Right-angle free beam lasers for the treatment of benign prostatic hyperplasia

When comparing the efficacy of VLAP to TURP, the existing data are not entirely consistent. Several studies conclude that the two procedures have equivalent efficacy with respect to AUA symptom score, peak flow rate, and reduction of postvoid residual urine volume. None of these studies are designed to control for patient or investigator bias and generally only mean values are compared. To date, our study is the only double-blind, randomized trial that compares VLAP to TURP. Although the laser procedure was an effective alternative, it was not as effective as TURP as measured by the AUA symptom score, reoperation rate, or the patients' global assessment of symptomatic improvement. To be a useful procedure, it is not essential that the efficacy be equivalent to TURP, but it is clearly preferred particularly because an anesthetic is usually required. When comparing the efficacy of these two procedures, one cannot help asking an obvious question: What is the chance that the first attempt at a new procedure (VLAP), with relatively little prior testing, would be equally effective to a procedure (TURP) that has been performed hundreds of thousands of times and modified during the past 50 years? It should not be too disappointing or surprising that our data show the TURP to be more effective. These data represent the first attempts at laser treatment for BPH. Although it is an easy procedure for a urologist to learn, the optimal technique has not been defined. It is very likely that improvements in technology and technique will improve the efficacy while maintaining safety.(ABSTRACT TRUNCATED AT 250 WORDS)