Interstitial laser prostatectomy

Abstract

In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives to transurethral resection of the prostate (the standard treatment modality for benign prostatic hyperplasia) have been sought. Various types of laser prostatectomy have been proposed. Interstitial laser coagulation is performed by placing laser-diffusing fibers directly in the hyperplastic prostatic adenoma. The goal is to achieve coagulation necrosis within the adenoma, which causes the prostatic lobes to regress and thereby relieves the bladder outlet obstruction. Either the transurethral cystoscopic approach or the perineal approach can be used for laser application. Numerous published studies have shown that this laser procedure safely and effectively decreases symptoms of prostatism, increases the urinary flow rate, and reduces the volume of the prostate. Because of substantial tissue edema after treatment, catheter drainage may be necessary for 7 to 21 days. Although retrograde ejaculation has occurred occasionally (affecting from 0 to 11.9% of patients in reported studies) and uncomplicated urinary tract infections are common after interstitial laser coagulation, no cases of impotence or sustained incontinence have been described. Because interstitial laser coagulation is not associated with blood loss or intravascular fluid shifts and, if necessary, can be performed with a combination of local anesthesia and intravenous sedation, even high-risk patients are candidates for this procedure.