Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology

Interstitial laser coagulation (ILC) treatment is a recent technique in the treatment of BPH that is evolving rapidly. The results of a prospective ra ndomised study vs transurethral resection of the prostate (TURP) is present ed as well as results of patients treated with a temperature sensing laser system. The first study included 44 patients treated in a prospective randomised st udy (randomisation TLC vs TURF = 2:1) comparing changes in objective and su bjective parameters. In the second part of the study the outcome of the tre atment of 34 patients with BPH using ILC performed with a temperature-sensi ng laser system are presented. The clinical outcome at 12, 26, 52 and 104 w eeks was evaluated with symptom scores, quality of life measures, changes i n voided volume, post void residual, and peak now rate. In addition changes in prostate volume and urodynamic parameters at half a year follow-up are presented. In this randomised study patients improved markedly at any time during foll ow-up. In the ILC group there was a significant and persisting subjective i mprovement whereas the improvements in the TURF group were even more signif icant. The changes in voiding parameters, including changes in pressure flo w parameters, are superior in the TURF group compared to the changes in the ILC group. The retreatment rate for the TLC group is 21% compared to 7% in the TURF group, no patient with incontinence was documented in either grou p, while only one patients in the TURF group developed a urethral stricture . In the second part of the study, the clinical improvements following lase r therapy using the temperature sensing treatment mode were more pronounced in voiding parameters when compared to those of the randomised laser group . Lower energy interstitial laser treatment of the prostate results in a sign ificant improvement of all clinical parameters that are inferior to improve ment following transurethral resection of the prostate. When using a temper ature sensing system, the objective results of laser treatment improved and seem to be more durable.