Randomized trial of safety and efficacy of transurethral resection of the prostate using contact laser versus electrocautery.
The aim of this study was to prospectively evaluate the safety and efficacy of contact laser ablation of the prostate (CLAP) vs. transurethral resection of the prostate (TURP) in symptomatic benign prostatic hypertrophy (BPH). During a 1-year period (1995-1996), 37 males 50 years of age or older were randomized to either CLAP using Nd:YAG laser treatment or TURP. Patients with Qmax <15 mL/s, American Urological Association (AUA) symptom score >12, and postvoid residual (PVR) >125 mL were enrolled. Patients were excluded if they had prior surgical treatment for BPH or known conditions that could affect bladder function. Comparisons of preoperative and postoperative symptom scores, Qmax, PVR, total catheter time, hospital stay, complications, and hematocrit changes were performed. A 2:1 randomization was used, which resulted in 26 CLAP and 12 TURP patients. One-year follow-up data were available for 21 CLAP and 7 TURP patients. The mean prostate volume, age, AUA symptom score, and Qmax were not significantly different between the two arms. Significant differences in favor of CLAP were shorter catheter time (27.2 vs. 40.4 hours; p < .05) and shorter hospital stays (28.5 vs. 60.0 hours; p < .05). The only other significant difference between the two arms was a lower AUA symptom score in favor of TURP at 1 year (4.7 vs. 8.4; p < .05). Qmax, PVR, and postoperative hematocrit were similar between the groups. The only complications included recatheterizations, which occurred more frequently in the TURP patients (25% vs. 14%). CLAP appears to be slightly less effective in AUA symptom score reduction; however, it is equally safe and is superior for shortening catheter time and hospital stay compared to TURP.
Zorn
B H
BH
Department of Surgery, Walter Reed Army Medical Center, Washington DC 20307-5001, USA.
Bauer
J J
JJ
Ruiz
H E
HE
Thrasher
J B
JB
D000368:Aged; D016001:Confidence Intervals; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome