Contact laser treatment for benign prostatic hypertrophy.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Laser Technology

Background:

• Benign prostatic hypertrophy (BPH) is commonly treated with Transurethral Resection of the Prostate (TURP).
• Emerging surgical lasers offer potential advantages in perioperative complications, learning curve, and cost-effectiveness.
• Contact laser ablation of the prostate (CLAP) is a laser-based alternative for BPH treatment.

Purpose of the Study:

• To evaluate the efficacy, safety, and cost-effectiveness of Contact Laser Ablation of the Prostate (CLAP).
• To compare CLAP outcomes with the established standard treatment, TURP.
• To assess the long-term durability of BPH relief provided by CLAP.

Main Methods:

• A cohort of 67 patients with BPH underwent CLAP using a neodynium-YAG or diode laser.
• Preoperative and postoperative assessments included digital rectal examination, transrectal prostatic ultrasound, PSA levels, IPSS, post-voiding residual urine, and maximum flow rate.
• Bladder pressure at maximum flow (Pdet-Qmax) was measured preoperatively and at six months post-procedure.

Main Results:

• CLAP demonstrated significant improvements in IPSS, Qmax, Pdet-Qmax, and PVU compared to baseline.
• Mean operative time was 47.9 minutes, with a mean catheter time of 2.5 days and hospital stay of 4.8 days.
• While efficacious, CLAP incurred 13% higher costs than TURP, with longer operative times and less durable obstruction relief.

Conclusions:

• Contact laser ablation of the prostate is an effective treatment for BPH, comparable to TURP in symptom relief.
• Despite its efficacy, higher costs, longer operative times, and reduced long-term durability impede CLAP from replacing TURP.
• Further research may be needed to optimize laser techniques and cost-effectiveness for BPH management.