Interstitial laser coagulation in benign prostatic hyperplasia: A criticalevaluation after 2 years of follow-up

Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction wh o underwent interstitial laser coagulation (ILC) of the prostate. We evalua ted the safety and efficacy of ILC with respect to relief of symptoms and b ladder outlet obstruction. In addition to the critical evaluation of our cl inical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, includi ng prostate size, number of sticks per prostate volume and type of applicat ion. A total of 59 patients were treated with the Nd-YAG laser (mediLas fib ertom) between April 1993 and December 1996. At the time of reevaluation, 4 7 patients had completed a follow-up of up to 24 months. A perineal approac h was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% wer e high-risk patients in accordance with the ASA score (ASA III). The effica cy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in acco rdance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volum e reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A signific ant improvement in all voiding parameters (flow rate, residual volume), inc luding the symptom score, was observed. P-det decreased from an average of 90 cm H2O preoperatively to 42 cm H2O postoperatively after 24 weeks and th e mean reduction in prostate volume was 14 cm(3). Interestingly, it was not ed that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed a nd the improvemen t in objective and subjective parameters. In view of the low morbidity outc ome, especially in highrisk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia.