[Interstitial laser coagulation of the prostate in patients with prostatic hypertrophy: preliminary results with medium-term follow-up].
Although transurethral resection of the prostate (TURP) is the gold standard for treatment of BPH, a new, minimally invasive technique, called Interstitial Laser Coagulation (ILC), introduced by Muschter and Hofstetter, has been developed to treat BPH. ILC is base on the coagulation of prostatic tissue by means of diffused laser light using a diode laser system with a temperature feed-back (Indigo Medical 830e TM). We report our results in treating 20 patients with BPH and Bladder Outlet Obstruction (BOO), after a mean follow-up of 7 months. To define the indication for treatment and to monitor the success, urinary flow-rate (Omax), I-PSS symptoms score, residual urinary volume and prostate volume determined by ultrasound were recorded before treatment and after 3, 6, 12 months. Transurethrally, under spinal or regional anaesthesia, 2 or 3 insertions of the laser fibre in each prostatic lobe were performed beginning at the apex directly proximal to the bladder neck, made at 1 cm intervals, using a modified model Olympus cystoscope. After 6 months, Qmax increased from 6, 7 ml/sec to 11, 3 ml/sec; I-PSS score decreased from 18 to 8; residual urinary volume from 130 ml to 40 ml, prostate volume decreased from 60 to 48 ml. In selected cases, urodynamic evaluation was performed before and after treatment. Urodynamic findings were classified according Shafer diagram to grade B.O.O.: the score was 4 before treatment and 2 after 6 months. We observed UTI in 3 cases, retrograde ejaculation and acute urinary retention in 1 case, transitory irritative and obstructive syndrome in 8 cases after treatment. ILC is a simple, safe and effective treatment for BPH with significant improvements in both objective and subjective parameters. It is cheaper than others mini-invasive therapies and is able to treat any prostate volume, saving urethra and sexual function.
Clinica Urologica, Università degli Studi di Ancoma.
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Baldassari
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Galosi
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Cristalli
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Servi
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Polito
D000368:Aged; D000369:Aged, 80 and over; D004542:Ejaculation; D005069:Evaluation Studies as Topic; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016055:Urinary Retention / Q000209:etiology; D014552:Urinary Tract Infections / Q000150:complications; D014563:Urodynamics