TULIP: transurethral ultrasound-guided laser-induced prostatectomy

Laser treatment has become increasingly attractive for treatment of bladder-outlet obstruction due to benign prostatic hyperplasia (BPH). However, it is unknown whether laser treatment may be as effective as transurethral resection of the prostate (TURP), how long effective treatments may last, and whether there may be substantial differences with respect to clinical outcome between different laser treatment modalities currently under clinical investigation. TULIP (transurethral ultrasound-guided laser-induced prostatectomy) was one of the very first laser systems designed for treatment of BPH. The procedure is performed exclusively under transurethral ultrasound guidance, with which the surgeon has to become familiar. However, data reported from single-institution as well as multicenter studies demonstrate that the technique has only a small learning curve. The majority of patients treated by TULIP will experience substantial improvements in subjective and/or objective symptoms, which nevertheless do not appear to be as good as those seen after TURP. This is also shown by data from a prospective and randomized TULIP versus TURP study. However, it has to be emphasized that the clinical significance of such differences remains unknown. Advantageous for TULIP (which may be performed under analgosedation) are reduced blood loss, hospitalization, and rate of postoperative sexual dysfunction. Disadvantageous (as compared with TURP) are the delayed onset of success combined with the prolonged catheterization time and irritative symptoms in the early postoperative phase. In addition, as no tissue is obtained for histology examination, incidental prostate cancer may be missed.