that are reusable and made of fused silica, a small portion of the Nd:YAG wavelength from a Contact Laser System is absorbed at the probe surface, increasing its temperature, while the remaining native wavelength radiates into the tissue. The temperature gradient in the tissue resulting from this dual effect provides precise and hemostatic vaporization with depth of tissue necrosis as shallow as 0.5 mm when desired. Contact laser prostatectomy can be accomplished by vaporizing with WCE probes alone or in combination with a free-beam coagulation approach, in a procedure known as Laser CHRP$+TM$/ (coagulation and hemostatic resection of the prostate). Precise hemostatic incision and vaporization with WCE technology and a variety of other probe shapes have also proven effective in sphincterotomy, urethral strictures, transurethral incision of the prostate, bladder neck contracture and treatment of condyloma.