Assessment of Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser Fiber Wear and Tear Grade During Visual Laser Ablation of Prostatic Adenoma

Objective: The extent of Nd-YAG laser fiber damage due to inappropriate handling during a common surgical procedure was assessed. Materials and Methods: Nd:YAG laser and Urolase noncontact fibers with 7.5 F gold reflective surface tips have been used to treat benign prostatic hyperplasia since 1995. Nine gold Urolase fiber tips damaged during the procedure and one tip not used for the surgical procedure were analyzed. The surfaces and cross-sections of gold fiber tips used with an Nd:YAG laser were observed under a scanning electron microscope. In order to improve imaging quality, mirror cross-sections embedded in resin were analyzed. Results: The observations, both on the macro and micro scales, revealed a high degree of damage to the gold reflective tip surfaces. In order to observe changes taking place in the reflective surface structure, atomic maps of the studied fiber tips were obtained. Mixing of the atoms of the various elements present in the reflective surface structure was observed. The extent of this phenomenon was dependent on the energy applied during the surgery and on the duration of the procedure. Conclusion: The gold reflective surface tip of a Urolase fiber becomes damaged with inappropriate handling during visual laser ablation procedures. The amount of energy accumulated in the fiber tip leads to a considerable rise in temperature, which can be dangerous for living tissue and may lead to accidental damage of the urinary bladder wall or the urethra.