Thulium Laser Prostatectomy - Technical Information for GPs

The next generation Thulium laser offers highly effective treatment of enlarged prostate glands, with minimal risk. It has significant advantages over the traditional TURP operation, as well as alternative laser technologies such as the Holmium laser.

An alternative to TURP

Since the 1960s, transurethral resection of the prostate (TURP) has been the standard operation for benign prostatic hyperplasia (BPH). Although generally a safe and effective procedure, complications such as TUR syndrome and bleeding remain a concern, particularly with very large prostates.

Over the past 20 years, new surgical techniques have arisen, including various types of surgical lasers, which replace the cutting electrodes in TURP. Laser prostatectomy techniques are proven to be just as effective as TURP, but with substantially less risk of bleeding or reoperation.

Types of laser used in prostatectomy

The wavelength of a laser beam determines how far the laser light can soak into tissue.

Neodynium lasers

The now obsolete Neodynium laser at 1064nm penetrates 10mm into the tissue. It causes very little bleeding, but also little immediate vaporisation occurs. This means the 'cooked' prostatic tissue has to slough away causing significant discomfort, and often requiring prolonged catheterization.

KTP/LBO lasers

The more recent generation of lasers at 532nm wavelength, while being very good technology, are extremely expensive to operate and can cause severe eye injury. This is probably the reason they are not in common use in New Zealand.

Holmium lasers

Holmium laser energy at 2140nm wavelength incises tissue effectively yet penetration is very shallow at 0.4mm, so it avoids the problems of the Neodynium lasers. As the beam is highly absorbed in water it is perfectly safe to fire within the bladder.

Thulium lasers

Thulium laser machines produce a very similar wavelength at 2013nm, with physical and tissue properties virtually identical to Holmium, yet with an even shallower 0.25mm depth of tissue penetration. Thulium lasers offer minimal bleeding like Holmium, but are more powerful, so prostate tissue can be efficiently vaporised as with a LBO laser.

Thulium laser machines are quieter, require less cooling and don't need a special power supply. The beam is also continuous rather than pulsed, and can be used for a much wider range of soft tissue applications, open or laparoscopic kidney surgery as well as ENT and gynaecology procedures.

Operating room safety issues are relatively straightforward, as at this wavelength the beam cannot penetrate the eye (corneal injury is still possible).

Thulium laser advantages

Studies have shown that Thulium laser prostatectomy is just as effective as the traditional TURP operation, but offers the advantage of lower rates of bleeding and other complications. It has also been shown to cause less blood loss than Holmium laser prostatectomy.

RevoLix Thulium laser prostatectomy at Greenlight Urology

The superior German-designed RevoLix laser used by Greenlight Urology offers a highly effective solution to conditions such as benign prostatic hyperplasia and acute urinary retention. For more information, or to refer a patient, please contact us today.