CONTACT LASER VAPORIZATION TECHNIQUES FOR BENIGN PROSTATIC HYPERPLASIA

Contact laser applications for the relief of bladder outlet obstructio n caused by an enlarged prostate are different from the noncontact Nd: YAG laser methods. The noncontact techniques rely on coagulation necro sis or high power-density vaporization. The pure contact Nd:YAG laser allows cutting, coagulation, and vaporization of tissue with minimal p enetration beyond the contact surface. In the contact laser prostatect omy technique, the laser probe directly touches and vaporizes the pros tatic tissue. This results in immediate removal of the obstructing tis sue, 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 exp erience suggests that the contact technique (contact laser ablation of the prostate or CLAP) may be better suited for the smaller prostate g land (i.e., less than 20-30 g). For prostates larger than 30 g, a newl y described procedure known as coagulation and hemostatic resection of the prostate (CHRP) can be used. This method combines initial noncont act coagulation of the prostate with vaporization of a channel, The go al of CHRP is to allow more rapid removal of the catheter with a conti nued improvement in urine flow secondary to the coagulation effects. T he contact laser is specifically designed to vaporize tissue such as t he prostate and allows immediate observation of a TUR defect. Improvem ents in the delivery system and in the size of the contact laser probe s have made CLAP a useful modality for the treatment of symptomatic be nign prostatic hyperplasia.