VISUAL LASER-ABLATION OF THE PROSTATE - A PRELIMINARY-REPORT

Objective: To report our preliminary experience with visual laser abla tion of the prostate (VLAP) for treating bladder outlet obstruction ca used by benign prostatic hyperplasia (BPH) and to evaluate its shortte rm outcome. Design: We reviewed our laser technique in 47 men with sym ptomatic obstruction caused by BPH who underwent VLAP between July 199 2 and April 1993 at our institution, and we compared our results with those reported in the literature. Material and Methods: Our 47 patient s were from 43 to 87 years old (mean, 69.6). The mean pretreatment Ame rican Urological Association symptom score was 22, mean peak flow rate was 9.5 mL/s, and mean postvoid residual urinary volume was 136 mt. N eodymium:yttrium-aluminum-garnet laser energy was delivered at the 2-, 4-, 8-, and 10-o'clock positions and, when necessary, to the median l obe by one of two lateral-firing laser probes. All but the first four patients were treated on an outpatient basis, and all patients were ca theterized (Foley catheter) for 2 to 10 days after VLAP. Results: Of t he 47 patients, 32 had data pertaining to a mean follow-up of 5 months ; they had a mean symptom score of 10, mean peak flow rate of 15.7 mL/ s, and mean postvoid residual volume of 63 mt. In 12 patients, data fr om a mean follow-up of 11 months were available; they had a mean sympt om score of 6, mean peak flow rate of 18.8 mL/s, and mean postvoid res idual volume of 10 mt. Perioperative complications (myocardial infarct ion, thrombophlebitis, and epididymitis) in three patients responded t o conservative therapy. Urinary retention occurred for 2 to 60 days af ter initial removal of the Foley catheter in 12 patients, who then had resumption of spontaneous voiding. In three patients who stated their condition was worse postoperatively, conventional transurethral resec tion of the prostate was done 6 months after VLAP, and a fourth patien t had a persistently obstructive bladder neck incised 8 months after V LAP. Conclusion: Our early experience and that reported in the literat ure indicate that VLAP is a safe and efficacious alternative treatment of obstructive BPH. Although the early results of VLAP rival those of transurethral resection of the prostate, the success rate in treating large prostates should be improved, and long-term results should be a ssessed to determine the durability of the beneficial effects.