Researchers at the Columbia University Medical Center examined the existing literature on high power thulium laser, a technique introduced in 2005 for the surgical treatment of benign prostatic obstruction. The researchers discuss its effectiveness and safety for the treatment of benign prostatic hyperplasia (BPH) and comparative studies with other surgical approaches, such as monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP).
The review paper, “Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction,” was published in Therapeutic Advances in Urology.
Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for BPH and associated lower urinary tract symptoms (LUTS) relief, and the technique with the most follow-up data. Despite being a safe and effective procedure, TURP is associated with significant morbidity from bleeding and fluid shifts. As such, its use has decreased in favor of medical therapy and alternative surgical techniques, such as minimally invasive laser therapies, including enucleation, vaporization, vapoenucleation, and resection.
The high power thulium laser, first introduced in 2005 for the treatment of BPH, consists of high energy delivered in a continuous wave, which theoretically translates to more efficient vaporization, shallower depth of penetration in tissue, and less damage and unwanted side-effects.
The literature review included case series, review papers, cohort studies, and retrospective and prospective studies from 2005 to 2015, obtained in a PubMed search. According to the review, thulium laser prostatectomy represents a safe and effective procedure for benign prostatic obstruction. And the comparative studies with more traditional treatments TURP, BiTURP, and HoLEP demonstrate that thulium laser is similarly effective and safe. This technique seems to result in less morbidity, shorter catheterization time and a shorter hospital stay compared to traditional TURP.
Researchers also found that thulium laser vaporization is an easier technology for the average urologist to learn to use than the holmium laser.
“Due to the physical properties of the laser, thulium laser prostatectomy may theoretically be associated with lower rates of dysuria compared with PVP, although studies are lacking. Further comparative studies are needed to explore this promising and user-friendly technology,” the authors concluded.