Laser treatment of benign prostate enlargement--which laser for which prostate?

Laser-based prostatectomy for benign prostatic obstruction has emerged over the past decade as a treatment alternative to transurethral resection of the prostate (TURP) and open prostatectomy. These techniques set new standards in minimally invasive surgery and aim to obviate the complications of open surgery while ensuring durability of outcomes. Enucleation, which mimics open prostatectomy in that the whole prostate adenoma is removed, and vaporization, which involves ultra-rapid heating of superficial tissue layers and subsequent ablation, are the most often used surgical techniques in laser prostatectomy. The wavelength and the power output of the laser influence the tissue-laser interactions, which determine the physical properties and the safety profile of the technique. Holmium laser enucleation of the prostate (HoLEP) and GreenLight(™) laser vaporization of the prostate are the two reference techniques for laser prostatectomy, both of which have been shown to be as effective as TURP, while offering advantages in the safety profile in various randomized trials. Thulium laser enucleation of the prostate (ThuLEP) shares similarities with HoLEP and has shown encouraging results. However, more controlled trials with longer follow-up assessment are needed. Diode lasers come in various wavelengths and fibre designs and have been used for vaporization and enucleation, but require high-quality data to support their clinical use.