Laser therapy for benign prostatic hyperplasia: a review of recent developments.
OBJECTIVE
Over the past 10-15 years a variety of endoscopic laser techniques have evolved for the treatment of benign prostatic hyperplasia. The laser is merely an energy source with the ability to coagulate, incise, vaporize, resect and dissect (enucleate), all fundamentally different procedures. Generalization regarding "laser prostatectomy" is therefore inappropriate. The potential for shorter hospital stays and decreased morbidity while maintaining the efficacy and durability of transurethral resection of the prostate has been the driving force behind the laser techniques that acutely remove tissue, whereas the ideal minimally invasive non-tissue removing laser technique is a well-tolerated office procedure, performed under local anaesthesia. We define the various laser techniques currently available for the treatment of benign prostatic hyperplasia, and review developments reported during the period July 2001 to July 2002.


RESULTS
Although there are few long-term data available on laser techniques, more medium-term data is emerging. Issues such as cost-effectiveness and applicability to certain sub-groups of patients are being investigated as each laser technique aims to find its own niche in the ever-expanding treatment armamentarium for benign prostatic hyperplasia.


CONCLUSIONS
Satisfactory moderate term results are now available for several minimally invasive laser techniques including interstitial laser coagulation and visual laser ablation of the prostate. There are promising early results for holmium laser enucleation of the prostate and potassium titanyl-phosphate, which have the potential to rival transurethral resection if proved durable in the long-term. Holmium laser enucleation is currently a serious contender for the "gold standard" for large prostates.
Aho
Tevita F
TF
Department of Urology, Tauranga Hospital, Tauranga, New Zealand.
Gilling
Peter J
PJ
D000368:Aged; D001707:Biopsy, Needle; D004867:Equipment Design; D004869:Equipment Safety; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000601:surgery*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome