[Lasers as an alternative to the endoscopic surgery in BPH]

Neodymium laser (Nd:YAG) has been used for prostatic coagulation. New contact tips have been developed in order to cause vaporization of the prostate. With the objective to examine the effectiveness and safety of 2 new laser procedures. ITT (interstitial thermotherapy) and Sidefocus Technique, in patients with BPH, we have participated in a prospective, international, multicenter study comparing these technique with TURP and prostatic incision. A total of 80 patients suffering from symptomatic BPH in our center were randomized for the four procedures as follow: ITT (18): sidefocus technique (21), incision (20) and TURP (21). Inclusion criteria were at least 50 years old, prostate between 20 and 60 g, maximum peak-flow < or = 12 ml/s, and I-PSS > or = 15. The patient's pretreatment evaluation consisted in World Health Organization symptom score and quality of life, digital rectal examination, transrectal, ultrasound, PSA, urine culture, prostatic biopsy if malignity suspected, uroflowmetric parameters and residual volume. Follow-up was performed using the same pretreatment parameters at one month, three months and six months. Statistical analysis was performed using ANOVA test and Student-Newman-Keul test. Symptom score decreased significantly in all groups. Peak flow rate increase was observed in the four groups but without statistical significance in both laser techniques. Results at the sixth month control comparing peak-flow rates are significantly more favourable for endoscopic surgical techniques (TURP and incision). Other flowmetric parameters, days of hospital stay, duration of catheter drainage, symptom scores and morbidity are analyzed.