Laser prostatectomy under local anaesthesia in patients with acute retention of urine: relieving unfit patients of the necessity for long-term catheterisation

We evaluated the efficacy and complications of laser prostatectomy, under l ocal anaesthesia, in patients with acute retention of urine who were not fi t for general or spinal anaesthesia. This was a pilot study using the Indig o 830E laser device. Fourteen patients, from February 1996 to March 1997, w ho presented in urinary retention and were deemed unfit. for transurethral resection of the prostate, underwent laser prostatectomy. Diclofenac and 1% lignocaine, injected periprostatically, were used as local anaesthesia. At initial catheterisation, urine volume ranged from 700 to 2000 mL (median = 1262.5 mL). The prostate size on transrectal ultrasound was in the range 2 0-97 g (median = 48.5 g). At a mean follow-up of 8 months, 10 of the 14 pat ients are voiding. Three patients died in this period of unrelated medical causes, two voiding spontaneously and one still catheterised, having failed a trial of void. One patient still remains catheter dependent. Mean time t o catheter removal was 35 days (15-62). Mean international prostate symptom score (IPSS), flow rates and residual volumes at last follow-up were 4 (1- 12), 10.9 mL s(-1) (5.7-22) and 76.5 mt (18-143) respectively. One patient could not tolerate the procedure, another required a three-way catheter for bleeding and was admitted overnight. The remainder underwent the procedure as day-cases. Interstitial laser coagulation of the prostate under local a naesthesia is feasible. Its effectiveness is demonstrable, by both subjecti ve and objective criteria. It can be performed as an out-patient procedure and the majority of the patients subsequently void successfully. The main d isadvantage is the prolonged post-operative period of catheterisation.