Effect of Transurethral Ultrasound-guided Laser-induced Prostatectomy(TULIP) Procedure in Patient with BPH

Lee, In Kee; Lee, Tchun Yong

Abstract

Forty two patients (ages 55 to 88 years) who had bladder outlet obstruction due to benign Prostatic hyperplasia were treated with TULIP procedure from October 1993 to Apri1 1994. Preoperatively, the patients underwent digital rectal examinations, determination of prostate specific antigen levels and transrectal ultrasound guided biopsies when necessary to rule out the presence of prostatic cancer. The overall preoperatively estimated weight of prostate gland was 37.3+/-5.0g by transrectal ultrasonography, and all types of prostatic enlargement, including median lobe obstruction, were treated. The TULIP device incorporates ultrasound visualization with 90 degree angle, side-firing Nd: YAG laser to induce coagulation necrosis of prostatic tissue. Treatment was performed primarily under epidural anesthesia, and the mean irradiated laser energy was 20,315 joules. There were no intraoperative complications such as hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. The patients were evaluated at three months following treatment. The subjective symptom scores were significantly decreased from 23.7+/-4.3 to 3.2+/-1.9 for a 87% improvement(P<0.001). Maximum flow rate increased from 8.2+/-3.2ml/sec to 13.7+/-3.4ml/sec, for a 67% improvement (P<0.001). For three months follow-up period epididymitis was developed in 2 cases, but these were easily handled with antibiotics. There were no patients of incontinence or impotence, as a complication, after TULIP procedure With these results we can conclude that TULIP is a reliable and effective procedure of little morbidity, especially for the aged patients with various medical problems.