Neodymium:yttrium-aluminum-garnet laser prostatectomy

Since 1986, benign prostatic hyperplasia has been treated with lasers, but clinical use was not practical until the right-angled fiber was developed in the early 1990s. The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is one of four types available for treating the prostate. Laser energy levels can be adjusted to provide coagulation (at lower energy densities) or vaporization (at higher energy densities). In a randomized study of these two techniques, symptom scores were similar at 1-year follow-up, but the peak urinary flow rate was higher and the reoperation rate was lower in the patients who received vaporization treatment. In randomized investigations that have compared laser prostatectomy and transurethral resection of the prostate (TURP), symptom scores and urinary flow rates improved in both groups, but results were somewhat better after TURP. Cumulative data for 3-year follow-up after laser prostatectomy have shown that the improved symptom scores and urinary flow are durable. The major disadvantages with use of Nd:YAG prostatectomy are delayed time to voiding, posttreatment dysuria (which occurs in 15 to 30% of patients), and total cost. Overall, Nd:YAG prostatectomy has both pros and cons. In comparison with TURP, the laser procedure is shorter, has fewer complications, can be done on an outpatient basis, and provides quicker recovery and equivalent results.