Visual Laser Ablation Of The Prostate Research Articles

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Historical Aspects of Laser Therapy for Benign Prostatic Hyperplasia

The gold standard treatment of benign prostatic hyperplasia (BPH) has been the transurethral resection of the prostate (TURP). However, this procedure is associated with a number of complications, and other surgical therapies, including laser prostatectomy, have been developed to overcome these issues. Laser prostatectomy involves tissue coagulation or vaporization. Coagulation of the tissue results in debulking of the gland through sloughing of necrotic tissue, while vaporization results in an instantaneous debulking of prostatic tissue. The laser procedures developed over the past decade include visual laser ablation of the prostate using the neodymium:yttrium-aluminium-garnet laser. Clinical outcome with this procedure shows good results up to 3 yr. The same laser can be applied through direct insertion of the laser fibres into the prostate in a procedure termed interstitial laser coagulation. Holmium laser enucleation of the prostate is one of the most investigated of the laser procedures and is associated with a good outcome over a long follow-up period. One drawback is the high degree of training required to master the technicalities of the procedure. The latest addition to laser therapy for BPH is photoselective vaporization of the prostate. This procedure results in rapid vaporization of prostate tissue with good outcome up to 5 yr reported. The procedure can be applied to large glands, patients in retention, and those on anticoagulants. Clinical evidence now exists on the effectiveness of both the holmium and potassium-titanyl phosphate lasers, and these therapies now represent a valid clinical alternative to TURP.

Nd:YAG laser ablation plus transurethral resection for large prostates in high-risk patients

Objectives To evaluate the outcome and morbidity rate of combined visual laser ablation of the prostate and transurethral resection of the prostate (TURP) in high-risk symptomatic patients with large prostates. Methods A total of 28 patients evaluated according to the American Society of Anesthesiologists (ASA) classification to have ASA grade 3 or greater and who had a prostate volume of 50 cm 3 or greater, and peak urinary flow rate of less than 15 mL/s underwent visual laser ablation of the prostate plus TURP for severe lower urinary tract symptoms due to benign prostatic hyperplasia. The postoperative evaluation included the American Urological Association symptom score index, maximal urinary flow rate measurement, postvoid residual urine volume, and morbidity. Results The mean baseline prostate volume and duration of surgery was 85 cm 3 (range 50 to 120) and 70 minutes (range 55 to 105), respectively. Surgery was performed under local and spinal anesthesia in 18 and 10 patients, respectively. No perioperative bleeding requiring transfusion or TURP syndrome developed. Urethral catheter drainage was continued for an average of 1.7 days. Only 1 patient developed irritative voiding symptoms. The postoperative follow-up period ranged from 6 to 21 months (median 11). Improvement in the evaluation parameters was noted in all cases. Conclusions The results of our study show that visual laser ablation of the prostate plus TURP has the advantage of excellent homeostasis and lower morbidity in men with large prostates. When the patient's medical condition precludes TURP, this combination of techniques may be considered an option in such cases for symptomatic relief of obstructive urinary symptoms due to benign prostatic hyperplasia.

Free-beam and contact laser coagulation.

Laser coagulation of benign prostatic hyperplasia (BPH) encompasses a variety of techniques using different laser wavelengths, application systems, and surgical techniques to achieve contrasting tissue effects. During transurethral laser coagulation, known as visual laser ablation of the prostate (VLAP), the prostate is irradiated by free-beam Nd:YAG or diode laser energy. The coagulated and necrotic tissue sloughs off within weeks to months. In randomized studies comparing laser coagulation and transurethral resection of the prostate (TURP), symptoms and some voiding parameters improved significantly after laser coagulation, although not to the level obtained with TURP. However, the operative duration and the length of hospitalization have been shorter than for TURP, and major complications have not occurred. Follow-up clinical data and retreatment rates are available for up to 5 years with a remarkable variability. Although retreatment rates may be high, patients who are "responders" to the treatment after 2 to 3 years seem to have durable results after 4 to 5 years and even longer.

A Prospective Randomized Study of Combined Visual Laser Ablation and Transurethral Resection of the Prostate versus Transurethral Prostatectomy Alone

Introduction: Visual laser ablation of the prostate (VLAP) has a clinical failure rate of up to 18% which is 3 times higher than transurethral resection of the prostate (TURP) alone. Prolonged spontaneous passage of necrotic debris is the major shortcoming of this method. Therefore combined visual laser-assisted and transurethral prostatectomy was compared to TURP alone. Materials and Methods: 105 patients were evaluated in a prospective randomized study comparing TURP alone and VLAP combined with TURP. The patients were evaluated 1, 3 and 12 months after surgery. First VLAP was performed using a neodymium:yttrium-aluminum-garnet laser with the prolase fiber followed by standard resection of the necrotic and remaining prostatic tissue. Treatment efficacy was assessed by the American Urological Association (AUA) symptom score, measurements of peak urinary flow, residual urine volume, intraoperative bleeding, and by the occurrence of intra- and postoperative complications. Results: The use of VLAP and consecutive TURP improved the AUA symptom score, urinary flow and residual volume and was comparable in all patients treated. Intraoperative bleeding was significantly reduced from 522 ± 45 ml by TURP to 214 ± 33 ml by VLAP+TURP (p < 0.05). There was a significant improvement in the postoperative values of the parameters observed in both groups. Conclusions: It appears that the combined method for treatment of benign prostatic hyperplasia reduced the specific intraoperative morbidity of TURP while achieving the same clinical effect as TURP alone.

Long Term Follow-Up after Visual Laser Ablation of the Prostate

Long Term Follow-Up after Visual Laser Ablation of the Prostate

Laser therapy for benign prostatic hyperplasia: a review of recent developments.

Over the past 10-15 years a variety of endoscopic laser techniques have evolved for the treatment of benign prostatic hyperplasia. The laser is merely an energy source with the ability to coagulate, incise, vaporize, resect and dissect (enucleate), all fundamentally different procedures. Generalization regarding "laser prostatectomy" is therefore inappropriate. The potential for shorter hospital stays and decreased morbidity while maintaining the efficacy and durability of transurethral resection of the prostate has been the driving force behind the laser techniques that acutely remove tissue, whereas the ideal minimally invasive non-tissue removing laser technique is a well-tolerated office procedure, performed under local anaesthesia. We define the various laser techniques currently available for the treatment of benign prostatic hyperplasia, and review developments reported during the period July 2001 to July 2002. Although there are few long-term data available on laser techniques, more medium-term data is emerging. Issues such as cost-effectiveness and applicability to certain sub-groups of patients are being investigated as each laser technique aims to find its own niche in the ever-expanding treatment armamentarium for benign prostatic hyperplasia. Satisfactory moderate term results are now available for several minimally invasive laser techniques including interstitial laser coagulation and visual laser ablation of the prostate. There are promising early results for holmium laser enucleation of the prostate and potassium titanyl-phosphate, which have the potential to rival transurethral resection if proved durable in the long-term. Holmium laser enucleation is currently a serious contender for the "gold standard" for large prostates.

RABBIT MUSCLE AND URETHRAL IN SITU BIOCOMPATIBILITY PROPERTIES OF THE SELF-REINFORCED L-LACTIDE-GLYCOLIC ACID COPOLYMER 80: 20 SPIRAL STENT

A new type of self-reinforced L-lactide-glycolic acid copolymer, molar ratio 80:20, stent was developed. We evaluated the tissue biocompatibility properties of the new material. Rods made of self-reinforced L-lactide-glycolic acid copolymer were inserted into rabbit dorsal muscles and rods of latex or polyvinylchloride and silicone served as positive and negative controls, respectively. Urethral stents of self-reinforced L-lactide-glycolic acid copolymer and steel were inserted in situ via cystoscopy into the rabbit prostatic urethra. The animals were sacrificed after 2 weeks, 1, 2 and 3 months, respectively. In situ histological analysis was done. Tissue reactions around the implantation types were analyzed histologically and scored semiquantitatively. In addition, macroscopic analysis was done of the urethral in situ stents. In rabbit muscle implantation test tissue reaction to the self-reinforced L-lactide-glycolic acid copolymer stent resembled that of negative control silicone. Less than moderate chronic inflammatory changes gradually subsided after 2 weeks. Foreign materials in the tissue and the reaction to these materials began to disappear after 1 month and at 3 months were completely absent. All rabbits fitted with the stent voided normally postoperatively. Self-reinforced L-lactide-glycolic acid copolymer stents were soft, partially fragmented and easily disintegrated when touched at 2 months, and were almost completely degraded at 3 months. The material did not encroach into the urethral wall macroscopically or microscopically. No calcification on the self-reinforced L-lactide-glycolic acid copolymer stents or bladder stone formation was seen. The new self-reinforced L-lactide-glycolic acid copolymer 80:20 material is safe, highly biocompatible and suited for future clinical use. It is most appropriate for preventing postoperative urinary retention after most minimally invasive thermal treatments for benign prostatic hyperplasia.

Economic evaluation of treatment for benign prostatic hyperplasia--transurethral resection vs thermotherapy vs laser vaporization

Cost containment has become an important issue in medical practice because of recent bad economic conditions. We analyzed the cost of benign prostatic hypertrophy (BPH) patients and cost-effective analysis was carried out comparing transurethral resection of prostate (TURP), visual laser ablation of the prostate (VLAP) and transurethral microwave thermotherapy (TUMT). Our series consists of 95 BPH patients treated with TURP, VLAP and TUMT between January 1, 1994 and March 31, 1997. The cost for each patient was calculated (46 were treated with TURP, 31 with VLAP and 28 with TUMT). Considering the clinical outcome, cost-effectiveness was compared in 3 groups retrospectively. The median level of total charges (insurance points) was 59,395 points for the TURP group, 66,784 points for the VLAP group and 14,927 points for the TUMT group. The median follow-up period was 12.4 months, 46.7 months and 14.4 months, respectively. Several patients needed medication after operation in the VLAP group. In the TUMT group, 3 patients needed re-operation and 5 other needed an alternative surgical method (TURP or transurethral needle ablation) and 1 needed both methods. TUMT is the most cost-effective method, however the recurent rate is highest in the follow-up period among the three groups. The costs of recurent cases were most expensive. We should select surgical treatment for BPH very carefully.

TRANSURETHRAL PROSTATIC RESECTION OR LASER THERAPY FOR MEN WITH ACUTE URINARY RETENTION: THE CLASP RANDOMIZED TRIAL

Transurethral resection of the prostate is the standard operation for acute urinary retention, although laser prostatectomy is reportedly effective and safe. The ClasP (conservative management, laser, transurethral resection of the prostate) study compared transurethral prostatic resection and noncontact neodymium (Nd):YAG visual laser assisted prostatectomy for treatment of acute urinary retention. This study was a multicenter randomized controlled trial, analyses were by intention to treat and followup was at 7.5 months after randomization. Primary outcomes were treatment failure, and included International Prostate Symptom Score, International Prostate Symptom Score quality of life score, residual urine and flow rate. Secondary outcomes included complications, and duration of catheterization and hospitalization. A total of 148 men were randomized to transurethral prostatic resection (74) and laser (74). There were fewer treatment failures after prostatic resection (p = 0.008) and fewer men after resection required secondary surgery for poor results (1 versus 7, p = 0.029). Maximum flow rates after transurethral prostatic resection were better than after laser (mean difference 4.4 ml. per second). Comparison of symptom and quality of life scores demonstrated that any clinically significant advantage for laser could be ruled out. Patients stayed a mean of 2 extra days in the hospital after resection. The duration of catheterization was greater after laser but significantly fewer major treatment complications were found with laser therapy. Transurethral prostatic resection was more effective, resulted in fewer failures than laser treatment and remains the procedure of choice for men with acute urinary retention.

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 management of lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) are not well known. We studied the durability of the effect of laser prostatectomy and tried to identify the factors predictive of treatment outcome. Methods. Between December 1992 and November 1996, 190 patients underwent laser prostatectomy because of LUTS suggestive of BOO. One hundred seven patients received visual laser ablation of the prostate (VLAP), 30 received contact laser vaporization (CLV), and 53 received interstitial laser coagulation (ILC). The baseline evaluation included the International Prostate Symptom Score (IPSS), uroflowmetry (maximum urinary flow rate), postvoid residual urine (PVR), prostate volume measurement, and urodynamic investigation. Patients were followed up until April 1999. Kaplan-Meier plots were constructed 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 retreatment rate was 14% (95% confidence interval [CI] 6% to 22%). The corresponding numbers for the CLV and ILC groups were 47 months and 14% (95% CI 1% to 26%) 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 ILC group, were associated with increased retreatment risk. Conclusions. VLAP and CLV have a durable effect, as demonstrated by their low 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 grade of obstruction and PVR.

Two–Year Results of Transurethral Resection of the Prostate versus Four ‘Less Invasive’ Treatment Options

Objective: The aim of this study was to compare the efficacy or transurethral resection of the prostate (TURP) versus four less invasive treatment options during a 2–year follow–up.Material and Methods: 95 elderly men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) were assigned prospectively to the following five treatment arms; transurethral resection of the prostate (TURP; n = 28), transurethral electrovaporization (TUVP; n = 17), visual laser ablation of the prostate (VLAP; n = 17), transrectal high intensity focused ultrasound (HIFU; n = 20) and transurethral needle ablation (TUNA); n = 15). Preoperative workup included the International Prostate Symptom Score (IPSS), uroflowmetry, post–void residual volume (PVR), prostate volume determined by transrectal ultrasonography and a multichannel pressure flow study. Postoperative follow–up at 6, 12, 18 and 24 months included assessment of IPSS, PVR and uroflowmetry.Results: At study entry, patients assigned to one of the five treatment arms were comparable with respect to age, peak flow rate (Q_max), IPSS, prostate size and the degree of bladder outflow obstruction. During study, 1 patient in the TURP group (4%) required a secondary TURP, as compared to 23.5% (n = 4) after TUVP, 26.7% (n = 4) after VLAP, 15% (n = 4) after HIFU and 20% (n = 3) following TUNA. In patients not subjected to a secondary procedure, the IPSS decreased a mean 13.9 after TURP, as compared to 12.7 after TUVP, 12.9 after VLAP, 7.0 after HIFU, and 9.8 after TUNA. Q_max increased 11.5 ml/s (mean) after TURP, as compared to 11.1 ml/s after TUVP, 5.6 ml/s after VLAP, 2.5 ml/s after HIFU and 2.3 ml/s after TUNA.Conclusion: In up to a quarter of the patients, a secondary TURP is performed within the first 2 years after ‘less invasive’ procedures. These data underline the need for long–term studies to reliably assess the role of less invasive procedures and to indicate that TURP is still competitive.

Holmium laser enucleation of the prostate with tissue morcellation: initial United States experience.

BENIGN PROSTATIC HYPERPLASIA (BPH) affects 70% of men over age 70 and is a significant cause of morbid. ity in this population.1 Endoscopic surgery for BPH has evolved over the past decade with technological advances that offer significant advantages in perioperative and postoperative morbidity and hospital stay. One of the technological advances has been the holmium laser, a multifunction tool in urology that can be used for intracorporeallithotripsy, stricture and ureteropelvic junction incision, excision and ablation of urothelial tumors or condylomata, and resection/vaporization of prostatic adenomataus tissue. We report the initial use in the United States of the holmium laser with transurethral tissue morcellation for the endoscopic treatment of BPH. The surgical technique for the use of the holmium laser in the treatment of BPH has evolved over the past 5 years, due in large part to the work of Gilling and associates.25 Initially, the holmium laser energy was used in concert with Nd:YAG energy to vaporize and coagulate tissue, and the procedure was termed endoscopic laser ablation of the or CELAP. Unfortunately, many of the irritative voiding symptoms experienced by patients undergoing visual laser ablation of the prostate (VLAP) with the Nd: Y AG laser were also seen using the dual-laser technique. Vaporization alone was next used with holmium energy (holmium laser ablation of the prostate, or HoLAP) with excellent voiding results and low rates of transfusions, but the time required to vaporize significant volumes of adenoma was excessive. Using the holmium laser to resect the prostate into its anatomic lobes (HoLRP) was the next step in the development of the technique. This method also provided excellent results, but the issue of how to remove the large adenomas from the bladder after resection was unresolved. Development of a transurethral tissue morcellator now allows efficient removal of adenomatous tissue of any size. The technique has progressed to a true anatomic enucleation, similar to an endoscopic open ·prostatectomy, abbreviated HoLEP (holmium laser enucleation of prostate), which is the procedure on which this work is based. The surgical advantages of HoLEP compared with standard transurethral electroresection (TURP) are in the areas of blood loss and electrolytic effects of irrigant. The laser technique is hemostatic, allowing operation in a virtually bloodless field, and decreases or eliminates the need for postoperative bladder irrigation. Consequently, catheters may be removed earlier, length of stay is decreased, and return to normal activity is hastened. The reported blood transfusion rate is 1 per 1000 procedures.6 Additionally, patients with altered coagulation profiles from therapeutic or pathologic etiologies may undergo HoLEP without increased bleeding complications. Because thermal energy is the mechanism through which the holmium laser works, physiologic irrigants, such as normal saline, may be used for HoLEP. The use of normal saline eliminates the risk of dilutional hyponatremia and potential TUR syndrome. The combination of the hemostatic capabilities of the holmium laser and transurethral tissue morcellation allow enucleated adenoma of very large size to be removed effectively from the bladder, offering a possible alternative to open prostatectomy. In this work, we review the first 61 HoLEPs with tissue morcellation performed at our institution.

HOLMIUM LASER VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE: A RANDOMIZED PROSPECTIVE TRIAL WITH 1-YEAR FOLLOWUP

The high-powered holmium:YAG laser can be used for incision, ablation and resection of the prostate. The technique of holmium laser resection of the prostate is compared to transurethral prostatic resection for surgical management of benign prostatic hyperplasia in this prospective randomized study. A total of 120 urodynamically obstructed cases were randomized to holmium laser or transurethral prostatic resection. All eligible patients were assessed preoperatively and at 3 weeks, and 3, 6 and 12 months postoperatively with an American Urological Association symptom score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow study, ultrasound prostate volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All complications were noted. Holmium laser and transurethral resections resulted in significant improvements in symptom score, quality of life score, peak urinary flow rate and post-void residual urine measurements. Operating time was significantly longer in the holmium group but nursing contact time, catheter time and hospital stay were significantly less compared to the transurethral prostatic resection group. Urodynamic results were equivalent at 6 months. There were fewer side effects in the holmium group. Effects on continence, potency and symptoms were similar with 1-year followup. Holmium and transurethral resections of the prostate appear to be equivalent in surgical management of bladder outflow obstruction due to benign prostate hyperplasia. Perioperative morbidity was less in the holmium group.

Holmium Laser Resection of the Prostate Versus Neodymium:Yttrium-Aluminum-Garnet Visual Laser Ablation of the Prostate: A Randomized Prospective Comparison of Two Techniques for Laser Prostatectomy

Objectives. To directly compare holmium laser resection of the prostate (HoLRP) with neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate (VLAP), which represent two fundamentally different methods of laser prostatectomy. Methods. In a randomized, prospective comparison, a total of 44 men with symptomatic benign prostatic hyperplasia (BPH) were treated with either HoLRP or VLAP. Standard preoperative assessment included American Urological Association (AUA) symptom score, peak urinary flow rates (Qmax), ultrasound prostate volume, and residual urine measurements. Pressure-flow urodynamics were performed preoperatively and at 3 months postoperatively. Intraoperative and perioperative factors were assessed. The patients were followed at 1, 3, 6, and 12 months following the procedure. Results. There were no significant differences between the patient groups for any preoperative parameter. The mean total operating time was longer in the HoLRP group (52 minutes) compared with the VLAP group (41 minutes) ( P <0.01). The mean catheter times were 1.4 days (HoLRP) and 11.6 days (VLAP) ( P <0.001). These times included the 9% of patients undergoing HoLRP and 36% of patients undergoing VLAP who required recatheterization. Immediate postoperative dysuria scores were higher in the VLAP group compared with the HoLRP group. There were no significant differences in AUA scores between the two treatment groups at any postoperative interval. The Qmax values were greater at follow-up in the HoLRP group, but statistical significance was not achieved at 12 months. However, both PdetQmax and Schäfer grade measurements taken at 3 months postoperatively were significantly lower in the patients undergoing HoLRP. Three patients (14%) required reoperation in the VLAP treatment arm but no patient who underwent HoLRP has required reoperation to date. Conclusions. HoLRP results in significantly improved patient outcomes compared to VLAP.

Early Clinical Experience with Transurethral Electrovaporization of the Prostate for Benign Prostatic Hyperplasia: Comparison with Transurethral Resection of the Prostate and Visual Laser Ablation of the Prostate

Recently, several alternatives have been attempted in the management of benign prostatic hyperplasia (BPH) to reduce morbidity of traditional transurethral resection of the prostate (TURP). Among new modalities, transurethral electrovaporization (TEVP) is considered as a promising alternative. To evaluate the safety and initial efficacy of JEVP using the roller loop electrode (ProSurg Inc. USA) on BPH patients, we compared the results of TEVP with those of TURP and visual laser ablation of the prostate (VLAP). In this study, a total of 115 patients with symptomatic BPH were underwent TEVP (n=17), TURP (n=59) or VLAP (n=39) since 1995. Before treatment, patients were evaluated with an International Prostate Symptom Score (IPSS) and the measurement of maximal uroflow rate (MFR) and postvoid residual urine (PVR). After treatment, the operative and hospital records were reviewed. The uroflowmetry and IPSS were re-evaluated 3-10 months after treatment. In clinical outcome of re-evaluation compared to the preoperative parameters, there was a clinically significant improvement in three procedures. TEVP resulted in 62% reduction in IPSS (TURP, 73% : VLAP, 69%), 84% improvement in MFR (TURP, 113% : VLAP, 91%), and 74% reduction in PVR (TURP, 88% : VLAP, 78%). TEVP had shorter duration of hospitalization and catheterization than the others. TEVP was associated with lower rates of treatment-related complication than TURP. In conclusions, TEVP is considered as a useful procedure to treat symptomatic BPH. And, the advantages of TEVP over TURP include excellent intraoperative hemostasis, lower morbidity, shorter hospital stay and simple technique. In addition the advantages over VLAP include lower cost, shorter duration of catheterization and early symptom improvement.

Transurethral visual laser ablation of the prostate for benign prostatic hyperplasia using a KTP/YAG laser.

Transurethral visual laser ablation of the prostate (VLAP) has been established as an alternative method for the treatment of benign prostatic hyperplasia (BPH). However, most VLAP procedures utilize only a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Since a potassium-titenyl-phosphate (KTP) laser offers limited tissue penetration, KTP can be safely utilized to excise part of the obstructing prostatic tissue. This study assessed the interaction between KTP vaporization and YAG coagulative ablation to determine the safety and efficacy of VLAP utilizing a combined KTP/YAG treatment. Forty patients with bladder outlet obstruction secondary to BPH were treated with VLAP using a KTP/YAG laser. The laser light was delivered by an angle delivery device. Most cases demonstrated a significant improvement in routine subjective and objective parameters (AUA symptom score, peak flow rate, average flow rate, and amount of residual urine). No significant complications relating to this procedure were reported, however, 4 patients experienced postoperative acute urinary retention. KTP/YAG laser ablation of the prostate is safe and effective for the treatment of BPH.

Visual laser ablation of the prostate (VILAP): experience of the first one hundred cases in Jakarta

Transurethral resection of the prostate (IUR P) is still regarded as a standard treatment for BPH, but still have complication.Visual laser ablation of the prostate (VIL P) usingNeod.ymiumYttriumAluminum Garnet laser has been introduced as an alternativetrealmenl for BPH since 1992. We have treated 700 cases of BPH by VII,AP since April 1993 iill May 1994 in Sumber Waras Hospital. Mean age of the patients is 67.8 years range 41-91 years. From the 700 palients, only in 85 patients was the data obtained enough for analysis. There were improvement of mean symptom score (Mad,sen lversen) from 18.3 initially to 8.4 and 6.0 after 7 month and 2 months respectively (p<0.05) and, mean maximal flow rate increased from 6.7 ml/second to 10.8 ml/second and lj ml/second after 1 month and 2 months respectively (p<0.05) while rest urine dropped from 107.8 ml initially to 34.4 ml and 11.2 ml1 month and 2 months respectively (p<0.05). Complications : Post operative bleeding occured in2 patients but no blood transfusionwas required, post operative painwere found. in 3 cases and. prolonged retention (more than one week) in 79 cases and in two cases TUR P were done. From 74 cases who are still concern with sex, retrograde ejaculation were found in 2 cases, impotence in one case and in 3 cases failure to have full rigidity were noticed.

Visual Laser Ablation of the Prostate (VLAP) with Bare Fiber in Conjunction with Laser Bladder Neck Incision in The Treatment of Patients with Benign Prostatic Hyperplasia (BPH)

The objective of this paper was to assess the effectiveness of visual laser ablation of the prostate (VLAP) using a bare fiber with simultaneous laser incision of the bladder neck for patients with symptomatic benign prostatic hyperplasia. Sixty-seven patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia were entered into a prospective trial where VLAP was done with neodymium:YAG laser, while the bladder neck incision was done with KTP laser. The laser was delivered using a bare fiber. There was marked improvement demonstrated at three months post-lasing in symptom score and flow rate. No significant changes were noticed in the subsequent follow-up. However, the addition of the bladder neck incision increased the rate of retrograde ejaculation without appreciable improvement in symptom score or flow rate when compared to other published data. None of the patients developed bladder neck contracture. VLAP, using a bare fiber, in conjunction with laser bladder neck incision, produces durable improvement in urine flow rate and symptom score in patients with symptomatic benign prostatic hyperplasia without the development of bladder neck contracture. This method will reduce the costs of laser prostatectomy.

A Randomized Study to Compare Biodegradable Self-reinforced Polyglycolic Acid Spiral Stents to Suprapubic and Indwelling Catheters After Visual Laser Ablation of the Prostate

A randomized controlled study was done to evaluate the efficacy of the self-reinforced polyglycolic acid spiral stent compared to a suprapubic catheter, and combined suprapubic and indwelling catheters in the prevention of urinary retention after visual laser ablation of the prostate. We studied 72 men with benign prostatic hyperplasia who underwent placement of a suprapubic catheter and visual laser ablation of the prostate. In 27 men in group 1 the self-reinforced polyglycolic acid spiral stent was inserted into the prostatic urethra after visual laser ablation of the prostate, while 23 in group 2 received no other devices. In 22 men in group 3 an indwelling catheter was left in situ for an average of 6.5 days. Voiding began 1 or 2 days postoperatively in 20 of 27 patients (median 1 day) in group 1, and 8 of 23 (median 6 days) in group 2. In 16 of 22 men in group 3 voiding began 1 or 2 days (median 6) after removal of the indwelling catheter. Improvements in patient weighted symptom score, mean peak urinary flow rate and post-void residual volume were significant (p < 0.001) at 6 months of followup in all groups. The overall infection rate was 30%. The self-reinforced polyglycolic acid spiral stent is superior to the suprapubic catheter alone, and to combined indwelling and suprapubic catheters for the treatment of postoperative urinary retention after laser therapy, offering possibilities for shorter catheterization time.