Transurethral interstitial laser coagulation for benign prostatic hyperplasia: treatment outcome and quality of life

Abstract

To assess the efficacy and safety of transurethral interstitial laser coagulation (ILC) in the treatment of benign prostatic hyperplasia (BPH). From December 1993 to March 1995, 61 patients (mean age 69.7 years, range 55-89) with symptomatic BPH were treated with ILC. A neodymium: YAG laser was used in combination with specially designed interstitial thermotherapy light-guides. The tip of the light guide was inserted repeatedly into each lobe of the prostate transurethrally, under direct vision. The number of fibre placements depended on the size and configuration of the gland. The prostatic urethra was preserved during the procedure. Treatment outcome was evaluated using the International Prostatic Symptom Score (IPSS), measurement of urinary flow rate and post-void residual urine volume (PVR). The disease-specific quality of life (QOL) was assessed using a QOL assessment score and a BPH impact index. Independently of the symptom assessment, a self-reporting questionnaire was completed 3 months after treatment to determine the patients' satisfaction with the treatment and their sexual function. Among the 31 patients followed for 6 months, the mean IPSS decreased significantly, from 18.9 at baseline to 7.7 (59% improvement; P < 0.001), the mean peak flow rate increased from 6.7 mL/s to 10.0 mL/s (49% improvement; n = 29; P < 0.001), the mean PVR decreased from 119 mL to 29 mL (76% improvement; n = 28, P < 0.001) and the mean prostate volume decreased significantly, from 37.1 mL to 31.6 mL (15% reduction at 3 months; n = 52, P < 0.001). There was a steady and progressive improvement in both the QOL assessment and the BPH impact index scores at 3 and 6 months. More than 90% of the patients reported satisfaction with the treatment and none reported the new onset of erectile dysfunction. There were no serious side-effects, except for two cases of loss of ejaculation. The early clinical results suggest that the ILC procedure is a safe and effective less-invasive treatment for BPH that appears to have favourable effects on the patients' quality of life.