A MULTICENTER, RANDOMIZED, PROSPECTIVE-STUDY OF ENDOSCOPIC LASER-ABLATION VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE

Objectives. To assess the safety and efficacy of endoscopic laser abla tion of the prostate (ELAP), performed with the Urolase fiber and the neodymium:yttrium-aluminum-garnet laser, compared to transurethral res ection of the prostate (TURP) in patients with bladder outflow obstruc tion secondary to benign prostatic hyperplasia (BPH). Methods. In this multicenter, prospective, randomized study, a total of 151 patients w ere treated (ELAP, 76; TURF, 75) of whom 137 completed 1 year follow-u p (ELAP, 67; TURF, 70). Safety parameters included measurement of preo perative and 24-hour postoperative sodium, hematocrit, and hemoglobin values and careful monitoring of adverse events. Efficacy was assessed with the American Urological Association symptom score (6), urinary f low rates, and residual urinary volume measurements. Results. There wa s 1 death in each group during the study period unrelated to the treat ment procedure. There was a clinically significant improvement in all efficacy parameters in both groups. Between group comparisons favored TURF in maximum flow rate, residual urinary volume, and symptom score. ELAP had a bet ter safety profile than TURF in the defined safety par ameters of drop in hemoglobin and hematocrit values. In 16% of patient s, a blood transfusion was required after TURF compared with no transf usions in the ELAF group. Urinary tract infections and dysuria were mo re frequent in the ELAP group. Conclusions. ELAP performed with the Ur olase fiber is a useful alternative therapy to TURF in patients presen ting with bladder outflow obstruction secondary to BPH.