Article

London Urology Online

Niagara Prostate Vapourisation

email us Although we appear to have in TURP a very good and tested operation, there are side effects and costs associated with hospitalisation. This has led to a number of new minimally invasive approaches over the last decade. Sadly most of these have been abandoned due to or a high risk of pain or other side effects compared to TURP, or because they simply did not work! Now it seems a new technique may be able to offer an accessible therapy with equal efficacy and fewer side effects This technique instantly gives a TURP like cavity Previous attempts with lasers The Niagara system Results Many laser energies have been used in the prostate before now, but limitations on laser power have meant removal of significant amounts of prostate tissue (the real test) has been impossible or unfeasibly slow. The only two contenders for the TURP crown up until now have been prostate electrovaporisation (easy to learn but higher risk of infection, impotence and incontinence) and holmium laser prostate enucleation (as effective as TURP but extremely difficult to learn and associated with severe operative complications in all but the most expert hands). The Niagara system from Laserscope appears to address this problem by means of delivering a very powerful modulated KTP-YAG laser beam which is absorbed by the haemoglobin pigment in tissue. This means that when the laser is applied to prostate tissue massive localised heating of the tissue occurs resulting in instantaneous vapourisation: due to the laser characteristics bleeding is close to zero. Initial results using this technique in a number of different centres in the USA have consistently shown a fast operating time and little or no bleeding, with most patients now being able to go home on the day of the procedure with no catheter. While long term results are awaited, the figures after months of follow up show improvements in symptoms and urological measurements at least as good as TURP. In particular it appears that the prostate tissue removal seen at the time of surgery is genuine when assessed by post-operative prostate ultrasound. Strikingly, very few patients report pain after the procedure: pain and burning on urinating have limited both laser techniques and TURP in the past> Also, the initial impression is that sexual side effects are reduced compared to the standard technique. Several hundred men have now been treated. It is not always possible to extrapolate results from US centres across the Atlantic, so we have started a formal evaluation of the Niagara laser at King’s College Hospital. We have now treated a number of men with proven outflow obstruction listed for prostatectomy (including two with very large prostates who in most hospitals would have been subjected to open surgery). Only one man has required a hospital stay of more than 18 hours. Our initial impressions are extremely favourable: the technique allows rapid creation of a generous prostate cavity with almost no bleeding. Although we have placed catheters post operatively in this evaluation period, only one man has had to have a catheter for more than 12 hours, and all have voided extremely well on catheter removal. One of the attractive features of this laser is an intuitive technique for surgeons who are already familiar with transurethral surgery. So far for our patients, post operative bleeding and discomfort has appeared less than we would expect with standard TURP, and we are confident that this technique will be applicable as a genuine day case procedure in a European setting. While there are extra costs involved in terms of the laser generator and fibres, the cost saving of up to four hospital bed days per patient will be compelling. Although a randomised trial against TURP would be the ideal to evaluate this new technology, it must be remembered that most surgical techniques are not scrutinised in this way. If the apparent benefits of the Niagara laser hold out over the next 18 months I think it likely that patient pressure will make such a trial difficult if not impossible to recruit to. [Practice details][Research News][Publications][Information][Links][Referrals] Copyright (c) 1999-2001 GH Muir. All rights reserved. [email protected]

Although we appear to have in TURP a very good and tested operation, there are side effects and costs associated with hospitalisation. This has led to a number of new minimally invasive approaches over the last decade. Sadly most of these have been abandoned due to or a high risk of pain or other side effects compared to TURP, or because they simply did not work! Now it seems a new technique may be able to offer an accessible therapy with equal efficacy and fewer side effects

This technique instantly gives a TURP like cavity Previous attempts with lasers The Niagara system Results

Niagara Prostate Vapourisation

email us

This technique instantly gives a TURP like cavity Previous attempts with lasers The Niagara system Results

This technique instantly gives a TURP like cavity

Previous attempts with lasers

The Niagara system

Results

Many laser energies have been used in the prostate before now, but limitations on laser power have meant removal of significant amounts of prostate tissue (the real test) has been impossible or unfeasibly slow. The only two contenders for the TURP crown up until now have been prostate electrovaporisation (easy to learn but higher risk of infection, impotence and incontinence) and holmium laser prostate enucleation (as effective as TURP but extremely difficult to learn and associated with severe operative complications in all but the most expert hands).

The Niagara system from Laserscope appears to address this problem by means of delivering a very powerful modulated KTP-YAG laser beam which is absorbed by the haemoglobin pigment in tissue. This means that when the laser is applied to prostate tissue massive localised heating of the tissue occurs resulting in instantaneous vapourisation: due to the laser characteristics bleeding is close to zero.

Initial results using this technique in a number of different centres in the USA have consistently shown a fast operating time and little or no bleeding, with most patients now being able to go home on the day of the procedure with no catheter. While long term results are awaited, the figures after months of follow up show improvements in symptoms and urological measurements at least as good as TURP. In particular it appears that the prostate tissue removal seen at the time of surgery is genuine when assessed by post-operative prostate ultrasound. Strikingly, very few patients report pain after the procedure: pain and burning on urinating have limited both laser techniques and TURP in the past> Also, the initial impression is that sexual side effects are reduced compared to the standard technique. Several hundred men have now been treated.

It is not always possible to extrapolate results from US centres across the Atlantic, so we have started a formal evaluation of the Niagara laser at King’s College Hospital. We have now treated a number of men with proven outflow obstruction listed for prostatectomy (including two with very large prostates who in most hospitals would have been subjected to open surgery). Only one man has required a hospital stay of more than 18 hours.

Our initial impressions are extremely favourable: the technique allows rapid creation of a generous prostate cavity with almost no bleeding. Although we have placed catheters post operatively in this evaluation period, only one man has had to have a catheter for more than 12 hours, and all have voided extremely well on catheter removal. One of the attractive features of this laser is an intuitive technique for surgeons who are already familiar with transurethral surgery.

So far for our patients, post operative bleeding and discomfort has appeared less than we would expect with standard TURP, and we are confident that this technique will be applicable as a genuine day case procedure in a European setting. While there are extra costs involved in terms of the laser generator and fibres, the cost saving of up to four hospital bed days per patient will be compelling. Although a randomised trial against TURP would be the ideal to evaluate this new technology, it must be remembered that most surgical techniques are not scrutinised in this way. If the apparent benefits of the Niagara laser hold out over the next 18 months I think it likely that patient pressure will make such a trial difficult if not impossible to recruit to.