Long-term results of contact laser versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia with small or moderately enlarged prostates.
OBJECTIVE
To evaluate the long-term results of contact laser vaporization (CLV) of the prostate and transurethral resection of the prostate (TURP) in patients with symptomatic bladder outflow obstruction (BOO) caused by benign prostatic hyperplasia (BPH) with prostates smaller than 40 ml.


METHODS
A total of 52 patients with lower urinary tract symptoms (LUTS) and urodynamically confirmed BOO caused by BPH with glands smaller than 40 ml were treated by means of CLV or TURP in a randomized trial. Changes in symptom score, urodynamics and prostate volume were evaluated during a 4-year follow-up period.


RESULTS
A total of 42 (81%) of the patients were available for review at 4 years. The re-operation rate was 1/26 for each treatment. A sustained improvement in median Danish Prostate Symptom Score was seen in the laser group from 18 (range 5-54) to 5 (0-34) and in the TURP group from 18 (4-46) to 4 (0-18) (p<0.001 for both). A sustained improvement in maximum urinary flow rate was also seen in the laser group from 8.3 (4.8-19.6) ml/s to 14.3 (10.1-33.6) ml/s (p<0.001) and in the TURP group from 8.6 (5.0-15.9) ml/s to 16.1 (7.7-39.6) ml/s (p<0.01), without differences between the study groups. Median detrusor pressure at maximum urinary flow rate decreased significantly after both treatments, in the CLV group from 64 (32-112) cmH2O to 38 (18-65) cmH2O and in the TURP group from 57 (40-137) cmH2O to 28 (9-44) cmH2O (p<0.001 for both), and at 48 months was significantly higher in the laser group (p<0.01). At 4 years, 7/22 (32%) of the laser patients and 2/20 (10%) of the TURP patients were urodynamically obstructed. Post-void residual at 48 months was significantly lower in the TURP group than in the CLV group. Median prostate volume was smaller after TURP at 6 and 48 months (p<0.05).


CONCLUSIONS
Long-term data of CLV and TURP treatments for BPH with small or moderately enlarged prostates indicate no significant difference in the relief of symptoms or in the rate of re-operations. However, the number of patients in this study was small and consequently the power to detect differences between the study groups was low. Regarding most objective outcome parameters, long-term follow-up revealed a slight advantage of TURP over CLV.
Tuhkanen
Kari
K
Department of Urology, Kuopio University Hospital, Finland. Kari.Tuhkanen@kuh.fi
Heino
Antero
A
Aaltomaa
Sirpa
S
Ala-Opas
Martti
M
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011468:Prostatectomy / Q000379:methods; D011470:Prostatic Hyperplasia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000175:diagnosis*; D016055:Urinary Retention / Q000150:complications / Q000175:diagnosis; D014563:Urodynamics