Skip to main content

Advertisement

SpringerLink
Log in

Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications.

Methods

A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios. Settings were compared for the reported laser types, and common settings and preventive measures were identified.

Results

Twenty-two experts completed the survey with a mean filling time of 12.9 min. Ho:YAG, Thulium fiber laser (TFL), continuous wave (cw) Tm:YAG, pulsed Tm:YAG and Greenlight™ lasers are used by 73% (16/22), 50% (11/22), 23% (5/22), 13.6% (3/22) and 9.1% (2/22) of experts, respectively. All experts use anatomical enucleation of the prostate (EEP), preferentially in one- or two-lobe technique. Laser settings differ significantly between laser types, with median laser power for apical/main gland EEP of 75/94 W, 60/60 W, 100/100 W, 100/100 W, and 80/80 W for Ho:YAG, TFL, cwTm:YAG, pulsed Tm:YAG and Greenlight™ lasers, respectively (p = 0.02 and p = 0.005). However, power settings within the same laser source are similar. Pulse shapes for main gland EEP significantly differ between lasers with long and pulse shape modified (e.g., Moses, Virtual Basket) modes preferred for Ho:YAG and short pulse modes for TFL (p = 0.031).

Conclusion

Ho:YAG lasers no longer seem to be the mainstay of EEP. TFL lasers are generally used in pulsed mode though clinical applicability for quasi-continuous settings has recently been demonstrated. One and two-lobe techniques are beneficial regarding operative time and are used by most experts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Enikeev D, Taratkin M, Azilgareeva C, Glybochko P (2020) Knowing the inside of a laser. Arch Esp Urol 73(8):665–674

    PubMed  Google Scholar 

  2. Huang SW, Tsai CY, Tseng CS, Shih MC, Yeh YC, Chien KL et al (2019) Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ (Clin Res Ed) 367:l5919. https://doi.org/10.1136/bmj.l5919

    Article  Google Scholar 

  3. Enikeev D, Taratkin M (2023) Thulium fiber laser: bringing lasers to a whole new level. Eur Urol Open Sci 48:31–33. https://doi.org/10.1016/j.euros.2022.07.007

    Article  PubMed  Google Scholar 

  4. Enikeev D, Taratkin M, Babaevskaya D, Morozov A, Petov V, Sukhanov R et al (2022) Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 40(8):2047–2053. https://doi.org/10.1007/s00345-022-04046-8

    Article  PubMed  Google Scholar 

  5. Hartung FO, Kowalewski KF, von Hardenberg J, Worst TS, Kriegmair MC, Nuhn P et al (2022) Holmium versus Thulium laser enucleation of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol Focus 8(2):545–554. https://doi.org/10.1016/j.euf.2021.03.024

    Article  PubMed  Google Scholar 

  6. Perri D, Mazzoleni F, Besana U, Pacchetti A, Morini E, Berti L et al (2023) Pulsed-wave vs continuous-wave Thulium fiber laser enucleation of the prostate (ThuFLEP): a comparison of perioperative outcomes. Urology. https://doi.org/10.1016/j.urology.2023.05.013

    Article  PubMed  Google Scholar 

  7. Huusmann S, Lafos M, Meyenburg I, Muschter R, Teichmann HO, Herrmann T (2021) Tissue effects of a newly developed diode pumped pulsed Thulium:YAG laser compared to continuous wave Thulium:YAG and pulsed Holmium:YAG laser. World J Urol 39(9):3503–3508. https://doi.org/10.1007/s00345-021-03634-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Large T, Nottingham C, Stoughton C, Williams J Jr, Krambeck A (2020) Comparative study of Holmium laser enucleation of the prostate with MOSES enabled pulsed laser modulation. Urology 136:196–201. https://doi.org/10.1016/j.urology.2019.11.029

    Article  PubMed  Google Scholar 

  9. Nevo A, Faraj KS, Cheney SM, Moore JP, Stern KL, Borofsky M et al (2021) Holmium laser enucleation of the prostate using Moses 2.0 vs non-Moses: a randomised controlled trial. BJU Int 127(5):553–559. https://doi.org/10.1111/bju.15265

    Article  CAS  PubMed  Google Scholar 

  10. Nottingham CU, Large T, Agarwal DK, Rivera ME, Krambeck AE (2021) Comparison of newly optimized Moses technology vs standard Holmium:YAG for endoscopic laser enucleation of the prostate. J Endourol 35(9):1393–1399. https://doi.org/10.1089/end.2020.0996

    Article  PubMed  Google Scholar 

  11. Pang KH, Ortner G, Yuan Y, Biyani CS, Tokas T (2022) Complications and functional outcomes of endoscopic enucleation of the prostate: a systematic review and meta-analysis of randomised-controlled studies. Cent Eur J Urol 75(4):357–386. https://doi.org/10.5173/ceju.2022.174

    Article  CAS  Google Scholar 

  12. Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Renaldo J, Wirjopranoto S (2022) Comparative efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) using Moses technology and standard HoLEP: a systematic review, meta-analysis, and meta-regression. Ann Med Surg (2012) 81:104280. https://doi.org/10.1016/j.amsu.2022.104280

    Article  Google Scholar 

  13. Socarrás MR, Del Álamo JF, Espósito F, Elbers JR, Monsalve DC, Rivas JG et al (2023) En Bloc enucleation with early apical release technique using MOSES (En Bloc MoLEP) vs. classic En Bloc HoLEP: a single arm study comparing intra- and postoperative outcomes. World J Urol 41(1):159–165. https://doi.org/10.1007/s00345-022-04205-x

    Article  PubMed  Google Scholar 

  14. Taratkin M, Azilgareeva C, Cacciamani GE, Enikeev D (2022) Thulium fiber laser in urology: physics made simple. Curr Opin Urol 32(2):166–172. https://doi.org/10.1097/mou.0000000000000967

    Article  PubMed  Google Scholar 

  15. Ortner G, Rice P, Nagele U, Herrmann TRW, Somani BK, Tokas T (2023) Tissue thermal effect during lithotripsy and tissue ablation in endourology: a systematic review of experimental studies comparing Holmium and Thulium lasers. World J Urol 41(1):1–12. https://doi.org/10.1007/s00345-022-04242-6

    Article  CAS  PubMed  Google Scholar 

  16. Barco-Castillo C, Plata M, Zuluaga L, Santander J, Trujillo CG, Caicedo JI et al (2020) Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement. Neurourol Urodyn 39(1):303–309. https://doi.org/10.1002/nau.24195

    Article  PubMed  Google Scholar 

  17. Knapp GL, Chalasani V, Woo HH (2017) Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W greenlight lithium triborate laser. BJU Int 119(Suppl 5):33–38. https://doi.org/10.1111/bju.13822

    Article  CAS  PubMed  Google Scholar 

  18. Elshal AM, El-Nahas AR, Ghazy M, Nabeeh H, Laymon M, Soltan M et al (2018) Low-power vs high-power Holmium laser enucleation of the prostate: critical assessment through randomized trial. Urology 121:58–65. https://doi.org/10.1016/j.urology.2018.07.010

    Article  PubMed  Google Scholar 

  19. Pirola GM, Castellani D, Maggi M, Lim EJ, Chan VWS, Naselli A et al (2022) Does power setting impact surgical outcomes of Holmium laser enucleation of the prostate? A systematic review and meta-analysis. Cent Eur J Urol 75(2):153–161. https://doi.org/10.5173/ceju.2022.0104

    Article  CAS  Google Scholar 

  20. Gkolezakis V, Somani BK, Tokas T (2023) Low- vs. high-power laser for Holmium laser enucleation of prostate. J Clin Med. https://doi.org/10.3390/jcm12052084

    Article  PubMed  PubMed Central  Google Scholar 

  21. Scoffone CM, Cracco CM (2020) Prostate enucleation, better with low or high-power Holmium laser? A systematic review. Arch Esp Urol 73(8):745–752

    PubMed  Google Scholar 

  22. Tuccio A, Grosso AA, Sessa F, Salvi M, Tellini R, Cocci A et al (2021) En-bloc Holmium laser enucleation of the prostate with early apical release: are we ready for a new paradigm? J Endourol 35(11):1675–1683. https://doi.org/10.1089/end.2020.1189

    Article  PubMed  Google Scholar 

  23. Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Hennenberg M et al (2023) Efficacy, efficiency, and safety of en-bloc vs three-lobe enucleation of the prostate: a propensity score-matched analysis. Urology 175:48–55. https://doi.org/10.1016/j.urology.2023.02.014

    Article  PubMed  Google Scholar 

  24. Rücker F, Lehrich K, Böhme A, Zacharias M, Ahyai SA, Hansen J (2021) A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe. World J Urol 39(7):2337–2345. https://doi.org/10.1007/s00345-021-03598-5

    Article  PubMed  Google Scholar 

  25. Ortner G, Pang KH, Yuan Y, Herrmann TRW, Biyani CS, Tokas T (2023) Peri- and post-operative outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP): a systematic review and meta-analysis. World J Urol. https://doi.org/10.1007/s00345-023-04308-z

    Article  PubMed  Google Scholar 

  26. Press B, Ghiraldi E, Kim DD, Nair H, Johnson K, Kellner D (2022) “En-Bloc” enucleation with early apical release compared to standard Holmium laser enucleation of the prostate: a retrospective pilot study during the initial learning curve of a single surgeon. Urology 165:275–279. https://doi.org/10.1016/j.urology.2022.01.011

    Article  PubMed  Google Scholar 

  27. Gauhar V, Gilling P, Pirola GM, Chan VW, Lim EJ, Maggi M et al (2022) Does MOSES technology enhance the efficiency and outcomes of standard Holmium laser enucleation of the prostate? Results of a systematic review and meta-analysis of comparative studies. Eur Urol Focus 8(5):1362–1369. https://doi.org/10.1016/j.euf.2022.01.013

    Article  PubMed  Google Scholar 

  28. Li K, Meng C, Li J, Gan L, Peng L, Li Y et al (2023) Efficiency and clinical outcomes of Moses technology for Holmium laser enucleation of the prostate: an evidence-based analysis. Prostate 83(1):3–15. https://doi.org/10.1002/pros.24438

    Article  PubMed  Google Scholar 

  29. Ortner G, Nagele U, Herrmann TRW, Tokas T (2022) Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review. World J Urol 40(3):697–708. https://doi.org/10.1007/s00345-021-03769-4

    Article  PubMed  Google Scholar 

  30. Tokas T, Ortner G, Herrmann TRW, Nagele U (2021) Relevance of intravesical pressures during transurethral procedures. World J Urol 39(6):1747–1756. https://doi.org/10.1007/s00345-020-03401-x

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria

    Gernot Ortner, Andre Nicklas & Udo Nagele

  2. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Gernot Ortner, Andre Nicklas, Udo Nagele, Thomas R. W. Herrmann & Theodoros Tokas

  3. Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey

    Selcuk Güven

  4. Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Bhaskar Kumar Somani

  5. Department of Urology, Cottolengo Hospital of Torino, Turin, Italy

    Cesare Marco Scoffone & Cecilia Gracco

  6. Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy

    Ioannis Kartalas Goumas

  7. Department of Urology, Asklepios Westklinikum Rissen, Hamburg, Germany

    Thorsten Bach

  8. Department of Urology, ICUA-Clínica CEMTRO, Madrid, Spain

    Fernando Gómez Sancha

  9. Instituto da Próstata Aumentada, Hospital Pompéia, Caxias do Sul, Brazil

    Felipe C. A. Figueredo

  10. Department of Urology, Northwestern Medicine, Chicago, IL, USA

    Amy Krambeck

  11. Department of Urology, ASST Lariana, Como, Italy

    Giorgio Bozzini

  12. Department of Urology, Urological Laser Center, Vivantes Auguste-Viktoria-Hospital Berlin, Berlin, Germany

    Karin Lehrich

  13. Department of Urology, University of Patras, Patras, Greece

    Evangelos Liatsikos & Panagiotis Kallidonis

  14. Department of Urology, Clinique Saint-Augustin, Bordeaux, France

    Jean Baptiste Roche

  15. Department of Urology, University of Freiburg, Freiburg, Germany

    Arkadiusz Miernik

  16. Department of Urology, Medical University of Vienna, Vienna, Austria

    Dmitry Enikeev

  17. Karl Landstainer Institute of Urology and Andrology, Vienna, Austria

    Dmitry Enikeev

  18. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Dmitry Enikeev

  19. Department of Urology, Acibadem Hospital, Ankara, Turkey

    Lutfi Tunc

  20. Division of Urology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC, Canada

    Naeem Bhojani

  21. Department of Urology, Tauranga Hospital, University of Auckland, Auckland, New Zealand

    Peter Gilling

  22. ROC Clinic and HM Urological Department, Fundación Investigación HM Hospitales, HM Hospitales, Madrid, Spain

    Javier Romero Otero

  23. Department of Oncological Urology, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy

    Angelo Porreca

  24. Department of Urology, Medical University of Graz, Graz, Austria

    Sasha Ahyai

  25. Department of Urology, Asklepios Klinik Barmbek, Hamburg, Germany

    Christopher Netsch

  26. Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany

    Ali Serdar Gözen

  27. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  28. Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece

    Theodoros Tokas

Authors
  1. Gernot Ortner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selcuk Güven
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bhaskar Kumar Somani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andre Nicklas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cesare Marco Scoffone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cecilia Gracco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ioannis Kartalas Goumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thorsten Bach
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fernando Gómez Sancha
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Felipe C. A. Figueredo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Amy Krambeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Giorgio Bozzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Karin Lehrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Evangelos Liatsikos
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Panagiotis Kallidonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Jean Baptiste Roche
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Arkadiusz Miernik
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Dmitry Enikeev
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Lutfi Tunc
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Naeem Bhojani
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Peter Gilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Javier Romero Otero
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Angelo Porreca
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Sasha Ahyai
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Christopher Netsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Ali Serdar Gözen
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Udo Nagele
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Thomas R. W. Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Theodoros Tokas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GO and TT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TT, GO. Acquisition of data: GO, TT, SG, BKS, AN, CMS, CG, IKG, TB, FGS, FCAF, AK, GB, KL, EL, PK, JBR, AM, DE, LT, NB, PG, JRO, AP, SA, CN, ASG, UN, TH. Analysis and interpretation: GO, TT. Drafting of the manuscript: GO, TT. Critical revision of the manuscript: TT, BKS, SG, TH, UN, ASG. Statistical analysis: GO. Obtaining funding: None. Administrative, technical or material support: GO, TT, UN, TH. Supervision: TT.

Corresponding author

Correspondence to Gernot Ortner.

Ethics declarations

Conflict of interest

Gernot Ortner certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Karin Lehrich: Consultant Boston scientific, Coloplast, Olympus. Udo Nagele: Consultant Karl Storz, Baxter, Boston Scientific, Optimed, Storz medical, B + K. Javier Romero Otero: Member of advisory board for BPH for Coloplast, Olympus, Jena. Naeem Bhojani: Consultant Boston Scientific, Olympus, Procept Biorobotics, Amy Krambeck: Consultant Boston scientific, Storz Medical, Richard Wolf, Sonomotion Viruoso, Uriprene. Panagiotis Kallidonis: Consultant Cook Medical, EMS.

Research involving human participants and/or animals

This work does not involve human participants and/or animals.

Informed consent

No patients were included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 31 KB)

Supplementary file2 (DOCX 33 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ortner, G., Güven, S., Somani, B.K. et al. Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 41, 3277–3285 (2023). https://doi.org/10.1007/s00345-023-04565-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-023-04565-y

Keywords

Search

Navigation