title: Combination of channel-TURP and ILC versus standard TURP or ILC for elderly with benign prostatic hyperplasia: a randomized prospective trial.
abstract: OBJECTIVE
  A prospective randomized controlled trial was performed in elderly patients with benign prostatic hyperplasia (BPH) to evaluate the clinical effectiveness of channel transurethral resection of the prostate (C-TURP) combined with an interstitial laser coagulation (ILC) technique during a 4-year follow-up period.
  
  
  METHODS
  A total of 150 consecutive BPH patients were randomized to an ILC+C-TURP group (n = 50), an ILC group (n = 50) and a TURP group (n = 50). Urinary tract infection, acute urinary retention and retrograde ejaculation were monitored, and the retreatment rate, international prostate symptom score (IPSS) and maximum flow rate (Q(max)) were measured.
  
  
  RESULTS
  A total of 142 patients completed the follow-up and were recruited for further analysis. At 1 month, the proportion of patients with urinary tract infection was similar between the C-TURP+ILC group and the TURP group (8.5 and 6.5%, p > 0.05), but significantly higher than that in the ILC group (51%, p < 0.001). Acute urinary retention was found in 30.6% of patients in the ILC group, but was not observed in the C-TURP+ILC and TURP groups. In the TURP group, the rate of retrograde ejaculation was significantly higher than that in the other 2 groups (p < 0.001). The retreatment rate was 8.5, 36.7 and 2.2% in the C-TURP+ILC, ILC and TURP groups, respectively (p < 0.001). When compared with baseline, the IPSS in the C-TURP+ILC, ILC and TURP groups was decreased by 70.6, 45.4, and 81.0%, respectively (ILC vs. C-TURP+ILC or TURP, p < 0.01) at the 48-month follow-up. One month after surgery, the Q(max) was significantly increased in the C-TURP+ILC group and the TURP group when compared with that at baseline (p < 0.01). The TURP group had the highest and the ILC group had the lowest increase in the Q(max) at the 12-, 24-, and 48-month follow-ups (p < 0.05).
  
  
  CONCLUSIONS
  C-TURP+ILC is a safe and effective modality for the treatment of BPH, and exhibits favorable short-term clinical response and long-term durability. It is relatively reasonable and acceptable for treatment of high-risk elderly patients or those with a limited life expectancy.
authors.affiliation: Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Guojun
authors.initials: G
authors.lastname: Wu
authors.forename: Changsheng
authors.initials: C
authors.lastname: Chen
authors.forename: Bin
authors.initials: B
authors.lastname: Song
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Zhong
authors.forename: He
authors.initials: H
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D003131:Combined Modality Therapy; D004542:Ejaculation; D006772:Hospitals, Military; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology; D014563:Urodynamics