Prospective evaluation of interstitial laser coagulation of the prostate: importance of surgical technique and patient selection.
OBJECTIVE
To evaluate the impact of improvements in surgical technique and patient selection on overall outcomes of interstitial laser coagulation (ILC) of the prostate and to describe our treatment algorithm.


METHODS
During a 4-year period, 66 men with bothersome lower urinary-tract symptoms underwent ILC of the prostate using the Indigo 830e Diode Laser System (Ethicon Endo-Surgery). Patients were assessed preoperatively and followed prospectively. Parameters included American Urological Association Symptoms Index, Quality of Life Scale, Problems Due to Symptoms Score, postvoiding residual volume, maximum flow rate, number of treatment punctures, and adverse events. One-year follow-up data were compared with baseline data using the Wilcoxon signed rank test or Fisher's exact test. Patients were stratified into those treated during the first 2 years (group 1) and those treated in the latest 2 years (group 2), corresponding to changes in surgical technique and patient selection.


RESULTS
Maximum flow rates improved by 47% and 85% in groups 1 and 2, respectively, at 12 months postoperatively compared with baseline (P = 0.04)l. The mean number of punctures differed significantly, with 6.4 in group 1 and 8.4 in group 2 (P = 0.03). Subjective measures were significantly improved from baseline in both groups and did not differ between groups. The incidence of adverse events was similar in the two groups.


CONCLUSIONS
Improvements in surgical technique and patient selection described herein corresponded to significantly higher maximum flow rates without an increase in adverse events.
Ng
Christopher S
CS
Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ulchaker
James C
JC
Kursh
Elroy D
ED
D000465:Algorithms; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012044:Regression Analysis; D014463:Ultrasonography; D014555:Urination Disorders / Q000209:etiology / Q000601:surgery*