Laser photocoagulation of prostate: influence of dosimetry

Recently, increasing enthusiasm has been shown for application of lasers for the treatment of benign prostate hyperplasia (BPH). However, little is known about the thermodynamics of prostatic tissue response during laser irradiation and how the treatment outcome can be optimized. Our objective was to conduct a systematic study of the influence of exposure parameters on the extent of tissue coagulation and to determine the effects of rate of tissue heating on lesion size by comparing the tissue response to high laser power rapid heating vs. low laser power slow heating.

Nd:YAG laser irradiation of prostate was performed in 15 mongrel canines, using an incident power of 15, 30, or 50 Watts (at the fiber tip) and an exposure time varying from 30 to 300 seconds. The laser beam was delivered via a Urolase side-emitting catheter. The tissue response was compared based on gross as well as histological evaluations of thermal lesions.

The depth of coagulation necrosis increased as the laser power was reduced from 50 W to 30 W and further to 15 W while the total delivered energy was kept constant at 2,700 J by adjusting the exposure time. The difference between the three heating rates was more dramatic when the estimated volume of coagulated tissue was considered. Increasing the irradiation time for the low power (15 W) from 180 to 300 seconds resulted in enlarging the coagulated volume by a factor of 1.6. However, for high power (50 W), increasing the exposure time from 54 to 90 seconds resulted in increasing the coagulated volume by a factor of 1.2.

This study suggests that a slow heating regimen yields larger volumes of coagulation necrosis than the currently used rapid heating approach.