The Transurethral Vaporization of the Prostate Enlargement with Green-Laser or with the Bipolar Plasma Vaporization Technique

Semir A. S. Al Samarrai

Benign prostatic hyperplasia (BPH) is highly prevalent disease in men over 50 year of age. The enlargement of this secondary sexual gland is the major etiology of lower urinary tract symptoms (LUTS) in men.

The symptoms are usually assessed by the subjective bothersome micturation as frequency, hesitancy and urgency. In cases of moderate to severely bothersome symptoms, medical treatment is appropriate with 5-a-reductase inhibitors in combination with a-adrenergic inhibitors. Surgical therapy, aiming at relieving obstruction is indicated after the failure of maximal drug therapy or with complications of the disease (1,2).

Transurethral resection of the prostate (TURP) remains the reference standard, with which any new surgical innovation should be compared (3).

Photoselective Vaporization of the Prostate (PVP) using the 80-W Potassium-Titanyl-Phosphate (KTP) 532-nm Laser is a recent technological development in the use of Lasers as an alternative to Transurethral Resection of the Prostate (TURP) for treatment of symptomatic benign prostatic hyperplasia. Originally introduced by Malek et al in 1998. Utilizing a 80-W KTP Laser, a subsequent pilot study of PVP with the 80-W KTP Laser showed a good outcome and minimal side effects in men with prostate volumes of 24-76 ml (4). Further progress with PVP has been the introduction of the high-performance system (HPS) 120-Watt Laser, which aim to reduce Lasing time and improve clinical outcomes while maintaining the same degree of safety for patients (4).

General Principles: 

Several factors have to be considered when using the Greenlight HPS 120-W Laser. The new HPS system operates with a fibre that emits a beam that is more collimated and more powerful than the 80-W KTP Laser.

Photoselective vaporization of the prostate (PVP) by Greenlight Laser has been presented as a minimally invasive surgical alternative to TURP, with several advantages such as reduced bleeding complications and short hospital stay (5-7). 

Whereas Transurethral Resection of the Prostate (TURP) removes tissue by resection of the prostatic tissue and causes hemostatis by fulguration, transurethral vaporization of the prostate (TUVP) is brought about by combining the concepts of vaporization and desiccation. Desiccation is the drawing out of water from tissue, by drying out, rather than vaporizing the cells.

The Mechanism of Action:

With TUVP, low electrosurgical effects are combined; vaporization and desiccation. Vaporization steams tissue away using high heat, and coagulation uses lower heat to dry out tissue 

The bipolar plasma vaporization of the prostate using the “button” electrode was described as a safe and efficient treatment modality for average size (30-80 ml) of the benign prostate enlargement patients.

According to some short-term (8) as well as medium-term (9) prospective randomized trials, the plasma vaporization technique produced significantly improved symptom scores and voiding parameters compared with either standard monopolar (8,9) or bipolar (9) resection. It was found that simple bipolar vaporization was only slightly effective for dealing with high volume prostatic enlargement and that a new use of the plasma-button concept would most probably required.

A vaporization technique that uses a spherical shape of a PlasmaButton Vaporization Electrode (TUR-PVP-System: Olympus) which utilizes a plasma corona created by a controlled pulsing, ultra-low voltage and high current energy, reducing penetration and resulting in well-coagulated smooth tissue performed safely in normal physiological saline, avoiding hyponatremia (TUR-Syndrome). This Vaporization technique is peculiar for the treatment of the prostate enlargement for average size (30-80 ml) was recently introduces; this technique resulted in superior efficacy and lower complication rates than previous techniques (TURP), patients who underwent Plasma Vaporization of the prostate have less bleeding during or after the PVP and reduced post operative urethral-stricture than Post (TUR-P) (10).

The PlasmaButton Vaporization technique emphasized an overall significantly lower peri-operative morbidity and an improved postoperative recovery compared with standard operations of the Prostate. In terms of haemorrhagic risks, the substantially reduced post-operative haematuria, mean haemoglobulin drop and blood-transfusion rates confirmed the superior hemostatic capabilities of BPVP. Moreover, the significantly decreased catheterization period and hospital stay may constitute reliable arguments in favour of the clearly shorter convalescence period related to the Plasma Vaporization Procedure.


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Professor Doctor of Medicine-Urosurgery, Andrology, and Male Infertility
Dubai Healthcare City, Dubai, United Arab Emirates.
Mailing Address: Dubai Healthcare City, Bldg. No. 64, Al Razi building, Block D,
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