Contact laser applications for the relief of bladder outlet obstruction caused by an enlarged prostate are different from the noncontact Nd:YAG laser methods. The noncontact techniques rely on coagulation necrosis or high power-density vaporization. The pure contact Nd:YAG laser allows cutting, coagulation, and vaporization of tissue with minimal penetration beyond the contact surface. In the contact laser prostatectomy technique, the laser probe directly touches and vaporizes the prostatic tissue. This results in immediate removal of the obstructing tissue, in a manner similar to the standard electrosurgical transurethral resection (TURP), and offers the patient the potential for decreased catheter time and a more rapid resolution of symptoms. Our initial experience suggests that the contact technique (contact laser ablation of the prostate or CLAP) may be better suited for the smaller prostate gland (i.e., less than 20-30 g). For prostates larger than 30 g, a newly described procedure known as coagulation and hemostatic resection of the prostate (CHRP) can be used. This method combines initial noncontact coagulation of the prostate with vaporization of a channel. The goal of CHRP is to allow more rapid removal of the catheter with a continued improvement in urine flow secondary to the coagulation effects. The contact laser is specifically designed to vaporize tissue such as the prostate and allows immediate observation of a TUR defect. Improvements in the delivery system and in the size of the contact laser probes have made CLAP a useful modality for the treatment of symptomatic benign prostatic hyperplasia.
[1]
I. Perkash.
Laser sphincterotomy and ablation of the prostate using a sapphire chisel contact tip firing neodymium:YAG laser.
,
1994,
The Journal of urology.
[2]
L. W. Rodgers,et al.
Depth of penetration of the neodymium:yttrium-aluminum-garnet laser in the human prostate at various dosimetry.
,
1994,
Urology.
[3]
K. Shinohara,et al.
Transurethral evaporation of prostate (TUEP) with Nd:YAG laser using a contact free beam technique: results in 61 patients with benign prostatic hyperplasia.
,
1994,
Urology.
[4]
David M. Albala,et al.
Contact laser vaporization of the prostate for benign prostatic hypertrophy
,
1994,
Photonics West - Lasers and Applications in Science and Engineering.
[5]
R. Dmochowski,et al.
Outpatient visual laser-assisted prostatectomy under local anesthesia.
,
1994,
Urology.
[6]
R K Babayan,et al.
Transurethral ultrasound-guided laser-induced prostatectomy: National Human Cooperative Study results.
,
1993,
The Journal of urology.
[7]
A. Costello,et al.
Laser ablation of the prostate in patients with benign prostatic hypertrophy.
,
1992,
British journal of urology.
[8]
A T Cockett,et al.
Transurethral prostatectomy: practice aspects of the dominant operation in American urology.
,
1989,
The Journal of urology.
[9]
J. Kabalin,et al.
Dosimetry studies utilizing the urolase right angle firing neodymium: YAG laser fiber
,
1994,
Lasers in surgery and medicine.