A growing armamentarium of surgical techniques is available for treatment of Benign Prostatic Hyperplasia (BPH). Transurethral Resection of Prostate (TURP) has become the gold standard, on account of its capability to remove obstructing prostatic tissue, with durable clinical efficacy. Hemorrhage and risk of transurethral resection syndrome (TURS) are significant disadvantages, and many patients requiring surgery are elderly and/or have significant comorbidities.

CYBER TM

In the past 20 years, various technologies have been developed for treatment of prostatic enlargement. Many promised some advantage that could not be sustained, due to insufficient capability for tissue removal, untoward side-effects and sometimes difficult operative learning curve. The 21st Century has witnessed major advances in laser engineering, providing operations for vaporization and enucleation of the prostate. Nevertheless, clinical performance has been limited by the technological ability to regulate sufficiently high laser power, at therapeutic wavelengths for tissue removal, simultaneous haemostasis and adaptability for dedicated vascular coagulation.

The Cyber TM 150W is a diode pumped solid state laser system able to operate both in CW and pulsed mode, emitting a 2010 nm wavelength. It offers great absorption in interstitial water, with optical penetration of only 0.2 mm. The 150W laser produces a instantaneous vaporcut effect for a precisely controlled, haemostatic incision into prostatic tissue, highly suited for enucleation, regardless of gland vascularity. Since the laser-tissue interaction does not depend on hemoglobin absorption, tissue vascularity does not contribute to its performance or depth of tissue penetration. Thus, the same vaporcut effect occurs in scarred and poorly vascularised tissue.

Vaporesection refers to simultaneous vaporization and resection, for prostatic enucleation. The Tm:Yag laser system uses this to great effect, unique on account of the combination of power, wavelength and fiber design. Using the continuous mode, the laser combines simultaneous vaporization at the incision with minimal bubble effect, shallow coagulation at the incision margin, size reduction of the enucleated fragment, and haemostasis. For dedicated haemostasis, the power can be reduced, and the distance of the fiber tip from the tissue can be increased.

THULEP--THULIUM LASER ENUCLEATION OF PROSTATE.This is the latest technology used for beningn enlargement of prostate. In routine procedure like TURP, The prostate gland is cut into pieces using electrocautery. Everytime the tissue is cut, there is bleeding, which is stopped bycoagulation. As water or GLYCINE is used as irrigating medium during the procedure, there is a risk of the DREADFUL TURP SYNDROME. These problems are overcome by THULEP as there is only 10% bleeding as compared to TURP and there is no risk of TURP SYNDROME as normal saline is used instead of water or Glycine. CATHETER can also be removed after one day instead of 3 to 4 days in routine TURP thereby shortening the hospital stay.

RIRS (Retrograde Intrarenal Surgery)- This is a very useful procedure for lesions in the kidney like stones or small growths. A small flexible URETEROSCOPE (size 2.5 MM diameter) is passed through URETHRA into the Ureter and into the PELVICALYCEAL SYSTEM of the kidlney. The scope is maneouvered into the respective calyx of the kidney and the stone or growth is avaporated by holmium laser. PRAMODINI UROLOGY FOUNDATION has the most advanced flexible ureteroscope -- TYHE FLEX EX 2 BY CARL STORZ (GERMANY) and it is backed by QUANTA HOLMIUM LASER (ITALY)