Factors affecting size and configuration of neodymium:YAG (Nd:YAG) laser lesions in the prostate

Laser surgery for benign prostatic hypertrophy is a clinical reality and a promising alternative to traditional transurethral electroresection of the prostatic adenoma (TURP). Current methods of laser prostatectomy involve coagulation of prostate tissue using a quartz side-firing fiber that redirects a Nd:YAG laser beam at 70-90 degrees most commonly by means of a metal reflector. In this communication we describe a method of tissue evaporation using a side-firing fiber that avoids use of a metal reflector by means of internal reflection. It is relatively resistant to damage when coming in contact with tissue. By placing the fiber tip in direct contact with tissue, much larger lesions are created because of more efficient energy transfer resulting in rapid evaporation of tissue under water. In prostate surgery, this phenomenon of accelerated evaporation can be used to bloodlessly evaporate adenomatous tissue creating a defect that resembles that of a traditional TURP.