Laser prostatectomy with a TURPETTE: evolution with right-angle technique

Fifty-five patients with symptomatic bladder outlet obstruction were treated with laser ablation of the prostate using right-angle fibers to deliver Nd:YAG laser energy. Dosimetry ranged between 60 and 80 W power in a noncontact mode to achieve both coagulation and vaporization of adenomatous prostate tissue. Most patients were followed for > 1 year. Efficacy of treatment was assessed with American Urological Association (AUA) symptom scores, uroflow studies, need for revision procedures, and catheterization. Perioperative morbidity and complications demonstrate results comparable to published statistics for transurethral resection of the prostate (TURP). Because patients with glands larger than 40 cm3 showed more postoperative symptoms of irritation and obstruction, 18 patients had visual laser ablation of the prostate (VLAP) alone and 37 patients were treated with a limited TURP, or TURPETTE, which includes removal of the coagulated tissue immediately after lasing to facilitate earlier voiding with minimal bleeding. The evolution of this combined technique in those patients with larger glands encourages more rapid urinary flow by providing an immediate channel, reducing acute swelling, and shortening the duration of necrotic slough. Eighty-six percent of patients voided with improved flow and reduced AUA symptom score. Fourteen percent required a revision procedure due to obstruction or bleeding. Modification in surgical technique and improved optical characteristics of fiber technology will determine the future of laser application to prostate surgery.