ENDOSCOPIC LASER THERAPY FOR PROSTATIC OU TFLOW OBSTRUCTION

As part of the search for alternatives to transurethral resection of t he prostate (TURP) attention has (re)turned to laser methods. We descr ibe our experience with the currently available endoscopic beam deflec tion devices, particularly the Prolase II. 25 patients, generally with medical reasons to avoid TURP, and with proven bladder outlet obstruc tion (BOO) due to benign prostatic enlargement (BPH) underwent prostat ic laser coagulation. Average age was 72 years (range 57-84), mean pro static size by transrectal ultrasound (TRUS) was 48 g (15-100), averag e pretreatment peak flow rate (FR) was 7.6 ml/s (4.56-12.4). All patie nts were markedly symptomatic. Patients underwent clinical examination , Prostate specific antigen assay (PSA = 3.75, range 0.1-10.2), and TR US preoperatively to exclude prostate cancer. After cystoscopic assess ment the prostate was lasered according to the device manufacturers re commendations and clinical experience. A suprapubic catheter (SPC) and urethral catheters were inserted, the urethral for 24 hours. If voidi ng was satisfactory the SPC was removed after 24-48 hrs. Alternatively the patient was discharged and assessed at weekly intervals for SPC r emoval. Mean duration of SPC drainage was 11 days. Total mean impatien t stay was 4.5 days (2-13) during a mean of 2 admissions. Blood loss w as minimal and there were no other significant complications. At a min imum follow up of 3 months mean peak FR was 15.3 ml/s (9-31). Symptom scores (IPSS) fell from a mean of 21 to 10 by 3 months after treatment . There was an initial period of irritability for up to 12 weeks but s ymptomatic improvement was noted in all.