Dosimetry studies utilizing the urolase right-angle firing neodymium:YAG laser fiber in the human prostate

Background and Objective: Until recently, little or no objective data have been available to support either the choice of power setting or the timing of laser applications to achieve optimal tissue ablation in the human prostate. The objective of this study was to define quantitative dosimetry curves for the Urolase right angle laser fiber in human prostates. Study Design Materials and Methods: Transurethral Neodymium:YAG laser application was performed with the Urolase right-angle laser fiber in adult human prostates prior to planned radical surgery. Depth and volume of prostatic tissue coagulation for single, continuous laser applications were measured at variable power settings from 20 to 60 watts while holding total energy delivery constant. Then, holding the power setting constant at 40 watts, the extent of tissue coagulation was measured for variable treatment times from 60 to 120 seconds. Results: Peak tissue coagulation was observed at 40 watts up to a maximum of 14 mm tissue penetration and 4.23 cc volume coagulated following a single spot laser application. The mean depth of tissue coagulation at 40 watts power setting was 13.5 mm, with a mean volume of tissue coagulation of 3.68 cc. The mean depth of tissue penetration at 40 watts was more than 25% greater than that observed at 60 watts, and the mean volume of tissue coagulation was 190% greater than that observed at 60 watts. As treatment time was increased from 60 to 90 seconds, extent of tissue coagulation increased significantly. However, beyond 90 seconds continuous laser application at 40 watts, a plateau in tissue effects was observed, with minimal increase in tissue coagulation between 90 and 120 seconds. Histologic examination of prostates removed acutely showed heat-induced damage to both stromal and glandular epithelial elements in laser-treated areas. At 1 year, the prostatic urethra was lined with a normal transitional epithelium, and mild periurethral fibrosis with focal squamous metaplasia was seen. Conclusion: Using the Urolase right-angle laser fiber, this study suggests that 40 watts power setting and 90 seconds continuous application time with a Neodymium:YAG laser source represent optimal treatment parameters to maximize prostatic tissue coagulation.