[Therapy by endoscopic laser for prostatic obstruction]

As part of the search for alternatives to transurethral resection of the prostate (TURP) attention has (re)turned to laser methods. We describe our experience with the currently available endoscopic beam deflection devices, particularly the Prolase II. 25 patients, generally with medical reasons to avoid TURP, and with proven bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPH) underwent prostatic laser coagulation. Average age was 72 years (range 57-84), mean prostatic size by transrectal ultrasound (TRUS) was 48 g (15-100), average pretreatment peak flow rate (FR) was 7.6 ml/s (4.56-12.4). All patients were markedly symptomatic. Patients underwent clinical examination, Prostate specific antigen assay (PSA = 3.75, range 0.1-10.2), and TRUS preoperatively to exclude prostate cancer. After cystoscopic assessment the prostate was lasered according to the device manufacturers recommendations and clinical experience. A suprapubic catheter (SPC) and urethral catheters were inserted, the urethral for 24 hours. If voiding was satisfactory the SPC was removed after 24-48 hrs. Alternatively the patient was discharged and assessed at weekly intervals for SPC removal. Mean duration of SPC drainage was 11 days. Total mean impatient stay was 4.5 days (2-13) during a mean of 2 admissions. Blood loss was minimal and there were no other significant complications. At a minimum follow up of 3 months mean peak FR was 15.3 ml/s (9-31). Symptom scores (IPSS) fell from a mean of 21 to 10 by 3 months after treatment. There was an initial period of irritability for up to 12 weeks but symptomatic improvement was noted in all.