High-power 532 nm laser prostatectomy: an update

Traditionally, the gold standard for treatment of benign prostatic hyperplasia was the electrocautery-based transurethral resection of the prostate. The number of laser techniques performed is rapidly increasing. Advantages of laser include decreased morbidity and shorter hospitalization. Our purpose is to review current status of the high-power 532 nm laser prostatectomy.

The 120 W, 532 nm laser differs from the 80 W, 532 nm laser in higher power, better beam collimation, and greater efficiency. Animal studies suggested that slower sweep speed might increase vaporization efficiency. However, we believe that this may not correctly guide clinical recommendations in humans due to differences in tissue composition, instrumentation, and techniques utilized. Studies demonstrated that 532 nm laser prostatectomy is safe and effective in patients with large prostates, high comorbidity, and in those taking oral anticoagulation. There is a short learning curve, reported to be less than five cases in urologists, with previous transurethral resection experience. Several studies have compared these two techniques with transurethral resection of the prostate. Frequently reported advantages of holmium laser enucleation of the prostate over the 532 nm laser prostatectomy are the availability of a pathology specimen and ability to remove a higher percentage of prostate tissue. However, the transurethral laser enucleation of the prostate addresses these concerns and has shown durable outcomes at 2-year follow-up.

Laser prostatectomy has proven to be a safe, efficacious, and durable surgical intervention to relieve symptomatic bladder outlet obstruction.