A Prospective Randomized Study of Combined Visual Laser Ablation and Transurethral Resection of the Prostate versus Transurethral Prostatectomy Alone

Abstract

Introduction: Visual laser ablation of the prostate (VLAP) has a clinical failure rate of up to 18% which is 3 times higher than transurethral resection of the prostate (TURP) alone. Prolonged spontaneous passage of necrotic debris is the major shortcoming of this method. Therefore combined visual laser-assisted and transurethral prostatectomy was compared to TURP alone. Materials and Methods: 105 patients were evaluated in a prospective randomized study comparing TURP alone and VLAP combined with TURP. The patients were evaluated 1, 3 and 12 months after surgery. First VLAP was performed using a neodymium:yttrium-aluminum-garnet laser with the prolase fiber followed by standard resection of the necrotic and remaining prostatic tissue. Treatment efficacy was assessed by the American Urological Association (AUA) symptom score, measurements of peak urinary flow, residual urine volume, intraoperative bleeding, and by the occurrence of intra- and postoperative complications. Results: The use of VLAP and consecutive TURP improved the AUA symptom score, urinary flow and residual volume and was comparable in all patients treated. Intraoperative bleeding was significantly reduced from 522 ± 45 ml by TURP to 214 ± 33 ml by VLAP+TURP (p < 0.05). There was a significant improvement in the postoperative values of the parameters observed in both groups. Conclusions: It appears that the combined method for treatment of benign prostatic hyperplasia reduced the specific intraoperative morbidity of TURP while achieving the same clinical effect as TURP alone.

Lasers for lower urinary tract symptoms secondary to benign prostatic hyperplasia: When is the fuss worth it?

“…In two large clinical trials, an average symptom improvement of 61% at 12 months has been reported [19]. Results of randomized trials comparing visual laser ablation of the prostate (VLAP) with TURP have confirmed the satisfactory clinical outcome of the laser procedure [15,[20][21][22][23][24][25][26]. Peak flow rates increased by 93% 12 months after VLAP compared with 109% after TURP.…”

Lasers for lower urinary tract symptoms secondary to benign prostatic hyperplasia: When is the fuss worth it?

“…The applications are repeated systematically and with overlap until all visible obstructing prostatic tissue has been coagulated [14]. Results of randomized trials comparing visual laser ablation of the prostate (VLAP) with TURP have confirmed the satisfactory clinical outcome of the laser procedure [15,[20][21][22][23][24][25][26]. Coagulated tissue eventually will necrose and slough within weeks or months, often accompanied by bothersome irritative voiding symptoms [3,[15][16][17][18].…”

Prostate Vaporization in the Treatment of Benign Prostatic Hyperplasia by Using a 200-W High-Intensity Diode Laser

“…After surgery, urinary retention and the need for long-lasting catheterization rate are still the drawbacks. Postoperative irritative voiding symptoms due to late sloughed off necrotic tissue makes VLAP not succeed in replacing TURP [4,5]. A high retreatment rate of 1.8% to 38% was also reported by Muschter [6].…”