Endoscopic laser incision of the prostate

Peter T. O. Gilbert

doi:10.1117/12.312273

1 July 1998 Endoscopic laser incision of the prostate

Peter T. O. Gilbert

Proceedings Volume 3245, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems VIII; (1998) https://doi.org/10.1117/12.312273
Event: BiOS '98 International Biomedical Optics Symposium, 1998, San Jose, CA, United States

Abstract

To reduce morbidity and costs of transurethral incision of the prostate in cases with bladder neck obstruction and insignificant prostatic hyperplasia, a Nd:YAG laser, wavelength 1064 nm, was used for endoscopic tissue vaporization. Twenty seven patients suffering from severe urinary obstructive symptoms due to a high-riding vesical neck, were operated on under general anesthesia. Under endoscopic control and by means of a 600 micrometer lateral- firing quartz fiber two incisions were performed, starring at the 7 o'clock and 5 o'clock position, respectively, of the bladder neck and following the floor of the prostatic urethra to either side of the verumontanum. Vaporization was achieved with the fiber in permanent tissue contact and the laser working at 60 W power in continuous mode. Total energy averaged 10,000 J. No catheter was inserted and all patients were discharged on the same day after the first micturition. Anti-inflammatory agents were administered for two weeks. No serious complications were encountered postoperatively. Results were evaluated by means of clinical examination, uroflowmetry, sonographic measurement of residual urine and the International Prostate Symptom Score (IPSS) questionnaire. Considering a mean follow up of 15 months, all patients experienced considerable improvement of their obstruction, their urinary peak flow averaging 21 ml/s and their IPSS score 6.7 (preoperatively 12.2 ml/s and 21.8, respectively). As compared to the Collings knife, laser-incision of the prostate carries no risk of bleeding, thus obviating the need of catheterization. It can safely be done in an outpatient setting, probably as well under local as under general anesthesia.

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Peter T. O. Gilbert "Endoscopic laser incision of the prostate", Proc. SPIE 3245, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems VIII, (1 July 1998); https://doi.org/10.1117/12.312273

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KEYWORDS

Prostate

Endoscopy

Neck

Bladder

Laser tissue interaction

Laser ablation

Nd:YAG lasers

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