Transperineal Laser Ablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Long-Term Follow-Up in 40 Patients.

PURPOSE: To evaluate the durability, effectiveness, and safety of transperineal laser ablation (TPLA) of the prostate. MATERIALS AND METHODS: Patients with symptomatic benign prostatic hyperplasia (BPH) underwent TPLA with a 1,064-nm continuous-wave diode laser. International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), and prostate volume were evaluated at baseline and successive timepoints. RESULTS: Forty prospectively enrolled patients had follow-up of ≥36 months; median duration of follow-up was 57 months (range, 36-76 months). Compared with baseline, the median reduction in IPSS at 12-month follow-up was 74% (interquartile range [IQR], 60%-81%) (P < .001). Median QoL score at 12 months was improved from 5 (IQR, 4-5) at baseline to 1 (IQR, 0-1) (P < .001). Median PVR at 12 months decreased from 108 mL (IQR, 38-178 mL) to 13.5 mL (IQR, 0-40.5 mL) (P < .001), a median reduction of 88% (IQR, 61%-100%). At 12 months, median prostate volume was significantly reduced from 66 mL (IQR, 48.5-86.5 mL) to 46 mL (IQR, 36-65 mL) (P < .001), a median reduction of 32% (IQR, 21%-45%). For all of these parameters, the benefit of TPLA persisted at last follow-up, and all changes were statistically significant compared with baseline. There were no intraprocedural adverse events; periprocedural adverse events consisted of 1 case of prostatitis and 1 case of urinary tract infection (both Society of Interventional Radiology [SIR] Grade I). CONCLUSIONS: TPLA for symptomatic BPH produced durable benefits across a range of clinical outcomes and was well tolerated in follow-up at median duration of 57 months.

Comparative analysis of the safety and efficacy of 1470-nm diode laser enucleation of the prostate and plasmakinetic resection of prostate in the treatment of large volume benign prostatic hyperplasia (>80 ml).

OBJECTIVE: To compare the efficacy and safety of 1470-nm diode laser enucleation of the prostate (DiLEP) with that of plasmakinetic resection of the prostate (PKRP) in treating patients with large benign prostatic hyperplasia (BPH > 80ml). METHODS: The clinical data from 211 cases of BPH (>80 ml) were collected for analysis. The patients were divided into two groups: the PKRP group (n = 118) and the DiLEP group (n = 93), based on the surgical method used. RESULT: The DiLEP group demonstrated significantly lower surgical time (p < 0.001), intraoperative bleeding (p < 0.001), bladder flushing time (p = 0.003), indwelling catheter time (p < 0.005), and length of hospital stay (p = 0.018) compared to the PKRP group. However, the quality of the prostatectomy was significantly higher in the DiLEP group (p = 0.005). The Qmax for the DiLEP group was significantly higher than that of the PKRP group (p < 0.05). Compared to the PKRP group, the incidence of urinary incontinence in the DiLEP group increased significantly 4 weeks post-surgery (p = 0.026), although the need for blood transfusion during surgery was significantly reduced (p = 0.037). CONCLUSION: Both DiLEP and PKRP are safe and effective methods for treating large-volume BPH. However, DiLEP offers advantages such as more thorough glandular resection, shorter surgical time, reduced bleeding, quicker recovery, and fewer complications.

Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia.

OBJECTIVES: We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. METHODS: A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. RESULTS: We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. CONCLUSIONS: Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.

[Comparative evaluation of transscleral laser exposure in anatomical experiment]. / Sravnitel'naya otsenka lazernogo transskleral'nogo vozdeistviya v usloviyakh anatomicheskogo eksperimenta.

PURPOSE: This study comparatively analyzed the morphology of eye tissues after laser exposure using the latest generation of transscleral laser techniques - micropulse transscleral cyclophotocoagulation (MP-TSCPC) and laser activation of scleral hydropermeability (LASH) - in an anatomical experiment. MATERIAL AND METHODS: The study used pulsed-periodic radiation of an Er-glass fiber laser (λ=1.56 µm) and radiation of a diode laser (λ=0.81 µm) in the micropulse mode. A comparative morphological evaluation of histological preparations of target scleral and ciliary body (CB) tissues was performed with the study of laser-induced changes occurring after LASH and MP-TSCPC. RESULTS: The study of histological preparations obtained after MP-TSCPC and LASH did not reveal any noticeable signs of an inflammatory reaction or significant destructive changes. There were no signs of pronounced coagulative changes in the form of disorganization of connective and muscle tissue in the exposure area. At the same time, MP-TSCPC was accompanied by thinning and discontinuity of the CB pigment epithelium in the projection of its flat part and expansion of the gaps between the anterior connective tissue fibers fixing the CB to the sclera, which is likely a factor contributing to uveoscleral outflow. After LASH, in the irradiated areas at the level of the outer layers of the sclera (¾ of its thickness) located in the projection of the flat part of the ciliary body, multiple slit-like cavities and enlargements (stretching) of interfiber spaces were revealed with simultaneous compaction of the inner part of the sclera (» of its thickness). CONCLUSION: The identified morphological changes may indicate certain differences in the mechanisms of intraocular pressure (IOP) reduction after MP-TSCPC and LASH. The results of this study suggest that the enhancement of uveoscleral outflow of intraocular fluid and the hypotensive effect after MP-TSCPC may be associated with laser-induced expansion of the interspaces between the anterior connective tissue fibers of the CB in the suprachoroidal space. With LASH, the possible mechanism of lowering IOP may be related rather to an increase in transscleral filtration due to the appearance of slit-like interfiber spaces in the sclera, caused by local contraction of scleral fibers in the area of laser exposure. The absence of pronounced destructive changes at the histological level indicates the gentle nature of both laser techniques and the possibility of expanding the indications for the use of LASH in the treatment of glaucoma, including at its earlier stages.

Study on the efficacy and safety of a high-power triple wavelength diode laser (810, 940, 1060 nm) for removing fine and less pigmented facial hair on Asian skin.

INTRODUCTION: Performing laser hair removal treatments on dark skin is limited by the quantity of melanin within the skin. To minimize side effects, lower values of fluence are selected when using standard 755 or 810 nm diode lasers. However, this approach may limit the effectiveness of the procedure, particularly when treating areas with thin and less pigmented hair, which is often the case in facial regions. To improve results, high-power triple wavelength diode lasers can be used. This study aims to assess the efficacy, safety, and comfort of treatments that remove facial hair with a high-power triple wavelength diode laser (810, 940, and 1060 nm) in static mode on Asian patients with thin and less pigmented hair. MATERIALS AND METHODS: A single-center retrospective cohort study was carried out using a high-power triple wavelength diode laser (810, 940, and 1060 nm), with a 2.7 cm2 spot size, on faces with thin and less pigmented hair. The study comprised 23 subjects with Fitzpatrick skin types IV and V. Effectiveness was measured by counting the hairs that appeared in high-resolution photos taken prior to and following the procedure, in addition to the Global Aesthetic Improvement Scale (GAIS). Furthermore, mathematical 3D simulations were created on the COMSOL Multiphysics® software to allow for comparisons to be made with regard to thermal damage sustained by the hair follicles and epidermal heating. Assessments were also made in relation to side effects. RESULTS: An average of 66% hair reduction was observed. Patient satisfaction was between 4 and 5 points on the GAIS scale, indicating that the treatment was very well received and tolerated. Adverse side effects were not observed. CONCLUSION: It can be concluded that the use of a high-power triple wavelength diode laser (810, 940, and 1060 nm) is safe and effective for the treatment of very fine and less pigmented facial hair on Asian skin. Furthermore, a triple wavelength (810, 940, and 1060 nm) laser is absorbed less by the melanin in the skin, enabling the use of higher fluences in stamping mode, with greater efficacy and safety for darker skin.

Is multiple wavelength diode laser for facial contouring safe?

The multiple wavelength diode laser (MWDL) is a sophisticated device designed to target deeper skin layers by emitting various wavelengths. Its unique feature is the ability to deliver heat to specific depths within the tissue using different wavelengths while simultaneously cooling the skin surface. Recent research by Choi et al. suggests that wavelengths of 755 and 810 nm can induce carbonization in hair follicles, while the 1064 nm wavelength penetrates deeper into tissues. MWDL has been proposed for fat redistribution in aging, but concerns have been raised regarding ocular safety and potential tissue damage, particularly when used near the eyes. Studies have shown ocular injuries during cosmetic laser procedures, emphasizing the need for robust ocular protection and safety protocols. Additionally, there are reports of internal ischemic necrosis and burns, highlighting the importance of precise energy settings and parameter management. While MWDL shows promise, further research and comprehensive guidelines are needed to ensure safe and effective usage in clinical practice.

Use of a fractional 1570-nm diode laser scanner for non-ablative face and neck rejuvenation.

BACKGROUND: The use of non-ablative fractionated lasers for skin rejuvenation has been proven to be effective in improving skin texture, and has become popular due to minimal wounding, significantly shorter recovery times and decreased adverse effects. OBJECTIVE: To retrospectively analyze improvement in skin texture in healthy women aged over 18 years with Fitzpatrick skin types II-IV. METHODS: Participants received three facial and/or neck treatments with the 1570-nm fractional scanning diode laser at 1-month intervals. Three months after the last treatment session two blinded evaluators assessed skin improvement using before and after photos. Pain and patient satisfaction were recorded. RESULTS: Sixteen women with a mean age of 45.4 ± 4.1 years (range 35-50 years) and skin type II-IV were included in the analysis. All 16 participants received facial treatments and seven (43.8%) also received neck treatments. Three months follow-up evaluation showed that the majority of participants had a visible change in the treated areas. Mean pain score was low and decreased with each treatment session. CONCLUSION: Skin treatment using fractional scanning 1570-nm diode laser improves skin laxity in women with skin types II-IV. Larger studies are warranted to further clarify the efficacy and safety of this modality.

Outcome of 1470nm laser diode ablation for superficial venous insufficiency / Resultado do tratamento da insuficiência venosa superficial com Laser Diodo 1470 nm

BACKGROUND: Endovenous laser ablation is a minimally invasive procedure that can be used to treat superficial venous insufficiency. We believe that using a longer wavelength will reduce the frequency of the most common adverse effects associated with the use of shorter wavelengths. OBJECTIVES: To report the results of an initial series of patients with chronic superficial venous insufficiency treated using a 1470 nanometer diode laser and to compare results using linear and radial laser fibers.METHODS: We conducted an observational cohort study. Seventy-four patients, for whom at least two postoperative Doppler ultrasonography scans were available, were recruited with a total of 121 saphenous veins treated (92 great and 29 small saphenous veins). There were 57 patients in Group A (treated with the linear fiber) and 17 in Group B (radial fiber). Follow-up ideally comprised clinical consultation and Doppler ultrasonography at 1 month, 6 months and 12 months after the procedure. Success was defined as total occlusion of the venous segment that had been treated.RESULTS: Success rates at mean follow-up of 13.4 months (range 7 - 27) were 83% for great saphenous veins and 89% for small saphenous veins. Patients treated with the radial fiber required less energy to achieve occlusion of the small saphenous vein and exhibited fewer adverse reactions, with statistical significance. CONCLUSIONS: Treatment of great and small saphenous vein insufficiency using the 1470 nm diode laser is safe and effective. The radial fiber was associated with fewer intercurrent conditions than the linear fiber, although success rates were similar.

CONTEXTO: A ablação endovenosa com laser consiste em um procedimento minimamente invasivo e é aplicada no tratamento da insuficiência venosa superficial. Acreditamos que o uso de uma onda de maior comprimento irá propiciar a diminuição dos principais efeitos adversos, relacionados com ondas de menor comprimento. OBJETIVOS: Demonstrar o resultado de uma série inicial de pacientes com insuficiência venosa crônica superficial, tratados com o uso do Laser Diodo 1470 nanômetros, e comparar as fibras linear e radial.MÉTODOS: Conduzimos um estudo observacional do tipo coorte histórico. Setenta e quatro pacientes, com no mínimo dois eco-Doppler pós-operatórios, foram incluídos, totalizando 121 veias safenas tratadas (92 magnas e 29 parvas). Tivemos 57 pacientes pertencentes ao Grupo A (fibra linear) e 17 ao Grupo B (fibra radial). O follow-up foi idealmente realizado com uma consulta clínica e eco-Doppler em um mês, seis meses e 12 meses, após o procedimento. O sucesso foi definido como a oclusão total do segmento venoso tratado.RESULTADOS: O sucesso no follow-up médio de 13,4 meses (7 - 27) foi de 83% para veias safenas magnas e 89% para veias safenas parvas. Pacientes submetidos ao uso de fibra radial necessitaram de menos energia para oclusão da veia safena parva e apresentaram menos reações adversas, com significância estatística.CONCLUSÃO: O tratamento da insuficiência de veias safenas magna e parva com o Laser Diodo 1470 nm é seguro e eficaz. A utilização da fibra radial foi associada a menos intercorrências em relação à fibra linear, apesar de sucesso semelhante.