TRANSURETHRAL EVAPORATION OF PROSTATE (TUEP) WITH ND-YAG LASER USING A CONTACT FREE BEAM TECHNIQUE - RESULTS IN 61 PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

Objective. This prospective study was undertaken to evaluate the safet y and efficacy of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser fo r treatment of symptomatic benign prostatic hyperplasia (BPH). Methods . A total of 61 patients at a mean age of 71.6 years with symptomatic bladder outlet obstruction due to BPH underwent transurethral evaporat ion of prostate (TUEP) using Nd:YAG laser. Twelve of the patients were experiencing acute retention. Pre- and postoperative evaluation consi sted of American Urological Association (AUA) symptom questionnaire an d a sexual function questionnaire, uroflowmetry, postvoid residual uri ne, electrolytes, blood urea nitrogen, creatinine, hematocrit, and pro state volume estimation by transrectal ultrasound. TUEP was achieved b y employing a side-firing Nd:YAG laser fiber with a durable quartz ref lector and high-power density (Ultraline, Heraeus LaserSonics, Milpita s, CA) that was used in a contact mode. Results. All patients have bee n evaluated for three months, 26 for six months, and 7 for twelve mont hs. Mean prostatic size was 41.1 g. The mean improvement in symptom sc ores at one, three, six, and twelve months was 69.8 percent, 70.9 perc ent, 76.0 percent, and 70.9 percent, respectively (P = < 0.0001). The mean increase in maximum uroflow at one, three, six, and twelve months was 63.4 percent, 66.7 percent, 41.94 percent, and 164.52 percent, re spectively (P = < 0.0001). There was no instance of significant fluid absorption or bleeding. The duration of postoperative catheterization was two days in 43 patients, three to seven days in 16 patients, and t wo to three weeks in 2 patients. There were no deaths. All patients ev aluated by TRUS at six months had open channeling defects. Videocystos copy performed in 1 6 patients at two to three months postoperatively revealed tissue slough. At repeat cystoscopy in these patients at six months, the prostatic fossa was completely healed with no evidence of tissue slough. Conclusions. It is concluded that the technique of TUEP using Nd:YAG laser is safe and, in preliminary results, appears appar ently effective in the management of BPH.