30 W THULIUM LASER : A HANDY TOOL FOR UROLOGISTS

Traditionally, the gold standard for treatment of BPH has been the electrocautery based TransUrethral Resection of the Prostate (TURP).But TURP is fraught with complications like bleeding(upto 30%),clot retention,residual prostate ,urethral stricture and TUR syndrome(syndrome characterised by fluid retention and hyponatremia). Because of TUR syndrome usually size of the prostate is limiting factor for the TURP.The TURP is usually not resorted to prostates more than 80 gm in size.Till now the TURP was supposed to be the Gold Standard for prostate resection. However, the LASER technology is safer in this aspect as the co-agulation is better and it uses Normal Saline during resection unlike TURP which uses Glycine(main reason for TUR Syndrome). Potential advantages of laser therapy over traditional TURP include decreased morbidity(bleeding is less than 2%) and shorter hospital stay(stay can be less than 48 hours while in TURP it can be 4-5 days). There are several techniques for laser prostatectomy that continue to evolve. 

Amongst all Thulium appears to be superior in terms of technique,its ability to vaporise( hence usage in cardiac ,anticoagulated and patients on antiplatelet agents),low learning curve ( so friendly for budding urologists unlike its counterpart Holmium LASER where the learning curve is long), precise planes( its well known fact that Holmium LASER prostatectomy is fraught with danger of losing planes and hence problems like extravasation, conversion to TURP or abandoning the procedure altogether).

 

But the Thulium LASER is expensive and cannot be used for stone fragmentation.Holmium LASER can be used in both prostate and stone diseases.

But there is a hope for urologists now.They can have both Thulium ( not 100 /150 w but 30 W) and Holmium 30 w so both stone and prostate can be tackled ( having the best of the both worlds).

The both machines are cost effective.There was initial criticism and apprehension regarding the 30 W LASER thinking that when Thulium LASER is being introduced in 100/120 and 150 W LASER buying anything less than 50 W would be a step backwards.There was a notion regarding the effectivity of 30 W LASER.Hence we decided to use 30 W LASER ; we did 20 cases ( size of the prostate 30-75 gm) .We did enucleation technique or tangerine technique for all patients.We even performed surgeries on cardiac patients with antiplatelet therapy.But the outcome was good.The enucleation was satisfactory and the prostatic fossa was wide.The only disadvantage was the LASING time was delayed.