Transurethral incision of the prostate using the holmium:YAG laser: a catheterless procedure.
OBJECTIVE
Transurethral incision of the prostate is a well established technique for relieving bladder outflow obstruction caused by prostate glands less than 30 gm. We present data showing that the holmium:YAG laser can prevent postoperative catheterization without compromising the outcome of surgery.


METHODS
We prospectively followed 100 men an average of 62 years old with symptomatic bladder outflow obstruction and a benign prostate gland less than 30 gm. clinically in whom serum prostate specific antigen was less than 4 microg./l. They were assessed using International Prostate Symptom Score, urinary flow rate, post-void residual estimation and sexual function questionnaires preoperatively, and 6 weeks, and 1 and 2 years postoperatively. With the patient under general anesthesia a single incision was made from the ureteral orifice to the verumontanum and out to fat using holmium:YAG laser energy transmitted through a 400 nm. fiber sheathed in a ureteral catheter.


RESULTS
A total of 97 patients voided without postoperative catheterization. Average International Prostate Symptom Score decreased from 19.2 to 3.7 at 6 weeks and it remained improved at 2 years (average 3.5). Reciprocal results were achieved with improvement in average urinary flow rate from 9.79 to 19.23 and 18.27 ml. per second at 6 weeks and 2 years, respectively. Residual urine measurement decreased from 133.6 ml. preoperatively to 27 and 10 ml. at 6 weeks and 2 years, respectively. All 77 patients potent preoperatively remained so, although retrograde ejaculation developed in 8.


CONCLUSIONS
The holmium:YAG laser allows transurethral prostatic incision to be performed without the need for postoperative catheterization while maintaining efficacy.
Cornford
P A
PA
Department of Urology, Countess of Chester Hospital, Chester, United Kingdom.
Biyani
C S
CS
Powell
C S
CS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*