Nd:YAG laser transurethral evaporation of the prostate (TUEP) for urinary retention

Little information is available regarding the effectiveness of laser prostatectomy in patients with urinary retention from benign prostatic hyperplasia since there is no paper specifically dealing with laser prostatectomy in patients in urinary retention.

Twenty two unselected consecutive patients presenting with urinary retention due to benign prostatic hypertrophy underwent transurethral evaporation of the prostate (TUEP) using a neodymium:YAG laser and total internally reflecting side-firing free beam quartz fiber. All patients failed at least one voiding trial and averaged > 30 days of urinary catheter drainage preoperatively. A contact evaporation technique was used to evaporate a "TURP-like" channel in the prostatic fossa by means of a series of parallel evaporation troughs.

Eighteen of 22 patients completed 6 months of follow up. Two patients were lost to follow up and two failed TUEP. The average AUA score dropped from 26 to 9 at 1 month and to 3.4 by 6 months postoperatively. All patients who successfully underwent TUEP were urinating spontaneously by 10 days. Average time to catheter removal was 3.5 days. Maximal uroflow was 15.7 ml/sec at 1 month and 20.3 ml/sec by 6 months. Postvoid residual preoperatively averaged 784 ml and decreased to 76 ml by 1 month. Pre- and postoperative hematocrit and serum sodium values did not vary by more than 5%.

From this preliminary series we conclude that aggressive evaporation of prostatic tissue is feasible endoscopically and provides a reliable method of near bloodless removal of tissue.