LASER PROSTATECTOMY - OUR INITIAL EXPERIENCE OF A TECHNIQUE IN EVOLUTION

Recently great interest has been generated in alternatives to transure thral resection for benign prostatic hyperplasia. Lasers are currently being assessed, but marketing has for the moment outstripped basic sc ience. A cystoscopic approach was used delivering Nd:YAG or KTP laser energy via forward and sidefiring fibers and contact tip devices in 51 patients. The sidefiring device is intended to coagulate a volume of prostate that subsequently sloughs, leaving a cavity. Treatment of the apical and middle lobe tissue using this technique was unsatisfactory . A further disadvantage was the interval between treatment and improv ement in urine flow, which was approximately 6 weeks. The use of tempo rary prostatic stents has helped to overcome this delay in treatment e ffect. Encouraging early results have been achieved using forward-firi ng fibers to treat apical and middle lobe tissue. The use of contact t ip devices to perform bloodless prostatotomies in combination with sid efire or bare fiber has also proved useful. Laser prostatectomy is an exciting field with considerable potential but remains in the developm ental stage.