Neodymium:YAG laser coagulation prostatectomy for patients in urinary retention

Urinary retention necessitating catheterization is the presenting complaint for a significant minority of men requiring surgical therapy for bladder outlet obstruction. A total of 67 men presented in acute or chronic urinary retention and underwent Nd:YAG laser prostatectomy. Their mean age was 71 years, the mean estimated excess transition zone tissue was 40 g, and the mean laser energy delivery was 48 kJ. The median postoperative catheterization time was 10 days. Five men required catheterization for > or = 6 weeks, and in five men, the catheter was removed within 48 hours. In four men (6%), a successful postoperative voiding trial was never achieved. Postoperatively, mean voiding measures for the remaining 63 men were a peak flow rate of 16.1 mL/sec, a post void residual volume of 113 mL, and an AUA Symptom Index score of 7.7. Complications included urinary tract infection in two, urethral stricture in one, and bladder neck contracture in 3 men. Four men have subsequently elected additional treatment for bladder outlet obstruction (two transurethral resections, one repeat laser, and one terazosin), for an overall treatment failure rate of 6 of 67 (9%), including the two men who remain catheterized. Laser coagulation prostatectomy produces little or no acute morbidity with a successful long-term voiding outcome in the majority of men requiring treatment for acute or chronic urinary retention.