Video-guided Laser Ablation of the Prostate (V-LAP): Evaluation for Effect of Laser Prostatectomy with Transrectal Ultrasonography

Shim, Bong Suk; Kwon, Sung Won

Abstract

The number of old patients suffering from benign prostatic hyperplasia is growing. TURP is still "gold standard" of relieving infravesical obstruction due to BPH, but the persistently high postoperative morbidity after TURP recently spurred the development of less invasive treatment options. Laser ablation of the prostate is a relatively new surgical treatment for BPH. According to studies published to date, laser prostatectomy is a simple and effective BPH-treatment modality with a low complication rate. We carried out Nd : YAG laser prostatectomy under visual control (VLAP) in 57 patients with BPH, aged 53-80 years (mean: 64.9 years). Preoperatively, the maximal flow rate (Qmax) ranged from 6-14 ml/sec (mean: 9.5 ml/sec), the residual urine volume (RUV) was 20-300 ml (mean: 109 ml), and the I-PSS ranged from 18-28 (mean: 20.4). The prostatic volume, measured with transrectal ultrasonography, was 26-72 gm (mean: 43.3 gm). There was no significant changes of hemoglobin, hematocrit and serum electrolytes, perioperatively. In 6 patients (10.5%), retention was developed after removal of urethral catheter at postoperative fifth day and so urethral catheter was reinserted for 5-7 days. After 6 months, Qmax was 9-22 ml/sec (mean: 15.4 ml/sec), RUV was 0-50 ml (mean: 15 ml), the I-PSS was 4-21 (mean: 8.3), and the prostatic volume was 11.3-51.9 gm (mean: 24.9 gm). In most patients, the prostatic volume was decreased as 42.6%, and Qmax, RUV and I-PSS were improved noticeably. Transrectal ultrasonography showed defect of bladder neck and prostatic urethra during immediate postoperative period, but normal prostatic architecture after 6 months In conclusion, the laser prostatectomy for BPH is considered the most promising alternative to TURP.