Dr. med. Dirk Manski



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Prostate Laser Vaporization (Greenlight KTP Laser)

Review literature: (Kuntz, 2006).

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fig. greenlight laser vaporization of the prostate:
Left: 30 degree angle view from the verumontanum to the bladder neck.
Middle: greenlight laser probe with pilot beam.
Right: View after prostate laser vaporization.
fig. greenlight laser vaporization of the prostate

Indications for Laser Vaporization of the Prostate

The indications for laser vaporization of the prostate are, in principle, not different to the indications for transurethral resection of the prostate (TURP). Symptoms due to benign prostatic hyperplasia should be treated with medication, until complications make surgery necessary:

The most common indication for laser vaporization of the prostate are moderate to severe symptoms of prostatic hyperplasia, which lower the quality of life and cannot be alleviated with medication (see section Alpha-blockers and medical treatment of BPH).

Due to the special coagulation ability of the greenlight laser therapy, surgery is possible despite the presence of coagulation disorders, anti-coagulation therapy or antiplatelet therapy. The likelihood of a TUR syndrome is considerably lower, since an isotonic irrigation solution is used during the procedure. The risk of postoperative bleeding is very low. Greenlight laser vaporization should be preferred to TURP in high-risk cardiac patients. Disadvantages of the laser prostate vaporization are the high costs of the laser probe, prostate ablation without histologic examination and disadvantages of the prostate ablation in large prostate glands with the development of a large necrotic zone.

Contraindications to Laser Prostate Vaporization

Surgical Technique of Laser Prostate Vaporization

Anesthesia for Prostate Laser Vaporization:

Spinal anesthesia or general anesthesia is recommended.

Perioperative Antibiotic Prophylaxis:

Antibiotic prophylaxis with e.g. ciprofloxacin 500 mg p.o. 1-0-1 is recommended. Since laser vaporization leaves behind a necrotic zone within the prostatic fossa, urinary tract infections are common after the procedure. A prophylactic lose-dose antibiotic treatment for 7 days is often done.

Preoperative Preparations:

The patient is placed in lithotomy position. Disinfection of the external genitalia, the lower abdomen and the perineum. Sterile draping.

Cystoscopy:

Check for the width of the urethra, prostate size and absence of bladder stones or bladder tumors.

Greenlight Laser Vaporization:

The laser probe is inserted through a resectoscope with continuous saline irrigation flow and 30 degree viewing angle. The vaporization begins at the bladder neck and is continued to the apex circularly. This guarantees a good flow of the irrigation solution to optimize the view and to remove the vaporization bubbles [fig. greenlight laser vaporization of the prostate]. Insert a 18 French Foley catheter after the vaporization.

.
fig. greenlight laser vaporization of the prostate:
Left: 30 degree angle view from the verumontanum to the bladder neck.
Middle: greenlight laser probe with pilot beam.
Right: View after prostate laser vaporization.
fig. greenlight laser vaporization of the prostate

Postoperative Management after Laser Vaporization of the Prostate

Complications of Greenlight Laser Treatment

Bleeding:

The intraoperative risk of bleeding is greatly reduced (in comparison to TURP). Later during healing of the necrotic prostate tissue, minor bleeding may occur in patients with oral anticoagulation treatment.

Urinary tract infections:

Laser vaporization leaves behind a necrotic prostatic fossa, urinary tract infections are common after the procedure. A prophylactic lose-dose antibiotic treatment for 7 days is often done.

Rare complications:







Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Kuntz 2006 KUNTZ, R. M.:
Current role of lasers in the treatment of benign prostatic hyperplasia (BPH).
In: Eur Urol
49 (2006), Nr. 6, S. 961–9


  Deutsche Version: KTP (greenlight) Laservaporisation der Prostata