Long-term follow-up of laser treatment for lower urinary tract symptoms suggestive of bladder outlet obstruction

Objectives. The long-term results of different laser technologies in the ma nagement of lower urinary tract symptoms (LUTS) suggestive of bladder outle t obstruction (BOO) are not well known. We studied the durability of the ef fect of laser prostatectomy and tried to identify the factors predictive of treatment outcome. Methods. Between December 1992 and November 1996, 190 patients underwent la ser prostatectomy because of LUTS suggestive of BOG. One hundred seven pati ents received visual laser ablation of the prostate (VLAP), 30 received con tact laser vaporization (CLV), and 53 received interstitial laser coagulati on (ILC). The baseline evaluation included the International Prostate Sympt om Score (IPSS), uroflowmetry (maximum urinary flow rate), postvoid residua l urine (PVR), prostate volume measurement, and urodynamic investigation. P atients were followed up until April 1999. Kaplan-Meier plots were construc ted to calculate the risk of retreatment, and the log-rank test was used to evaluate the predictive value of clinical parameters for treatment failure . Results. The median follow-up in the VLAP group was 53 months; the retreatm ent rate was 14% (95% confidence interval [CI] 6% to 22%). The correspondin g numbers for the CLV and ILC groups were 47 months and 14% (95% CI 1% to 2 6%) and 34 months and 41% (95% CI 23% to 60%), respectively. A high PVR and a high grade of obstruction in the VLAP group, and a younger age in the IL C group, were associated with increased retreatment risk. Conclusions. VLAP and CLV have a durable effect, as demonstrated by their l ow retreatment rate. ILC is a less aggressive procedure, at the expense of a high retreatment rate. Patient selection for VLAP can be based on the gra de of obstruction and PVR. UROLOGY 56: 604-609, 2000. (C) 2000, Elsevier Sc ience Inc.