Lasers in the treatment of benign prostatic obstruction: past, present, and future

Lower urinary tract symptoms caused by benign prostatic obstruction (BPO) has been, and still is, treated by performing a transurethral or open prostatectomy. During the last decade many alternative treatments have been introduced and one of these new modalities uses laser energy in the ablation of prostatic tissue. When reviewing the literature on laser treatment of the prostate using side-firing laser devices, this procedure has proven to be safer and almost as effective as transurethral resection of the prostate (TURP). But although severe complications as TURP syndrome, incontinence and the need for blood transfusions have not occurred during laser prostatectomies, morbidity consisting of irritative voiding compliants and long catheterization duration have been reported by several authors. With the development of the contact laser probe and the interstitial laser technique some of these problems are (partly) solved, but also these new techniques still have considerable limitations which may disappear with future developments of newer laser probes and refining of existing laser techniques. Also, a better understanding and control in the laser-tissue interaction may help in reducing morbidity and inducing a more effective treatment.