Preclinical Evaluation of Dual-Fiber Laser Ablation for Controlled Thermal Necrosis in Bovine Prostate Tissue Using the EchoLaser X4 System.

Introduction Benign prostatic hyperplasia is a common condition among aging men and a major cause of lower urinary tract symptoms that can significantly impact quality of life. The condition often leads to increased healthcare utilization and may require intervention when medical therapy is insufficient. Focal laser ablation has emerged as a minimally invasive technique that enables targeted tissue destruction while preserving surrounding structures. The EchoLaser X4 system (Elesta S.p.A., Calenzano, Florence, Italy) utilizes a dual-fiber configuration designed to optimize thermal distribution and lesion symmetry. Methods Seven bovine prostate specimens underwent ex vivo laser ablation using the EchoLaser X4 system. Two optical fibers were positioned 10 mm apart and inserted 2 cm into the tissue. Each fiber delivered up to 1000 J at 5 W. Temperature measurements were recorded at 300, 500, 800, and 1000 J. Lesion dimensions were measured in three axes, and volumes were calculated using ellipsoid geometry. Results Temperature increased in a predictable manner with escalating energy delivery, reaching mean values of 29.6°C, 37.3°C, 47.5°C, and 56.4°C at 300, 500, 800, and 1000 J, respectively. The mean necrotic volume was 2,457 mm³ (±184), with lesions demonstrating consistent ellipsoidal morphology. No evidence of thermal runaway, vaporization, or carbonization was observed. Conclusion Dual-fiber laser ablation with the EchoLaser X4 system produced controlled, reproducible tissue necrosis, supporting further investigation as a focal therapy modality for benign prostatic hyperplasia.