Laser treatment of benign prostatic hyperplasia

With the increasing longevity of the population, the incidence of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH) is expected to increase. Transurethral resection of the prostate (TURP) is currently considered the standard surgical treatment for this disease. However, TURP is an invasive procedure associated with some morbidity and, rarely, mortality. During the past several years, several alternative treatments for BPH have emerged. Visual laser ablation of the prostate (VLAP) is one of the more attractive choices among these alternatives. The use of laser energy to treat BPH has several advantages over TURP. Laser energy causes coagulation of the blood vessels, thus minimizing blood loss and fluid absorption. VLAP is an outpatient procedure performed under direct vision utilizing a standard or continuous-flow cystoscope. The technique of VLAP is relatively easily learned and has a much shorter learning curve than that of TURP. To date, clinical trials have confirmed the efficacy and safety of VLAP and the minimal associated morbidity. In the short-term follow-up, improvement in both subjective (symptom score) and objective (urinary flow rate) factors is similar to that after TURP. Although the results obtained with this laser technology are exciting and encouraging, further study and long-term follow-up are needed to confirm the durability of these results.