A RANDOMIZED STUDY COMPARING VISUAL LASER-ABLATION AND TRANSURETHRAL EVAPORATION OF PROSTATE IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

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.