Various lasers are used for the treatment of benign prostate enlargement (BPE). This is an interesting development, because lasers in this field have been discredited for many years after its uncritical use without knowledge of laser physics during the 1980s. Emission mode (cw or pulsed), wavelength and power used distinguish lasers from each other. To judge the quality of a laser for the treatment of BPE one has to check for the parameters immediate effect, clean cut, hemostasis, suitable for large glands (Fig. 48.2).

Lasers can either be used for vaporization or as a tool to remove pieces of the prostate. This can be done either by resecting or by enucleating the gland.

From a physical standpoint vaporization in BPE treatment is a so-called “vaporization”. During vaporization the tissue is converted into steam, but only as deep as the penetration depth of the laser is. The underlying tissue remains untouched. Pure vaporization can be used for small prostates. The advantage is that this procedure is easy to learn, but the anatomical structures cannot be recognized, so that vaporization is often incomplete. In addition, pure vaporization is very time consuming with far less than 1 g/min of tissue removed and no histology available (Table 48.1).