NEODYMIUM-YTTRIUM-ALUMINUM-GARNET LASER PROSTATECTOMY

Since 1986, benign prostatic hyperplasia has been treated with lasers, but clinical use was not practical until the right-angled fiber was d eveloped in the early 1990s, The neodymium:yttrium-aluminum-garnet (Nd :YAG) laser is one of four types available for treating the prostate. Laser energy levels can be adjusted to provide coagulation (at lower e nergy densities) or vaporization (at higher energy densities). In a ra ndomized study of these two techniques, symptom scores were similar at 1-year follow-up, but the peak urinary flow rate was higher and the r eoperation rate was loner in the patients who received vaporization tr eatment. In randomized investigations that have compared laser prostat ectomy and transurethral resection of the prostate (TURP), symptom sco res and urinary flow rates improved in both groups, but results were s omewhat better after TURF. Cumulative data for 3-year follow-up after laser prostatectomy have shown that the improved symptom scores and ur inary flow are durable, The major disadvantages with use of Nd:YAG pro statectomy are delayed time to voiding, posttreatment dysuria (which o ccurs in 15 to 30% of patients), and total cost. Overall, Nd:YAG prost atectomy has both pros and cons, In comparison with TURF, the laser pr ocedure is shorter, has fewer complications, can be done on an outpati ent basis, and provides quicker recovery and equivalent results.