Interstitial laser coagulation versus transurethral resection of the prostate for benign prostatic enlargementA prospective randomized study

Abstract

Interstitial laser coagulation (ILC) of the prostate is a minimally invasive method for treating symptomatic benign prostatic enlargement (BPE). We performed a prospective randomized study to compare the clinical outcomes of ILC and transurethral resection of the prostate (TURP). Between December 1997 and February 2000, 38 patients with moderate-to-severe symptomatic BPE were included in the study. Seven were subsequently excluded due to intercurrent disease or protocol violation and the remaining 31 were randomized to either TURP (n=11) or ILC (n=20). A suprapubic tube was inserted in all ILC-treated patients, and ILC was performed as an outpatient procedure when feasible. Data were recorded preoperatively and at 3-month and 1-year follow-up. The assessment parameters were International Prostate Symptom Score (IPSS), uroflow, prostate volume determined by means of transrectal ultrasound and postvoid residue. At 1-year follow-up, uroflowmetry indicated a more pronounced increase in peak urinary flow rate (Qmax) in the TURP patients than in the ILC subjects (p<0.02). Differences in postvoid residue, IPSS and prostate volume between the two treatments could not be evaluated due to the small number of patients in each group. Postoperative urinary tract infections occurred in 13 ILC patients but in only one TURP subject, and catheterization was done for 24 days after ILC and for 2 days after TURP. The study was ended prematurely due to the prolonged postoperative catheterization and the high rate of urinary tract infections in the ILC patients. At 1-year follow-up, the increase in Qmax was smaller in the ILC subjects than in the TURP patients. The ILC subjects had comparatively more postoperative urinary tract infections and more prolonged postoperative catheterization than the TURP patients.