Two-year follow-up results of a prospective randomized trial comparing hybrid laser prostatectomy with TURP in the treatment of big benign prostates

Objective: We compared conventional transurethral electroresection of the p rostate (TURP) and hybrid laser treatment in patients with symptomatic blad der outflow obstruction caused by a benign prostate bigger than 40 ml. Material and methods: Forty-six patients with symptomatic urodynamically co nfirmed outflow obstruction caused by benign prostate hyperplasia bigger th an 40 ml were accepted to the prospective trial and were randomized to rece ive hybrid laser treatment or TURF. The hybrid laser technique involved ini tial non-contact Nd:YAG coagulation followed by contact Nd:YAG vaporization to open the prostatic urethra. Patients were re-assessed after 3, 6, 12 an d 24 months. Results. Of the 46 patients, 37 (80%) were available at the 24-month follow -up. The re-operation rate was 14.3% in the hybrid laser group and 8.3% in the TURF group. The decrease in DanPSS-1 symptom score from baseline at 24 months was 51.0% in the hybrid laser group (p < 0.01) and 80.0% in the TURF group (p < 0.001), with no statistically significant differences between t he groups. Early improvement in objective urinary parameters of peak urinar y Row rate and residual urinary volume showed deterioration in hybrid laser group during longer follow-up, whereas in TURF group the improvement of th ese variables was sustained. Comparison between groups showed TURF to be su perior in peak urinary flow rate (p < 0.001) and residual urinary volume (p < 0.01) at the 24-month follow-up visit. Conclusions: Both hybrid laser treatment and TURF give good symptomatic rel ief lasting at least 2 years in the treatment of big obstructing prostates, but hybrid laser treatment is associated with a higher re-operation rate b ecause of inadequate initial prostate tissue removal and with inferior outc ome in objective urinary parameters compared with TURF.