Four Urology Experts Discuss China's Pioneering 200W Blue Laser: Revolutionizing BPH Treatment Paradigms

Benign Prostatic Hyperplasia (BPH) is a common urination disorder among middle-aged and elderly men. The incidence of BPH increases with age. According to incomplete statistics, approximately half of men aged 51–60 suffer from prostatic hyperplasia, while 90% of those over the age of 80 are affected by BPH. Based on these figures, it is estimated that there are tens of millions of BPH patients in China. As the aging population trend intensifies, both the overall incidence rate and the number of BPH patients in China will continue to rise.

Clinically, patients with benign prostatic hyperplasia (BPH) frequently present with symptoms such as urinary frequency, urgency, nocturia, and dysuria. Severe prostatic hyperplasia can lead to urinary retention and may also cause hematuria, urinary tract infections, bladder stones, hydronephrosis, or exacerbate hemorrhoids and hernias, significantly impairing patients’ health and quality of life. BPH can thus be regarded as the “primary enemy” of men’s health.

Traditional treatment modalities for benign prostatic hyperplasia (BPH) include transurethral resection and laser therapy, with laser options encompassing holmium laser, greenlight laser, thulium laser, and others. Recently,The First Affiliated Hospital of Xi'an Jiaotong UniversityandBlueray MedicalCo-developedWorld's First 200W Output Power Blue Laser Surgical DeviceOfficially issued by the National Medical Products AdministrationClass III Medical Device Registration Certificate and Clinical Implementation. Sparked a paradigm shift in laser-based treatment for BPH.

How does blue laser therapy differ from existing laser treatments and transurethral resection of the prostate (TURP)? What innovations and clinical value does it truly bring to the treatment of benign prostatic hyperplasia (BPH)? What are the future development prospects and applications of blue laser technology? What are the perspectives and judgments of leading medical experts?

In response to this, VCBeat interviewedZhejiang Provincial People's Hospital, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, The First Affiliated Hospital of Anhui Medical University, Taian Central HospitalInterviews with leading experts were conducted to gain insights into their genuine perspectives, first-hand clinical experiences, and future outlook on blue laser therapy for benign prostatic hyperplasia (BPH).

Deputy Director, Department of Urology, Zhejiang Provincial People’s Hospital; Director, Center for Lower Urinary Tract and Andrology

Prof. Xu Zhihui

In the past, transurethral resection of the prostate (TURP) was considered the gold standard for treating benign prostatic hyperplasia (BPH) and was widely adopted by many county-level and prefecture-level hospitals. However, with continuous clinical validation and advancements in medical technology, it has been recognized that TURP requires general anesthesia, making it unsuitable for patients who are intolerant to anesthesia, elderly, or at high risk. Furthermore, this procedure involves larger incisions and significant blood loss, potentially necessitating intraoperative transfusions, which reduces surgical efficiency. It also carries risks such as water intoxication, incomplete resection, postoperative complications, and even mortality, rendering it inappropriate for patients with significantly enlarged prostates.

The subsequent rise of laser and minimally invasive techniques has, to some extent, challenged the gold-standard status of TURP.

In 1995, Professor Peter Gilling from New Zealand pioneered the publication of holmium laser enucleation of the prostate (HoLEP) worldwide. However, due to the high technical demands on surgeons and slow equipment iterations, the adoption rate of holmium laser technology in the United States remained below 40% over the subsequent three decades. Around 2012, with support from Lumenis, urologists in Japan and South Korea obtained improved equipment, which helped promote holmium laser therapy to some extent. Holmium laser treatment for benign prostatic hyperplasia was introduced to China around 2015. Nevertheless, given the steep learning curve and high technical requirements—often necessitating hundreds of cases for proficiency among general urologists—this therapeutic approach is currently more widely adopted in larger hospitals across China.Nationwide, the coverage rate of holmium laser application in prostate procedures is less than 20%, with primary-care physicians more frequently adopting transurethral resection.

In addition to the aforementioned holmium laser, thulium and green lasers are also available. Although thulium lasers can perform vaporization, their vaporization efficiency is relatively low, and they present issues regarding hemostasis and adverse reactions. Green lasers demonstrate effective vaporization; however, their hemostatic capability is somewhat inadequate. Furthermore, in subsequent product technology iterations and optimizations, manufacturers have focused solely on increasing machine power, resulting in stagnation and insufficient improvement in product performance and operational experience.

Blueray Medical has adopted a clever approach with its blue laser. The blue laser operates at a wavelength of 450 nm,QiUnparalleled conversion efficiency,During vaporization, tissue disintegrates instantaneously. It is well known that excessively effective vaporization may compromise hemostasis; this issue has long persisted with green laser technology and remains unresolved. The ingenuity of Blueray Medical lies in itsThe system is integrated with a 50W 980nm laser., thereby simultaneously supporting vaporization, enucleation, and hemostasis, expanding the scope of application, reducing surgical duration, and ensuring medical safety.

In summary, while various lasers each have their own strengths, overall,Blue laser can replace all the aforementioned lasers.For instance, prior to the advent of blue laser technology, the holmium laser was the premier tool for enucleation. Although manufacturers attempted to address hemostasis challenges by developing long-pulse-width lasers, the steep learning curve associated with mastering the holmium laser remained an insurmountable hurdle for all physicians. This poses a significant implementation barrier for individual hospitals, particularly at the prefecture and county levels where patient volumes are relatively low. It is difficult to require every physician in these settings to achieve proficiency, as competence in holmium laser application can only be attained through high-volume surgical practice. In contrast, the operation of blue laser systems is remarkably straightforward, andBlue laser can be used for both vaporization and enucleation, offering versatile functionality.

Compared with electrosurgical knives and holmium lasers, blue lasers are much easier to master, offering strong controllability that allows precise vaporization of targeted tissues with exact depth and extent. The deviceThere is almost no noise during use, and due to the high power of blue laser and fast vaporization speed, it can also greatly shorten the operation time.Experienced surgeons can master blue laser surgery after performing just four or five procedures, unlike electrosurgery, which requires at least 50 cases, and holmium laser surgery, which demands hundreds of cases to achieve proficiency.

Furthermore, Blueray Medical’s 200W blue laser system offers highly flexible power modulation, allowing adjustments based on patient-specific conditions and treatment requirements. For instance, a power setting of 70–80 W is suitable for enucleation, while a range of 150–200 W can be used for vaporization. In cases where there is a risk of bleeding, the 980 nm laser can be employed for hemostasis.

Although I have not been using blue laser for very long, I have already performed 30 to 40 BPH surgeries. The largest prostate removed weighed nearly 200 grams, and the oldest patient was a gentleman in his nineties. This highlights another major advantage of blue laser—Suitable for elderly, high-risk patients, and those using anticoagulants.

I believe the greatest value of blue laser lies in its accessibility.Because holmium lasers have a steep learning curve and demand high operational proficiency from physicians, their widespread adoption in primary care hospitals has been challenging. Blue laser technology, by contrast, is fundamentally different. For county- and city-level hospitals, it can become a highly popular product if priced reasonably. It places lower demands on physicians’ expertise, allowing them to use it with minimal training; its ease of use, combined with integrated 980 nm laser hemostasis, ensures both safety and efficiency. Patients no longer need to travel to major cities for treatment of benign prostatic hyperplasia (BPH), thereby truly facilitating tiered diagnosis and treatment and alleviating the uneven distribution of medical resources.

Deputy Director of the Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Chief Physician; M.D.; Master’s Supervisor

Prof. Kang Jian

In China, benign prostatic hyperplasia (BPH) is a common progressive condition in urology. BPH symptoms worsen over time, significantly impairing quality of life, and if left untreated, may lead to bladder, urinary tract, or kidney complications.

However, the current state of diagnosis and treatment is far from optimistic. The main reasons are threefold: first, many people believe that as they age, a decline in physical function is inevitable, and that frequent urination and slow urinary flow are normal phenomena, thus overlooking potential diseases.Low Awareness Rate; second, many elderly men are reluctant to seek medical care at hospitals, leading toLow Consultation Rate; third, being aware of their condition and experiencing relatively severe symptoms, but missing the optimal window for diagnosis and treatment due to fear of surgery, resulting inLow Treatment Rate. Yet despite the three major factors of low awareness, low consultation rates, and low treatment rates, our department still performs nearly 10 prostate surgeries per week, keeping physicians heavily occupied.

Traditional transurethral surgeries for benign prostatic hyperplasia (BPH), including transurethral resection and laser enucleation, can significantly improve symptoms and urinary flow rates. However, these procedures are associated with significant side effects, such as bleeding, urinary incontinence, and sexual dysfunction. Patients with cardiac conditions or coagulation disorders face an increased risk of substantial blood loss. Other interventional treatment options also involve a trade-off between symptom relief and the risk of complications.

We have currently performed over a dozen procedures using blue laser, and all these patients have recovered very well postoperatively, with no issues such as urinary incontinence or dysuria. The most memorable case involved a patient whose one leg was straightened only due to muscle atrophy from neuropathy and could not bend, while the other leg was normal and flexible. In such a situation, neither transurethral resection nor holmium laser could resolve the issue, but blue laser successfully vaporized the benign prostatic hyperplasia by maneuvering the endoscope. Ultimately, we completed the surgery smoothly using blue laser, and the patient was able to urinate independently after the procedure.

During intraoperative procedures, physicians must pay special attention to protecting critical structures, such as the urethral sphincter. Additionally, certain technical nuances should be observed; for instance, careful modulation of energy settings is required. At the bladder neck, inadvertent laser irradiation into the bladder cavity may occur, resulting in thermal injury to the bladder mucosa. To prevent this, physicians should reduce the laser energy output during treatment, ensuring that the emitted laser does not penetrate into the bladder. Furthermore, by distending the bladder with continuous irrigation fluid, vaporization can be achieved safely without unintended damage. Overall,Blue laser is a very safe and user-friendly device.. I recently performed a procedure on an 81-year-old patient with a volume exceeding 100 mL. The entire surgery took approximately 50 minutes. Throughout the operation, the patient remained fully conscious and was able to watch the entire process, even offering suggestions such as recommending ablation in specific areas. The whole experience was very relaxed and proceeded quite pleasantly.

To use an inappropriate analogy,"Surgeons using blue laser for surgery is like taking photos with a point-and-shoot camera.". As long as physicians can comprehend the anatomical structures, they can precisely target tissues with blue laser technology, resulting in a lower threshold for clinical application. In contrast, holmium laser enucleation and transurethral resection of the prostate (TURP) are akin to using a DSLR camera, requiring extensive training in parameter adjustment and operational techniques; these procedures feature a steep learning curve and impose demanding requirements on surgeons. I believe that the widespread adoption of blue laser technology will empower junior physicians to effectively address the clinical needs of many patients.

Therefore, for tertiary hospitals, blue laser can serve as a supplement toOvercomes the contraindications associated with traditional surgical methods, expanding applicability to patients who cannot tolerate anesthesia, have difficulty with limb positioning, or are taking anticoagulant medications.For prefecture- and county-level hospitals, blue laser technology empowers grassroots physicians to excel, enabling them to perform high-quality surgeries with maximal efficacy and safety, thereby allowing patients to receive treatment close to home.

To promote blue laser technology to more hospitals and benefit a wider patient population, the primary challenge is gaining physicians’ acceptance of the equipment and technique. Based on my own practice and that of colleagues around me, we are confident that blue laser technology is entirely safe and effective. The second key factor is pricing. To penetrate grassroots hospitals with limited budgets, the product must be affordably priced, while also addressing medical cost considerations such as whether consumables are single-use.

The First Affiliated Hospital of Anhui Medical University, Associate Chief Physician, Associate Professor, Ph.D. in Surgery, Master’s Supervisor

Professor Zou Zhihui

Blueray Medical’s 200W blue laser system is China’s first independently developed 200W blue laser and the world’s first of its kind, currently offering the fastest vaporization speed among laser devices on the market. This device features strong vaporization capability, minimal thermal penetration injury, excellent hemostasis, shorter operative times, and ease of mastery.

Currently, holmium laser, red laser, and green laser devices used in clinical surgery mostly suffer from drawbacks such as insufficient vaporization efficiency, deep tissue damage, high equipment costs, and excessive noise. To date, I have performed over 100 BPH surgeries using the blue laser surgical system. In my experience, compared with other laser-based prostate surgeries and TURP, blue laser offers the following distinct advantages:

First, the blue laser is currently the energy platform with the fastest vaporization rate for the prostate, and it will redefine prostatic vaporization surgery.The Blue Laser Surgical System achieves satisfactory vaporization efficiency at an output power of 150W. Its 200W output represents the highest-power BPH laser currently available worldwide, delivering superior tissue vaporization efficiency. It effectively vaporizes prostatic tissue obstructing the urethra. Furthermore, due to the inherent hemostatic properties of blue laser technology, intraoperative hemostasis is rarely required. For a 30ml prostate gland, the entire procedure—from endoscope insertion to withdrawal—can be completed in just five minutes. This significantly reduces operative time, lowers surgical and anesthesia risks for patients, and enhances satisfaction among both physicians and patients.

Second, blue laser is currently the BPH laser with the shallowest thermal penetration depth worldwide, resulting in minimal tissue thermal injury.The blue laser has a wavelength of 450 nm, with a thermal penetration depth of only 0.1 mm. This is largely consistent with the color of the prostatic wound surface observed during surgery and the postoperative recovery from lower urinary tract symptoms (LUTS). During blue laser prostatectomy, the color of the entire surgical wound closely resembles that of normal human prostatic tissue, without eschar formation. Furthermore, the 450 nm blue laser is primarily absorbed by hemoglobin and not by water, thereby avoiding the tissue thermal injury associated with the inherent water-heating effect of other lasers. Consequently, patients experience rapid recovery from postoperative LUTS. Additionally, we have not observed a decline in sexual function following blue laser treatment for benign prostatic hyperplasia (BPH), a complication sometimes seen after green laser vaporization.

Third, the blue laser delivers stable energy output with a controllable range and broad indications. The system is complemented by a red laser with superior hemostatic performance, resulting in virtually no intraoperative bleeding and eliminating concerns about difficult-to-control hemorrhage from major blood vessels. It is suitable for treating elderly patients with chronic conditions such as hypertension, coronary heart disease, diabetes, chronic bronchitis, and emphysema.. Including patients as old as 98 years and those on anticoagulants, the procedure remains safe and feasible, fully meeting the hospital’s requirements for day surgery.

Fourth, the blue laser surgical system is simple to operate, easy to master, and has a short learning curve, potentially becoming the first device to overcome the challenges in promoting laser treatment for benign prostatic hyperplasia (BPH) at primary healthcare institutions.There is a significant disparity in the proficiency of laser prostate surgery across hospitals in different regions of China, with surgical volume being a key contributing factor. As a leading provincial hospital, our institution performs nearly 1,600 benign prostatic hyperplasia (BPH) surgeries annually. Most Grade A tertiary hospitals also perform over 300 BPH procedures per year, whereas most county-level hospitals may only conduct a few dozen. Furthermore, within the urology department of a single hospital, there are multiple surgeons, meaning the individual surgical volume for each doctor is even lower. Taking traditional holmium laser enucleation of the prostate (HoLEP) as an example, although physicians in high-volume centers can shorten their learning curve through extensive practice, they still require at least 50 cases to achieve competency. This presents a practical challenge for most county-level physicians. In contrast, blue laser vaporization of the prostate features a simpler operational technique, with a learning curve of only 2–10 cases, making it more conducive to promotion in primary care hospitals.

Furthermore, existing green laser systems require specially modified 30A AC power supplies, whereas blue laser systems can operate on standard 15A AC power.No special power plug is required; any power outlet in the room will suffice, including those in the operating room.. Moreover, when performing consecutive surgeries, we previously observed a significant rise in operating room temperature with green laser systems. However, due to the lower power consumption of blue lasers, this issue of excessive heat buildup during prolonged laser operation is avoided. This helps maintain a relatively lower temperature in the operating room, thereby reducing the potential for bacterial proliferation.

My greatest impression after using blue laser is“Smooth and Easy”For instance, a 60-gram green laser vaporization of the prostate typically takes over an hour, leading to surgeon fatigue after consecutive procedures. In contrast, blue laser vaporization of the prostate is generally completed within half an hour, which I find quite satisfactory. Once surgeons have performed a certain volume of procedures, their focus shifts from merely completing the surgery to emphasizing the experience and comfort during the process. The ability to perform a procedure with ease and satisfaction is highly rewarding. If one must identify a drawback of the blue laser, it would be the relatively high intensity of its visible light component; however, Blueray Medical provides protective eyewear that effectively addresses this issue.

Taian Central Hospital, M.D., Chief Physician, Master’s Supervisor at Shandong First Medical University and Qingdao University

Prof. Yongwei Zhao

Since the introduction of laser therapy for benign prostatic hyperplasia (BPH) in China, I have gained experience with virtually all types of lasers. Currently, holmium lasers and green-light lasers are the most commonly used in hospitals, representing two distinct surgical approaches: enucleation and vaporization, respectively.

Green laser, as the previous representative of vaporization technology, mainly has two issues. First, its penetration depth is shallow; the wavelength of green laser (532 nm) is still slightly long, resulting in low vaporization efficiency of prostate tissue and prolonged surgical time. Second, it is relatively difficult to achieve hemostasis with green laser when encountering active bleeding during surgery.

As a novel laser representing vaporization techniques, the blue laser effectively addresses the aforementioned issues. First, the power output of the blue laser has been increased to 200 W, making it the laser with the highest wattage and power currently available. The maximum wattage of American green lasers is 180 W, while the common maximum wattage of domestically produced green lasers is 160 W. The blue laser isThe fastest vaporization speed among all current lasers; secondly, blue laser, due to its shorter wavelength, possesses superior efficiency in tissue vaporization and cutting, whileAppropriate Coagulation Layer Thickness, meetingMinimal peripheral tissue damage, excellent visibility, absence of obturator nerve reflex, minimal intraoperative bleeding, no carbonized tissue, and rapid postoperative recovery., its intraoperative sealing and management of tissue vasculature is superior to that of green laser; furthermore,Blue laser is more tolerant of the surgical operating environment,It enables treatment without requiring a fluid-rich environment, thereby expanding the application scenarios for laser surgery.

Typically, gaining clinical acceptance for a new laser product takes several years. However, after just two months of trial use, the hospital decided to purchase it and established a dedicatedDay Surgery Unit for Blue Laser Prostatectomy, as we are fully aware of the advantages and disadvantages of various laser systems currently available. Blue laser technology effectively overcomes all these drawbacks, pioneering a new treatment paradigm for patients with benign prostatic hyperplasia (BPH) and facilitating the adoption of ambulatory surgical models.

Each surgeon has a distinct operative style. Our current approach to treating benign prostatic hyperplasia (BPH) is relatively conservative, with the largest prostate volume treated being 80 mL; we have successfully performed over 50 such procedures. Just a couple of days ago, we completed surgery on a centenarian in only 10 minutes—a feat that would have been unimaginable in the past. For smaller cases of BPH with prostate volumes around 30 grams, the procedure takes merely 4–5 minutes; for those around 60 grams, it can be completed in approximately 20 minutes. This efficiency significantly surpasses the typical operative times for transurethral resection or plasma kinetic resection performed by most surgeons.

Moreover, during the surgical procedure, blue laserPrecise cutting with a very clean wound surface, shallow penetration depth, minimal damage to surrounding tissues, and no thick eschar formation in the cut tissue.The tissue surface remains fresh while hemostasis is achieved, thereby promoting better wound healing and faster recovery. Patients can undergo surgery on the same day and be discharged the next day.

During our morning ward rounds on the Mid-Autumn Festival, patients who had undergone blue laser surgery the previous day were catheter-free and discharged, with particularly smooth urination. The normal white blood cell count in the morning urinalysis at discharge indicated that the blue laser elicited minimal wound trauma and inflammatory response. Blue laser prostatectomy enables discharge within 24 hours postoperatively, achieving true day-case surgery.