High Power Holmium Laser for BPH Treatments
 

 

 



The History of the Holmium Laser for the treatment of BPH


The Holmium Laser has been the Gold Standard for the treatment of calculi in the kidney, ureter and bladder since the 1990s and has been adopted by every urology service. Following the introduction of the holmium laser for calculi, it was then introduced for the treatment of BPH as an alternative option to the more invasive and aggressive Transurethral Resection of the Prostate (TURP) procedure performed with an electrosurgical generator.  The nature and tissue effect of the 2,100nm wavelength allows for excellent hemostasis, surgical performance, safety and patient outcomes as documented in over 1000 studies. These studies have also shown the durability and efficacy of the holmium laser for BPH compared to other lasers.

Lumenis has been partnering with urology programs for over 20 years to provide surgeons with high power holmium lasers, and now with their second generation side-firing Xpeeda fiber, they have provided surgeons two more effective treatments for BPH as described below. The inception of MOSES technology into the platform has made these procedures even more hemostatic and faster to perform.


Holmium Laser BPH Procedure Overview

Surgical Techniques

Typical Size

Post op Catheter

Fiber Required

Typical Learning Curve

Morcellation Required

Saline Fluid

Vaporization (HoLVP) 

Small - Medium

X

Xpeeda
Side Fiber

2-3
cases

X

Vaporization -Resection (HoLVRP)

Medium (up to 80g)

X

Xpeeda
Side Fiber

3-5
cases

X

Enucleation (HoLEP)

Large

End-fire

25-40
cases

Holmium Laser Vaporization of the Prostate (HoLVP)

HoLVP is a safe and effective BPH treatment option for smaller prostates, with a short learning curve.  This procedure utilizes the Xpeeda side-firing fiber with the Lumenis high power holmium laser to penetrate just enough to precisely and quickly vaporize tissue without causing deeper thermal injury, coagulation necrosis or collateral damage. 

HoLVP is a virtually bloodless, procedure that offers quick recovery time and a rapid return to normal activity with patients typically leaving the hospital the same day, most without a catheter.


The Xpeeda Side-Fire Fiber


This durable side-firing fiber provides excellent laser energy transmission to the prostatic tissue.  The probe is used in a standard continuous flow resectoscope set and connects to your high power Lumenis holmium laser system.  The Xpeeda operates in close proximately to the tissue and provides both vaporization and coagulation, depending on the distance from the tissue.  Unlike other lasers using a side-firing delivery mechanism, the holmium eliminates any risk of bladder damage due to the high absorption of energy in the saline fluid.




The improved durability and innovative design allow the fiber to withstand the high power laser emission of the Lumenis VersaPulse and Pulse120H and last the entire procedure.



Graph: In-Vivo Study Comparing Vaporization Rates and Safety between Xpeeda™ & MoXy™ Fibers Mostafa Elhilali, M.D, Ph.D1, Shadie Badaan M.D, Ph.D2, Yehudit Kraizer3, Arkady Khachaturov3


Holmium Laser VapoResection of the Prostate(HoLVRP) Procedure


This procedure takes vaporization to the next level, utilizing both vaporization + laser resection techniques.   The Xpeeda side-firing fiber is used to treat moderate sized prostates (<80g) faster and more efficiently without the use of a morcellator.  Prostatic chips are resected and then easily irrigated out of the bladder with a Toomey syringe.  The chips are then available for lab analysis.  Procedure times are typically under an hour, and due to the hemostasis, most patients leave the hospital the same day, most without a catheter.  Clinical results and patient outcomes are similar to HoLEP with a much lower learning curve.

HoLVRP - Courtesy of Hazem Elmansy MD, MSc, FRCSC

Twenty patients underwent holmium laser vaporesection of the prostate (HoLVRP) from July to September 2018. Read the study here:

Holmium Laser Vaporesection of the Prostate: A Step-by-Step Approach

 


The holmium Laser VapoResection of the Prostate (HoLVRP) procedure allows me to treat prostates under 80 grams within an hour without the use of a morcellator.  The learning curve is very short and provides a high safety profile.  The Lumenis Xpeeda side-firing fiber simply connects to my high power holmium laser and is used with my standard 26F Continuous Flow Resectoscope.  Prostatic chips are easily evacuated out of the bladder using a Toomey Syringe at the end of the procedure.  Due to the hemostatic properties of the laser, my patients go home the same day while 75% void and leave without a catheter.

HAZEM ELMANSY MD, MSC, FRCSC

BENEFITS OF HoLVRP


Short learning curve (3-5 cases)
Saline fluid 
No morcellation required
Excellent visibility - hemostatic
Ability to safely treat to capsule
Specimen available for screening 

 


Quick procedure under 1 hour for glands <80g
Excellent outcomes
Outpatient procedure - usually without catheter
Ability to treat calculi with the same device
Excellent procedure for transitioning into HoLEP for larger prostates

 

 

Holmium Laser Enucleation of the Prostate (HoLEP)


Holmium Laser Enucleation of the Prostate (HoLEP) is the gold standard laser treatment for larger prostates. This procedure has been helping men around the world since the 1990s suffering from BPH. The procedure offers the ability for surgeons to enucleate the prostatic glands into the bladder which then requires a morcellator to mechanically remove the tissue.  This procedure, although providing outstanding outcomes, requires extra time in the operating room and has a much longer learning curve for surgeons than other techniques. The newer “en bloc technique” has been helpful in shortening procedural times and learning curve.