Visual laser ablation of the prostate: a preliminary report

To report our preliminary experience with visual laser ablation of the prostate (VLAP) for treating bladder outlet obstruction caused by benign prostatic hyperplasia (BPH) and to evaluate its short-term outcome.

We reviewed our laser technique in 47 men with symptomatic obstruction caused by BPH who underwent VLAP between July 1992 and April 1993 at our institution, and we compared our results with those reported in the literature.

Our 47 patients were from 43 to 87 years old (mean, 69.6). The mean pretreatment American Urological Association symptom score was 22, mean peak flow rate was 9.5 mL/s, and mean postvoid residual urinary volume was 136 mL. Neodymium:yttrium-aluminum-garnet laser energy was delivered at the 2-, 4-, 8-, and 10-o'clock positions and, when necessary, to the median lobe by one of two lateral-firing laser probes. All but the first four patients were treated on an outpatient basis, and all patients were catheterized (Foley catheter) for 2 to 10 days after VLAP.

Of the 47 patients, 32 had data pertaining to a mean follow-up of 5 months; they had a mean symptom score of 10, mean peak flow rate of 15.7 mL/s, and mean postvoid residual volume of 63 mL. In 12 patients, data from a mean follow-up of 11 months were available; they had a mean symptom score of 6, mean peak flow rate of 18.8 mL/s, and mean postvoid residual volume of 10 mL. Perioperative complications (myocardial infarction, thrombophlebitis, and epididymitis) in three patients responded to conservative therapy. Urinary retention occurred for 2 to 60 days after initial removal of the Foley catheter in 12 patients, who then had resumption of spontaneous voiding. In three patients who stated their condition was worse postoperatively, conventional transurethral resection of the prostate was done 6 months after VLAP, and a fourth patient had a persistently obstructive bladder neck incised 8 months after VLAP.

Our early experience and that reported in the literature indicate that VLAP is a safe and efficacious alternative treatment of obstructive BPH. Although the early results of VLAP rival those of transurethral resection of the prostate, the success rate in treating large prostates should be improved, and long-term results should be assessed to determine the durability of the beneficial effects.