Urolase v Ultraline fibers in laser prostatectomy: 3-year follow-up of a randomized study

Recently, laser treatment of the prostate has been added to the urologist's armamentarium for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), Until now, limited data on long-term o utcome are available notwithstanding the fact that such information is cruc ial in determining the ultimate role of laser prostatectomy in the treatmen t of BPH, We now have 3-year data of a comparative study using the Urolase and Ultraline fiber in Nd:YAG sidefiring laser prostatectomy, The study was performed to compare laser prostatectomy using a pure coagulation (Urolase fiber) and a combination of a coagulation and vaporization (Ultraline fibe r). In a period of 15 months, 93 men were randomized for laser treatment wi th the Ultraline fiber (N = 44) or the Urolase fiber (N = 49), Symptom scor es, maximal uroflow, postvoiding residual volume, and sexual history were n oted over a 3-year period. Adverse events and retreatments were also record ed. The mean postoperative catheterization time was 18 days, without signif icant difference between the two groups. After 3 years, we demonstrated a d urable improvement in maximal flow rate, from 7.8 to 13.9 mL/sec in the Uro lase group and from 7.9 to 13.6 mL/sec in the Ultraline group. In both grou ps, however, a considerable decrease in the maximal flow rate was noted aft er 3 years compared with 3 months after treatment, from 18.7 to 13.9 mL/sec in the Urolase group and from 20.0 to 13.6 mL/sec in the Ultraline group. The symptom scores showed marked and lasting improvement. The postvoiding r esidual urine volume became very low in the early postoperative period but did significantly increase after 3 years; nevertheless, it was still only 5 0% of the preoperative value, Although after 3 years, the maximal uroflow r ate was still significantly improved compared with baseline, a considerable decrease was noted when compared with the early postoperative value. The s ame considerable and lasting improvement in subjective outcome (symptom sco res) was seen in both groups. Although the Ultraline fiber also causes vapo rization of prostatic tissue, no differences could be noted in the clinical outcome obtained with the two fibers.