Urology & Kidney Disease News Fall 2009 - Cleveland Clinic

28 Urology & Kidney Disease News
Benign Prostatic Disease
980: The New Hot Number in BPH Therapy
James C. Ulchaker, MD, FACS, and Khaled Fareed, MD
Over the last couple of years, we have evaluated the 980
nanometer (nm) wavelength laser vaporization system in
a multitude of ways. We feel that this wavelength of energy
has numerous potential advantages when compared to
other wavelengths. Herein, we present our current recommendations
regarding this technology.
The laser emits a wavelength of 980 nm, which is effectively
absorbed by both water and hemoglobin. This is significantly
different from the 532 nm wavelength device, which
is absorbed extremely well by hemoglobin, but poorly absorbed
by water. It also differs from the 2100 nm laser in
which the energy is highly absorbed by water, but insignificantly
absorbed by hemoglobin. Thus, at 980 nm, prostatic
tissue, which is either virgin tissue or has been previously
treated with other minimally invasive modalities or TURP,
can be effectively vaporized. Also, scar tissue and previously
radiated prostate tissue, both of which contain significantly
less amounts of hemoglobin, may be effectively and safely
vaporized.
The laser energy at 980 nm produces a slightly greater
penetration of energy into the prostate gland, producing
outstanding hemostasis. To date, no patient has required
reoperation for bleeding; catheter times have been 24 hours
or less, and delayed hematuria, which can be an issue with
other wavelengths, has not occurred.
Lastly, irritative symptoms, which commonly occur post
prostatic laser vaporization, have been very manageable.
One of the concerns has been that if the energy is driven
deeper into the prostatic tissue the result will be an increase
in both the severity and duration of irritative symptoms. To
date, this has not been observed. However, one complication
of delayed prostatic chip formation and slough has
been noted, but with a change in operative technique it
appears to have lessened in frequency.
Key Point:
The 980 nm wavelength has shown consistent promising
qualities as a desirable wavelength for prostate vaporization,
and will continue to be evaluated and investigated here.
This technology also has progressed in the last two years
in both its power capabilities and fiber tip design. The
early laser boxes were only able to generate significantly
less power, and it was not until the 120-watt device was
produced that prostatic vaporization became efficient.
Currently, we are evaluating the 180-watt device which, in a
limited number of cases, appears to be significantly more
efficient at vaporization, thus resulting in a shortening of
operative times. The fiber tip designs are also under continued
assessment and evaluation, and different tip designs
may be more or less efficient and desired depending on
certain prostatic characteristics. Presently, several fiber tips
are available and are under evaluation. Different fibers with
different characteristics may have physical advantages in
a variety of prostatic conditions, such as extensive middle
lobe intravesical extension, or bilobar hypertrophy with
“kissing” lobes. This aspect of the technology remains
under intensive investigation.
We continue to look at a variety of technologies for post
brachytherapy and post cryotherapy urinary retention, in
which no good therapeutic option currently exists. The 980
nm wavelength is currently under evaluation.