TY - JOUR
T1 - Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy
T2 - 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
AU - Ortner, Gernot
AU - Güven, Selcuk
AU - Somani, Bhaskar Kumar
AU - Nicklas, Andre
AU - Scoffone, Cesare Marco
AU - Gracco, Cecilia
AU - Goumas, Ioannis Kartalas
AU - Bach, Thorsten
AU - Sancha, Fernando Gómez
AU - Figueredo, Felipe C.A.
AU - Krambeck, Amy
AU - Bozzini, Giorgio
AU - Lehrich, Karin
AU - Liatsikos, Evangelos
AU - Kallidonis, Panagiotis
AU - Roche, Jean Baptiste
AU - Miernik, Arkadiusz
AU - Enikeev, Dmitry
AU - Tunc, Lutfi
AU - Bhojani, Naeem
AU - Gilling, Peter
AU - Otero, Javier Romero
AU - Porreca, Angelo
AU - Ahyai, Sasha
AU - Netsch, Christopher
AU - Gözen, Ali Serdar
AU - Nagele, Udo
AU - Herrmann, Thomas R.W.
AU - Tokas, Theodoros
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/11
Y1 - 2023/11
N2 - 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.
AB - 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.
KW - Laser
KW - Prostat hyperplasia
KW - Prostat hypertrophy
KW - Settings
KW - Survey
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U2 - 10.1007/s00345-023-04565-y
DO - 10.1007/s00345-023-04565-y
M3 - Article
C2 - 37632557
AN - SCOPUS:85169093726
SN - 0724-4983
VL - 41
SP - 3277
EP - 3285
JO - World journal of urology
JF - World journal of urology
IS - 11
ER -