Laser technologies in treatment of benign prostatic hyperplasia.

Abstract

Introduction. Benign prostatic hyperplasia (BPH) is a common disease among men over 40 years old. Transurethral resection of the prostate has traditionally been considered the «gold standard» for surgical treatment of patients with BPH. The emergence and popularization of laser energy has led to the development of surgical technologies that can closely approach, and in some cases even exceed the effectiveness and safety of TURP. Materials and тethods. The data were searched in the PubMed, Web of Scince. databases of Google Scholar and the scientific electronic library eLibrary.RU using the following keywords: benign prostatic hyperplasia, surgical treatment; transurethral resection of the prostate; tulium laser; holmium laser; photoselective vaporization; GreenLight system; laser energy; cost-effectiveness. Among all currently available laser energies the greatest number of publications is devoted to the use of holmium and thulium energy for laser enucleation of the prostate (HoLEP and THuLEP). Results. The effectiveness of HoLEP has been well studied with papers on the use of this technique, including numerous randomized controlled trials. The safety and efficacy of surgical intervention in patients with a large prostate volume (>100 g) was confirmed in 2000. The efficacy of the procedure was comparable to open surgery, while perioperative morbidity was lower in the group of patients who underwent HoLEP. The Tulium laser has a wavelength of 2013 nm and a penetration depth of 0.25 mm, using water as an absorbing chromophore. Unlike the holmium laser, energy is released in a continuous visible mode. This energy for the treatment of patients with BPH was first used in 2015. ThuLEP was studied in a metaanalysis by Kyriazis et al. Four studies (two randomized studies comparing ThuLEP with TURP or HoLEP and two prospective cohort studies with a follow-up period of 3-24 months) were included in this work. The authors reported an 87% reduction in prostate volume, a significant change in Qmax and IPSS, on par with TURP. Conclusion. A large variety of laser surgical systems are currently available, differing in the types of laser energy used. Surgical treatment of BPH can be performed using any method of laser surgery. The most promising and safe method for BPH treatment is the use of tulium laser energy. However, there is insufficient data on the cost-effectiveness of laser technologies.