Transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for benign prostatic hyperplasia: clinical utility at one-year follow-up and imaging analysis.
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.
Takahashi
S
S
Department of Urology, Faculty of Medicine, University of Tokyo, Japan.
Homma
Y
Y
Minowada
S
S
Aso
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology / Q000528:radiation effects; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014463:Ultrasonography / Q000295:instrumentation; D014563:Urodynamics