TRANSURETHRAL ULTRASOUND-GUIDED LASER-INDUCED PROSTATECTOMY - OBJECTIVE AND SUBJECTIVE ASSESSMENT OF ITS EFFICACY FOR TREATING BENIGN PROSTATIC HYPERPLASIA

We describe our experience with transurethral ultrasound-guided laser- induced prostatectomy (TULIP), a new procedure to relieve bladder outl et obstruction caused by benign prostatic hyperplasia. This device is composed of a real-time 7.5 MHz ultrasound transducer coupled to a Nd: YAG laser that fires through an intraprostatic balloon. To date, we pe rformed 16 TULIP procedures; all patients were evaluated from a subjec tive point of view by a questionnaire based on the Boyarsky scale. The y all underwent complete urodynamic studies, including flowmetry with measurement of the residual volume (by catheter) and pressure/flow stu dies. Preoperative symptom score ranged between 7 and 14 (mean 11.4). Preoperative peak flow rates ranged between 0 and 13 ml/s (mean 6.8). Suprapubic drainage was kept for a mean of 11.6 days after the procedu re (7-20 days). Postoperative acute retention was observed in 4 patien ts (25 %) 5-7 days after the procedure. In 13 out of 16 patients, urod ynamic obstruction was corrected by the procedure. Two patients kept a borderline obstruction. In 1 case transurethral resection of the pros tate (TURF) was performed for persisting obstruction and in another ca se TURF was performed for persisting untreatable irritative symptoms. At 3 months after the operation, the Boyarsky symptom score(l 1 patien ts) ranged between 3 and 12 (mean 7.7) and peak flow rates ranged betw een 11 and 30 ml/s (mean 16.3). One patient is managed with a suprapub ic tube. Retrograde ejaculation was observed in 2 out of 9 patients (2 2.2%). With a mean follow-up of 6.7 months, we did not observe any lat e complication.