HISTOPATHOLOGICAL CHANGES IN HUMAN PROSTATIC ADENOMA FOLLOWING NEODYMIUM-YAG LASER-ABLATION THERAPY

Transurethral laser ablation of the prostate is a procedure currently under evaluation as an alternative to transurethral resection of the p rostate in the management of benign prostatic hyperplasia. Removal of prostatic tissue by endoscopic resection or open surgical techniques f rom 7 patients in whom prostatic laser ablation was previously attempt ed offered an opportunity to evaluate the sequential effects of such e nergy upon the human prostate at varying intervals after treatment. A progressive inflammatory and necrotic response, initially akin to that demonstrated after a thermal burn, together with evolving vascular ch anges within the residual viable prostatic tissue were demonstrated. O ur study demonstrates the changes in the human prostate whereby neodym ium:YAG laser energy causes a deep coagulative necrosis and arterial t hrombosis in the prostatic adenoma. These changes differ significantly from those noted in canine studies. A slower cavitation effect is obs erved in the human compared with the canine, and this finding mirrors the continuing clinical improvement in voiding parameters with time.