Histomorphological changes after neodymium: YAG laser-coagulation of the human prostate with the Side Focus fiber. Effect of power setting and time.

The objective of our study was to determine optimal treatment parameters and appropriate methods of examination for neodymium:yttrium-aluminum-garnet (Nd:YAG) high-power laser coagulation of the human prostate in relation to power setting and time. Transurethral free-beam laser coagulation was performed with the Side Focus side-firing laser fiber in ten patients prior to planned radical surgery, of whom six underwent transperitoneal laparoscopic lymphadenectomy and laser coagulation 4-9 days prior to open surgery. Depth and volume of coagulated prostatic tissue were measured at power setting/time combinations of 40 W/90 s and 60 W/60 s, respectively, while holding total energy delivery constant. Microscopic examination in the early phase showed that epithelial cells had become loose from the basal-cell membrane. By 4-9 days there was evidence of conspicuous squamous epithelial metaplasia with a high proliferation rate as a sign of re-epithelialization. Using the Side Focus side-firing laser fiber, both treatment modalities showed comparable volume coagulation. In contrast there was a significant difference between those prostates removed at 4-9 days and those removed at 60-210 min after laser coagulation. We conclude that laser-induced changes in the human prostate are conclusively discernible only after 4 days.