Transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for benign prostatic hyperplasia: clinical utility at one-year follow-up and imaging analysis

Abstract

Objective: The clinical utility of transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for benign prostatic hyperplasia (BPH) and the laser effect on prostatic tissue were investigated.

Methods: TULIP was carried out under epidural anesthesia on 30 patients with symptomatic BPH (aged 63-92 years; mean, 73.9 years).

Results: Excluding 4 cases that were lost to follow-up, the mean modified Boyarsky symptom score significantly improved (P < 0.001) from a preoperative level of 22.2 +/- 5.3 to 7.7 +/- 4.3 at three months and 6.2 +/- 4.1 at one year. Maximum flow rate increased from 7.9 +/- 3.4 mL/sec to 14.5 +/- 5.9 mL/sec at three months and 14.7 +/- 6.3 mL/sec at one year (P < 0.001). A decrease in residual urine volume from 72 +/- 65 mL to 10 +/- 18 mL at three months and 16 +/- 17 mL at one year was also noted (P < 0.005). Transrectal ultrasonography revealed that estimated prostate volume was decreased from 39.7 +/- 20.4 mL to 26.9 +/- 20.3 mL at three months (P < 0.05) but it regrew to 32.2 +/- 26.2 mL at one year. Magnetic resonance imaging clearly showed less enhanced area to a depth of approximately 10 mm in the periurethral region, which could be attributable to coagulation necrosis in the prostatic tissue. Adverse effects were limited to epididymitis in 2 cases and no sexual dysfunction was associated with the procedure.

Conclusions: TULIP is an effective and safe alternative procedure to induce long-lasting relief of prostatic obstruction by coagulation necrosis in the periurethral region.