The Role and Optimization of High Power Visible KTP Laser in BPH Treatment: Numerical and Experimental Study in Native and Engineered Tissues.

摘要

Background. Benign prostatic hyperplasia (BPH), characterized by the enlargement of the prostate, afflicts a large number of elderly men lowering their quality of life. Transurethral resection of the prostate (TURP) is the current gold standard for treating BPH. However, the side effects associated with TURP, especially excessive bleeding, preclude its use in high risk patients. Laser prostatectomy, notably using KTP lasers, is gaining significant attention as a main competitor to TURP due to its ability to alleviate some of these side effects. However, long procedural time and formation of large coagulation zone are main limitations of KTP laser prostatectomy.;Objective. In this work, our goal is to explore avenues for enhancement of KTP laser prostatectomy by increasing ablation and reducing coagulation.;Methods. Laser ablation consists of three components: the surgical procedure, the laser, and the tissue; each with a unique set of tunable parameters. Optimization of surgical parameters was investigated in vitro and in vivo using rat muscle tissue. Agarose gel mixed with porcine blood was used as a tissue model to understand and optimize the effect of tissue parameters on the laser ablation outcome. Control volume finite difference models were developed to simulate the laser-tissue interaction and were compared to experimental results in terms of surgical and tissue parameters effect on the laser ablation outcome. Also, the importance of the laser parameters, which cannot be tuned experimentally, was explored using this computational model.