Standardization of 532 nm Laser Terminology for Surgery in Benign Prostatic Hyperplasia (BPH): A Systematic Review

The first human trials with the 60 W green laser (KTP/532 nm) used in the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) were conducted in 1998. The term ‘‘photoselective vaporization of the prostate’’ (PVP) was introduced by Professor Reza Malek. PVP is an established, safe, and effective alternative to transurethral resection of the prostate (TURP) for the treatment of BPH obstruction. Nowadays the majority of urologists are unaware of other approaches and techniques with green laser, apart from PVP.

For the past 20 years, green laser technology has undergone a radical evolution leading to improvements in the console crystal, increased power, and modifications of the fiber, resulting in a more efficient procedure.

‘‘Anatomic’’ PVP, vapoenucleation of the prostate, and green laser enucleation of the prostate (GreenLEP) represent different techniques that have evolved from classic PVP to improve their outcomes. Most of these techniques were first described by Dr. Fernando Gómez-Sancha, the clinician responsible for demonstrating the versatility of the 532nm laser.

In general, there is a lack of understanding of the different techniques and terminology of the 532nm laser and frequently multiple terms are used to refer to the same technique.

In September 2019 we performed a search in the databases Ovid MEDLINE®; Ovid EMBASE; and PubMed. We found 1115 unique records, and 27 articles were selected for inclusion. Of the 16 search terms used, we found that four terms could be used to describe the fundamental technique associated with each search term. These terms include “vaporization”, “vaporesection”, “vapoenucleation”, and “enucleation”.

Green laser technology and techniques have evolved tremendously over the past two decades, demonstrating that it is a very safe and versatile technology for the treatment of benign prostatic obstruction (BPO).

It’s very important to correctly understand the terminology of the 532nm laser technology and techniques. Each technique uses a different laser fiber (Moxy fiber or 2090 fiber) with or without the aid of mechanical dissection with the tip of the resectoscope and/or the extraction of the tissue with a mechanical morcellator.

Standardizing the terminology of the 532 nm laser is essential in order to be able to compare safety, efficacy and retreatment rates of the different techniques.

The 532 nm laser is an extremely versatile energy source for BPO treatment and we cannot continue to compare “GreenLight™” in general with other energy sources and techniques without correctly specifying the type of GreenLight™ technique (PVP, vaporesection, vapoenucleation or enucleation). We can’t continue comparing apples and oranges any longer.

Written by: Enrique Rijo, MD, PhD, FEBU, FACS, Department of Urology, Hospital Quirónsalud Barcelona, Barcelona, Spain.

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