Title:
The 532-nm 180-W (GreenLight®) laser vaporization of the prostate for the treatment of lower urinary tract symptoms: how durable is the new side-fire fiber with integrated cooling system?

Abstract:
The 532-nm side-fire laser vaporization is established for the treatment of symptomatic benign prostate hyperplasia. Meanwhile, the third generation of this system is offered by American Medical Systems, Inc. The laser power increased from 80 and 120 to 180 W from the first to the third generation. Despite good functional results, with the 80- and 120-W systems, the removal of prostate tissue is limited because of fiber degradation. To overcome this problem, the fiber was designed newly with an integrated cooling system and a sensor for decreasing the laser energy in case of overheating. We evaluate whether the new fiber still suffers from degradation with consecutive drop of power transmission during the procedure. The power output of the cooled fiber was measured in vitro and during prostate vaporization in ten patients. Laser beam power was measured at baseline and after the application each of 50 kJ during laser vaporization. Power emission of the fiber remains constant at 20, 80, and 180 W of power settings over the whole 40-kJ lifespan. During the transurethral procedure, a median total energy of 276 kJ (standard deviation 153 kJ) was applied for vaporization. Median power output from the fiber at the end of the procedure was 97% from the baseline value. There were no fiber malfunctions observed. In contrast to former generations, the third-generation laser fiber is durable without significant power loss during prostate vaporization.