Contact laser treatment for benign prostatic hypertrophy

Transurethral resection of the prostate (TURP) is still the standard treatment of benign prostatic hypertrophy (BPH) but the surgical lasers recently introduced seem to offer the patient a very low perioperative complication rate, a short learning curve, the reduced operating time and the health care system a very low cost/benefit ratio. We report our personal experience with contact vaporizing laser ablation of the prostate (CLAP) paying attention to efficacy, safety and costs. Between December 94 and March 97, 67 pts (mean age 62.8 +/- 9 years) underwent CLAP for BPH (mean prostate volume 40.4 +/- 17.1 cc). Five pts presented coagulation disorders, five were renal transplant recipients and one had chronic renal failure requiring peritoneal dialysis. All patients were preoperatively submitted to digital rectal examination, transrectal prostatic ultrasound, dosage of serum PSA, determination of the International Prostatic Symptom Score (IPSS), the post voiding residual urine and maximum flow rate. All these exams were repeated at 1, 3, 6, 12 and 24 months after CLAP. The bladder pressure at maximum flow (Pdet-Qmax) was preoperatively determined in 23 patients and repeated at the six months follow up. For CLAP we used an SLT neodynium-YAG laser or diode laser with maximum potency 60 W. For statistical analysis we used Student's t-test for paired data. The mean operating time was 47.9 +/- 12.5 min (range 18-75 min) and the laser energy averaged 17.707 +/- 11.239 J (range 3000-58,000 J). The mean catheter time after CLAP was 2.5 days and the mean hospital stay was 4.8 days. No intraoperative complications occurred. Two patients 48/72 h after surgery presented macrohematuria requiring laser revision, three patients presented an acute urinary retention post catheter removal and one patient had acute prostatis. At the follow up, the IPSS score, Q max, Pdet-Qmax and PVU showed a significant statistical difference respect to baseline values. The prostate volume at the 180-day follow up was not significantly different from baseline values (42.1 +/- 16.8 cc vs 40.4 +/- 17.1 cc). Contact laser ablation of the prostate has been demonstrated to be efficacious and comparable to TURP in relieving BPH obstruction however the higher costs exceeding the TURP ones by 13%, the longer operative times and the lower durability of laser disobstruction impede to replace TURP with the CLAP.