Amy Steigler, Henry H Woo
The 450 nm blue diode laser is a recently proposed minimally invasive treatment for benign prostatic obstruction. Its energy is strongly absorbed by haemoglobin and poorly by water, producing efficient vaporisation with a thin coagulation zone. This mini review synthesises the existing literature, comprising six clinical studies (four retrospective series, one prospective cohort, and one early randomised trial), two preclinical studies (an in vitro study and a canine study), and one narrative review. Across clinical studies, blue-light laser surgery achieved short-term urinary outcomes comparable to 532 nm photoselective vaporisation of the prostate (PVP), with a favourable perioperative profile in older men at high risk and superior preservation of erectile and ejaculatory function. The evidence is preliminary, with most studies being retrospective and single centre, and with follow-up rarely beyond 6 mo. Blue-light laser is a promising surgical treatment option for benign prostatic obstruction with theoretical advantages >532 nm PVP, which are yet to be confirmed by further clinical studies. PATIENT SUMMARY: Surgery for an enlarged prostate relieves urinary symptoms but can affect sexual function and cause bleeding. We reviewed early studies of a blue diode laser. It appears to work as well as existing methods in the short term, with less bleeding and better preservation of sexual function, though long-term evidence is currently lacking.