title: Interstitial laser coagulation combined with minimal transurethral resection of the prostate for the treatment of benign prostatic hyperplasia.
abstract: BACKGROUND
  Transurethral resection of the prostate (TURP) represents the gold standard in the surgical treatment of benign prostatic hyperplasia (BPH). However, this method still has significant morbidity mainly associated with irrigation fluid absorption and blood loss.
  
  
  METHODS
  A combination of interstitial laser coagulation (ILC) with limited TURP was established to reduce specific risks of transurethral resection and was applied in 41 patients with bladder outlet obstruction caused by BPH. In these patients, a subtotal resection of the prostate was not possible because of anesthesiologic risk factors. After insertion of a suprapubic catheter, ILC was performed under visual control using an Nd:YAG laser followed by resection of the bladder neck or the median lobe. Isotonic carbohydrate solution with 1% ethanol was used for irrigation, and irrigation fluid uptake was quantified by measurements of the ethanol concentration in the patients' exhaled breath. Additional measures such as blood loss, need for blood transfusions, and operative time were evaluated.
  
  
  RESULTS
  The operations were performed without major complications with a mean operative time of 35 +/- 11 minutes for the entire procedure. An irrigation fluid uptake of 9 +/- 32 mL and no TUR syndrome were observed. The mean blood loss was minimal with a change in the hemoglobin of -1.3 +/- 1.1 g/dL and no need for blood transfusions.
  
  
  CONCLUSIONS
  These results demonstrate that ILC with subsequent minimal TURP is an applicable method in the surgical treatment of BPH with reduction of blood loss and of the risk of TUR syndrome. This procedure may help to reduce the morbidity of TURP, especially in high-risk patients.
authors.affiliation: Department of Urology, Ludwig-Maximilians-Universitaet, Munich, Germany. Stefan.Corvin@uro.med.uni-muenchen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Corvin
authors.forename: Peter
authors.initials: P
authors.lastname: Schneede
authors.forename: Eleni
authors.initials: E
authors.lastname: Siakavara
authors.forename: Dominik
authors.initials: D
authors.lastname: Frimberger
authors.forename: Dirk
authors.initials: D
authors.lastname: Zaak
authors.forename: Michael
authors.initials: M
authors.lastname: Siebels
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Alfons
authors.initials: A
authors.lastname: Hofstetter
mesh_terms: D000368:Aged; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012307:Risk Factors; D007507:Therapeutic Irrigation; D020728:Transurethral Resection of Prostate / Q000379:methods*