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Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode-laser system with
J J de la Rosette1, R Muschter, M A Lopez
1Department of Urology, University Hospital Nijmegen, The Netherlands.
Objective:
To report the initial results of the treatment of patients with benign prostatic hyperplasia using interstitial laser coagulation (ILC) performed with a temperature-sensing laser system.
Patients And Methods:
Twenty-five patients were treated using ILC and in 12, 78 temperature-power curves were recorded. The aim of the treatment was to maintain a temperature of 100 degrees C during the entire treatment cycle, using the temperature-triggered feed-back system. The time to reach the maximum temperature, the maximum temperature and the energy delivered were related to the location of the punctures within the prostate. The clinical outcome at 1 and 3 months was evaluated with symptom scores and uroflowmetry variables.
Results:
Heating at the apex seemed to require less energy to achieve and maintain higher temperatures than heating of the median lobe or base of the prostate. Patients improved markedly 1 and 3 months after treatment; the respective mean symptom scores improved from 20.6 before treatment to 9.4 and 6.9, the maximum urinary flow rates from 9.1 mL/s to 14.1 mL/s and 20.3 mL/s and the post-void residual volume decreased significantly from 71 mL to 31 mL and 11 mL. No significant complications (incontinence, impotence or haemorrhage requiring transfusion) occurred.
Conclusion:
The energy needed to achieve coagulation differed at sites within the prostate, depending on local circumstances. Good results were obtained using the tissue-adaptive laser system.