Interstitial laser coagulation versus transurethral prostate resection for treating benign prostatic obstruction: a randomized trial with 2-year follow-up.
OBJECTIVE
To investigate whether interstitial laser coagulation (ILC) is as effective and as safe as transurethral resection of the prostate (TURP). The treatment of choice for bladder outflow obstruction secondary to benign prostatic hyperplasia is TURP. However, ILC is a less invasive outpatient procedure that may be as effective and safe as TURP.


METHODS
In a multicenter randomized trial at six U.S. tertiary care hospitals, we treated 72 men with bladder outflow obstruction secondary to benign prostatic hyperplasia with either TURP (n = 35) or ILC (n = 37). The outcome measures were peak flow rate, postvoid residual urine volume, prostate volume, prostate-specific antigen levels, symptom and quality-of-life indexes, sexual function, and adverse event rates. Measurements were taken at baseline and at 3, 6, 12, and 24 months.


RESULTS
At 2 years, the TURP patients had better median peak flow rates, but not significantly so (range 16.5 to 13.9 mL/s, 95% confidence interval for the 2.6 mL/s difference of -0.4 to 7.6). The median scores on the symptom indexes and quality-of-life measures were similarly improved in both groups. Of 37 ILC patients, 6 (16%) were retreated with TURP in the first year. Sexual function declined in the TURP group but remained stable in the ILC group. The adverse event rates were similar, although the events were more serious in the TURP group.


CONCLUSIONS
ILC compares respectably with TURP. Given the advantages of an outpatient procedure, similar results in symptom reduction and quality-of-life measures, and less severe adverse effects, ILC can be an acceptable alternative to TURP.
Kursh
Elroy D
ED
Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44122, USA.
Concepcion
Raoul
R
Chan
Seck
S
Hudson
Perry
P
Ratner
Mark
M
Eyre
Robert
R
D000556:Ambulatory Surgical Procedures; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000601:surgery*; D011788:Quality of Life; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*
D017430:Prostate-Specific Antigen