Lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) have long been predominantly treated with simple prostatectomy and transurethral resection of the prostate (TURP). Over the past 20 years, several laser-based procedures have been introduced as treatment alternatives in clinical practice. Laser endoscopic enucleation of the prostate (EEP) was shown to be more effective and caused fewer complications and less blood loss than TURP and open prostatectomy.
Holmium laser enucleation of the prostate (HoLEP) is the current gold standard surgical approach for BPH-related LUTS and first-line treatment for prostatic glands exceeding 80 cm³, in both the European Association of Urology and American Urology Association guidelines. HoLEP has been proven to be safe and efficient with excellent long-term clinical results.4 It uses a pulsed Holmium:yttrium-aluminium-garnet laser (Ho:YAG) with a 2120 nm wavelength and a peak power of up to 10 kW. Due to the high peak power, cavitation bubbles are created in water which emits a shock wave that exerts local pressure. This facilitates dissecting the prostate adenoma from the prostate’s pseudo-capsule.
As an alternative to Ho:YAG lasers, there are mainly two Thulium laser types used for EEP: the continuous wave Thulium:YAG (Tm:YAG) laser used for enucleation (ThuLEP), and the Thulium fiber laser (TFL). These two laser technologies offer potential benefits over Ho:YAG lasers, like precise tissue cutting and superior ablative and coagulative properties. However, these Thulium laser technologies (continuous wave Tm:YAG and TFL) do not permit the employment of cavitation bubble explosions for tissue dissection.8 To overcome the shortcomings of existing lasers, pulsed solid-state Tm:YAG lasers were introduced.
