Rapid Responses to:

PAPERS: Sara T Brookes, Jenny L Donovan, Tim J Peters, Paul Abrams, and David E Neal Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial BMJ 2002; 324: 1059 [Abstract] [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Tarred with the same brush : Not all lasers are the same

Tim R Larner   (20 May 2002)

Tarred with the same brush : Not all lasers are the same 20 May 2002
Tim R Larner, SpR Urology Guys Hospital, London, SE1 9RT Send response to journal: Re: Tarred with the same brush : Not all lasers are the same	Dear Sir, Having read the article "sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial" I was concerned that the term "laser therapy" may lead readers to consider that the presented data could be applied to all laser interventions for BPH. The specific laser therapy investigated is a non-contact laser and although not actually specified this probably refers to a side firing Neodynium:YAG laser. This modality of treatment results in light energy being absorbed by the prostate and being converted into heat energy, effectively "cooking" the prostate in-situ. Although some cavitation may be observed no tissue is removed at the time of operation and rather the necrotic prostate sloughs off later. This modality may be associated with prolonged catheterisation and significant dysuria and it is difficult to predict the eventual prostatic cavity formed. This is not the only form of laser therapy for the prostate. Using the Holmium:YAG laser popularised by P Gilling et al the laser fibre is in contact with the tissue. Bursts of laser energy result in vapourisation of tissue to a depth of approximately 0.5mm. The laser can be used as a "light scalpel" to accurately resect or enucleate the prostatic adenoma resulting in a similarly impressive defect to open prostatectomy. Morbidity, blood loss and in-patient stay are reduced in comparison to TURP and symptomatic and urodynamic outcomes are at least as good. Prolonged catheterisation and dysuria are uncommon. The only similarities between the two techniques are that they both are used for BPH and both use lasers. The blanket term "laser therapy" as used in this article is misleading and does a disservice to Holmium laser prostatectomies.