Laser prostatectomy: Two and a half years' experience with aggressive multifocal therapy (original) (raw)
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Urodynamics and laser prostatectomy
World Journal of Urology, 1995
A total of 81 patients with symptomatic bladder-outlet obstruction (BOO) due to benign prostatic hyper plasia (BPH) underwent visual laser ablation of the prostate (VLAP) using a right-angled firing neodynium: YAG laser. The mean pre-operative prostatic volume was 48.5 ml. All patients were discharged on the 1st post-operative day with an indwelling catheter. Two patients underwent a trans urethral prostatectomy (TURP) after failing a trial without catheter on two occasions. O f the remaining 79 patients, 75 were evaluated 6 months post-operatively. Mean symp tom scores (I-PSS) decreased from 20,9 to 5.8, the mean maximal urinary flow rate increased from 7.9 to 16.4 ml/s and the mean residual volume decreased from 88.1 to 15.6 ml. Several different methods of evaluating BOO from pressure-flow measurements were used and all showed im provement. All the above-mentioned parameters showed a highly significant improvement (P <0.01) at 6 months.
Nd:YAG laser ablation plus transurethral resection for large prostates in high-risk patients
Urology, 2003
Objectives. To evaluate the outcome and morbidity rate of combined visual laser ablation of the prostate and transurethral resection of the prostate (TURP) in high-risk symptomatic patients with large prostates. Methods. A total of 28 patients evaluated according to the American Society of Anesthesiologists (ASA) classification to have ASA grade 3 or greater and who had a prostate volume of 50 cm 3 or greater, and peak urinary flow rate of less than 15 mL/s underwent visual laser ablation of the prostate plus TURP for severe lower urinary tract symptoms due to benign prostatic hyperplasia. The postoperative evaluation included the American Urological Association symptom score index, maximal urinary flow rate measurement, postvoid residual urine volume, and morbidity. Results. The mean baseline prostate volume and duration of surgery was 85 cm 3 (range 50 to 120) and 70 minutes (range 55 to 105), respectively. Surgery was performed under local and spinal anesthesia in 18 and 10 patients, respectively. No perioperative bleeding requiring transfusion or TURP syndrome developed. Urethral catheter drainage was continued for an average of 1.7 days. Only 1 patient developed irritative voiding symptoms. The postoperative follow-up period ranged from 6 to 21 months (median 11). Improvement in the evaluation parameters was noted in all cases. Conclusions. The results of our study show that visual laser ablation of the prostate plus TURP has the advantage of excellent homeostasis and lower morbidity in men with large prostates. When the patient's medical condition precludes TURP, this combination of techniques may be considered an option in such cases for symptomatic relief of obstructive urinary symptoms due to benign prostatic hyperplasia. UROLOGY 62: 914-917, 2003.
Nd:YAG laser ablation of the prostate as a treatment for benign prostatic hypertrophy
Lasers in Surgery and Medicine, 1992
Many techniques have been used to relieve obstructive symptoms associated with benign prostatic hypertrophy. Transurethral resection of the prostate (TURP) with an electrocautery loop is the most commonly performed operation to relieve bladder neck and urethral obstruction caused by prostatic adenoma. There is increased interest in alternative therapies to reduce prostatic size for symptom relief in this condition. We describe a technique using the neodymium:YAG (NdYAG) laser and a 600-pm laser quartz fibre with an attached terminal gold-plated metal alloy reflector to provide reliable deep penetration into prostatic tissue for prostatic adenoma ablation. We report the first use of this technique in three patients with benign prostatic obstruction and one with localised adenocarcinoma of the prostate. 0 1992 Wiley-Liss, Inc.
Urology, 1998
Objectives. To directly compare holmium laser resection of the prostate (HoLRP) with neodymium:yttriumaluminum-garnet visual laser ablation of the prostate (VLAP), which represent two fundamentally different methods of laser prostatectomy. Methods. In a randomized, prospective comparison, a total of 44 men with symptomatic benign prostatic hyperplasia (BPH) were treated with either HoLRP or VLAP. Standard preoperative assessment included American Urological Association (AUA) symptom score, peak urinary flow rates (Qmax), ultrasound prostate volume, and residual urine measurements. Pressure-flow urodynamics were performed preoperatively and at 3 months postoperatively. Intraoperative and perioperative factors were assessed. The patients were followed at 1, 3, 6, and 12 months following the procedure. Results. There were no significant differences between the patient groups for any preoperative parameter. The mean total operating time was longer in the HoLRP group (52 minutes) compared with the VLAP group (41 minutes) (P Ͻ0.01). The mean catheter times were 1.4 days (HoLRP) and 11.6 days (VLAP) (P Ͻ0.001). These times included the 9% of patients undergoing HoLRP and 36% of patients undergoing VLAP who required recatheterization. Immediate postoperative dysuria scores were higher in the VLAP group compared with the HoLRP group. There were no significant differences in AUA scores between the two treatment groups at any postoperative interval. The Qmax values were greater at follow-up in the HoLRP group, but statistical significance was not achieved at 12 months. However, both PdetQmax and Schä fer grade measurements taken at 3 months postoperatively were significantly lower in the patients undergoing HoLRP. Three patients (14%) required reoperation in the VLAP treatment arm but no patient who underwent HoLRP has required reoperation to date. Conclusions. HoLRP results in significantly improved patient outcomes compared to VLAP. UROLOGY 51: 573-577, 1998.
New techniques for laser prostatectomy: an update
Therapeutic Advances in Urology, 2009
Traditionally, the gold standard for treatment of BPH has been the electrocauterybased TransUrethral Resection of the Prostate (TURP). However, the number of laser techniques being performed is rapidly increasing. Potential advantages of laser therapy over traditional TURP include decreased morbidity and shorter hospital stay. There are several techniques for laser prostatectomy that continue to evolve. The main competing techniques are currently the Holmium Laser Enucleation of the Prostate (HoLEP) and the 80W 532nm laser prostatectomy. The HoLEP, using the Holmium:YAG laser, has been shown to have clinical results similar to TURP and is suitable for patients on anticoagulation as well as those with large prostates. Disadvantages of this technique are the high learning curve and requirement of a morcellator. When used to treat BPH, studies have demonstrated that, like the HoLEP, the 80W KTP laser is safe and effective in patients with large prostates and in those taking oral anticoagulation. Several studies have compared these two techniques to TURP. Frequently reported advantages of the HoLEP over the 80W laser prostatectomy are the availability after the procedure of a pathology specimen and ability to remove a higher percentage of prostate tissue during resection. However, the transurethral laser enucleation of the prostate addresses these concerns and has shown to have durable outcomes at 2-year follow-up. Two new laser systems and techniques, the thulium laser and the 980nm laser, have emerged recently. However, clinical data from these procedures are in their infancy and large long-term studies are required.
Update on the use of diode laser in the management of benign prostate obstruction in 2014
World Journal of Urology, 2014
Aim To determine the status quo in respect of various diode lasers and present the techniques in use, their results and complications. We assess how these compare with transurethral resection of the prostate and other types of laser in randomized controlled trials (rcTs). When adequate rcTs were not available, case studies and reports were evaluated. Materials and methods Laser for the treatment of benign prostatic hyperplasia (BpH) has aroused the interest and curiosity of urologists as well as patients. The patient associates the term laser with a successful and modern procedure. The journey that started with coagulative necrosis of prostatic adenoma based on neodymium: yttrium-aluminum-garnet (Nd:YaG) laser has culminated in endoscopic "enucleation" with holmium laser. Diode laser is being used in urology for about 10 years now. Various techniques have been employed to relieve bladder outlet obstruction due to BpH. Results The diode laser scenario is marked by a diversity of surgical techniques and wavelengths. We summarize the current published literature in respect of functional results and complications. Conclusion More randomized controlled studies are needed to determine the position and the ideal technique of diode laser treatment for BpH.