Variation in output power of laser prostatectomy fibers: a need for power measurements

The aim of this study was the assessment of the quality of side-firing fibers that are being used for laser prostatectomy, either by a laser light transmission measurement or by visual inspection. A power meter (Aquarius) was developed to measure the actual power transmitted through a side-firing fiber and delivered to the prostatic tissue. The power measurements were performed under clinical conditions, that is, under water and at relatively high input power. Furthermore, a protocol was developed for visual inspection of the fibers. Eight types of side-firing fibers were measured before use. Before and after a procedure, three fiber types were measured: ProLase II (28 samples), UltraLine (23 samples), and UroLase (44 samples). All these fibers were used in standard treatment protocols. At 60 W the transmission of new fibers (not used) ranged between 49% and 83% when compared to a bare fiber. After use, a large variation was found in transmitted power between different samples of one device. A correlation with total transmitted power was not present. At higher power input, vapor bubbles are generated at the tip of the fibers. Depending on the fiber design, these bubbles have a major impact on the transmission. Only for the UroLase fiber was there a significant correlation between visual inspection and the transmission of used samples at 10, 20, and 40 W. The transmission strongly varies between fibers and between different samples of one fiber during clinical use. Moreover, the transmission does not correlate with visual inspection. A power measurement during a clinical treatment will contribute to a more controlled procedure and to a better comparison of clinical laser prostatectomy studies