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

Abstract

SummaryWe evaluated the efficacy and complications of laser prostatectomy, under local anaesthesia, in patients with acute retention of urine who were not fit for general or spinal anaesthesia. This was a pilot study using the Indigo 830E laser device. Fourteen patients, from February 1996 to March 1997, who 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 20–97 g (median = 48.5 g). At a mean follow-up of 8 months, 10 of the 14 patients 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 to 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 mL (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 anaesthesia is feasible. Its effectiveness is demonstrable, by both subjective and objective criteria. It can be performed as an out-patient procedure and the majority of the patients subsequently void successfully. The main disadvantage is the prolonged post-operative period of catheterisation.