P. Narayan et al., A RANDOMIZED STUDY COMPARING VISUAL LASER-ABLATION AND TRANSURETHRAL EVAPORATION OF PROSTATE IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA, The Journal of urology, 154(6), 1995, pp. 2083-2088
Purpose: We evaluated the safety, efficacy, failure and complications
of 2 techniques of laser prostatectomy for benign prostatic hyperplasi
a (BPH): transurethral evaporation of the prostate (evaporation) versu
s visual laser ablation of the prostate (coagulation) in a randomized
trial. Materials and Methods: A total of 64 consecutive patients with
symptomatic BPH was randomized to undergo evaporation (32) or coagulat
ion (32). American Urological Association symptom score, peak urinary
flow rate and post-void residual urine volume were measured at baselin
e, and at 1, 3, 6 and 12 months. Other parameters evaluated included p
rostate volume by transrectal ultrasound, total laser energy per patie
nt and per cc volume of the prostate, number of laser fibers per prost
ate, duration of catheterization and hospitalization, need for re-cath
eterization, and failure and complication rates. Results: Our main fin
dings were that patients undergoing laser prostatectomy using the coag
ulation technique (visual laser ablation of the prostate) had higher r
eoperation rates (16% versus 0%, p = 0.0199) and were 4 times more lik
ely to have prolonged postoperative urinary retention (25% versus 6.3%
, p = 0.0389), evaporation and coagulation were effective at relieving
symptoms of prostatism with significant improvement in American Urolo
gical Association symptom scores and post-void residual urine volumes
compared to baseline, improvement in peak flow rates was significantly
greater in patients undergoing evaporation at 1, 3, 6 and 12 months (
p < 0.001) compared to coagulation, and a significantly greater amount
of laser energy was required to evaporate a unit volume of prostate t
issue compared to coagulation (2,251 J./cc versus 1,036 J./cc, p < 0.0
3). Conclusions: Between the 2 major techniques of laser prostatectomy
, transurethral evaporation is associated with better results at up to
12 months of followup.