Lasers for the treatment of benign prostatic hyperplasia.
In our experience, efficacy favors the TURP and safety the laser. Unlike balloon dilatation of the prostate, there are likely to be technologic advancements that will allow more efficient tissue ablation, which will presumably result in more TURP-like efficacy. In addition, each of the many side-firing fibers has different physical properties that require fiber specific dosimetry studies. It is not clear how this will impact clinical efficacy; however, it is presumed that this will optimize efficacy while maintaining safety and minimizing catheterization time and postoperative irritative symptoms. VLAP is the surgical procedure of choice in high-risk patients and is an effective alternative for the treatment of symptomatic BPH. In high-risk patients, other devices such as stents may play an important role. From our assessment, TURP seems to provide greater symptomatic relief and probably is more durable than the VLAP procedure. Patients will often choose VLAP over TURP because of the lower risks of major complications and the perceived advantages of laser therapy over more conventional surgery. Other ablation techniques that are less invasive, more efficient, or do not require anesthesia but have equivalent efficacy could challenge the role of laser devices. Similarly, the continued development of more effective medical therapy will continue to challenge the role of all surgical interventions for BPH. Future investigations will focus on issues of dosimetry, tissue coagulation versus vaporization as well as fiber design and durability. The continued efforts to define the optimal technique reflect the general perception of the urologic community to improve the clinical outcome so that efficacy is more TURP-like. New delivery systems are being investigated as part of the effort to improve outcome. This includes the use of the holmium and diode lasers. The efficacy of these future delivery systems awaits proper study.
Dixon
C M
CM
Department of Urology, New York University School of Medicine New York, USA.
D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D011470:Prostatic Hyperplasia / Q000601:surgery*