Laser prostatectomy: which way forward?

A number of endoscopic laser strategies have been employed in the treatment of symptomatic benign prostatic hyperplasia at our hospital. The post-operative results in 102 patients are presented. Sidefiring fibres were coupled with the Nd:YAG laser to produce a deep coagulative necrosis within the prostatic adenoma. This approach was associated with a short operative time and a delay of up to three months before treatment effect. Contact laser techniques (with both the 1064 nm and 805 nm lasers) were used to vaporize prostatic tissue in an attempt to produce a defect similar to that following TURP. This provided an immediate treatment effect with early removal of catheters. The operative time, however, was long and this limited the procedure to glands of less than 40 ccs. The hybrid approach (combining laser prostatotomies with coagulation) provided an immediate relief of obstruction with an additional delayed effect as the coagulated cavity matured. All approaches were associated with minimal haemorrhage and limited morbidity with encouraging improvements in both symptom scores and uroflowmetry. The various advantages and disadvantages of each endoscopic laser strategy are discussed.