BMJ  2003;327:E126 (4 October), doi:10.1136/bmjusa.02070004 (published 9 October 2002)

BMJ USA: Letter

RAPID RESPONSE FROM BMJ.COM

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

From BMJ USA 2002;July:395

Editor—I am concerned that the term "laser therapy" may lead readers to apply the presented data to all laser interventions for benign prostatic hypertrophy.

The specific laser therapy investigated is a non-contact laser and, although not actually specified, this probably refers to a side-firing neodymium: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 the necrotic prostate sloughs off later. This modality may be associated with prolonged catheterization 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. The holmium: YAG laser popularized by Gilling et al places the tissue in contact with the laser fiber. Bursts of laser energy result in vaporization of tissue to a depth of approximately 0.5 mm. The laser can be used as a "light scalpel" to accurately resect or enucleate the prostatic adenoma, resulting in an impressive defect that resembles that from open prostatectomy. Morbidity, blood loss, and inpatient stay are reduced in comparison to transurethral resection of the prostate, and symptomatic and urodynamic outcomes are at least as good. Prolonged catheterization 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.

Guys Hospital, London tim_larner{at}hotmail.com

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