Clinical Experience of Laser Prostatectomy under Regional or Local Anesthesia in 77 Patients with Benign Prostatic Hyperplasia

Park, Myung Seung; Park, Jong Kwan; Park, Young Kyung

Abstract

PURPOSE: This prospective study was designed to evaluate the efficacy and safety of Nd: YAG laser for the treatment of benign prostatic hyperplasia(BPH).
MATERIALS AND METHODS
From January 1994 to March 1995, 77 patients with BPH were underwent laser prostatectomy. Of the 77 patients 17 were performed under local anesthesia. Preoperative and postoperative(at 1, 3 and 6months after operation) evaluation consisted of uroflowmetry, American Urological Association(AUA) symptom score and posboid residual urine. There were no limits of the prostatic size for operation and 2 cases had 100gm of prostatic weight. Multiple dragging technique(from the bladder neck to the verumontanum) with 90 degrees fiber at 80 to 90watts power were used in near contact or contact.
RESULTS
69 patients of total 77 patients have completed 6months follow-up evaluation. Mean prostatic size was 39.7gm. Preoperative mean urine flow rate was 3.0ml/sec and postoperative urine flow rate at one, three and six months was 10.7, 13.8 and 13.6m1/sec, respectively. Preoperative AUA score was 26.6 and postoperative AUA score at one, three and six month was 9.6, 7.6, respectively. Preoperative residual urine was 251.4ml and postoperative residual urine at one, three and six months was 57.0, 15.3 and 19.4ml, respectively. In 17 cases laser prostatectomy was done under local anesthesia due to poor medical condition. The results of laser prostatectomy under local anesthesia was not different from the cases with regional anesthesia. And the degree of subjective Pain of the Patients in local anesthesia was tolerable. The total energy used was about 129,000 Joules and the mean operative time was 103 minutes. Foley catheter was removed on postoperative 5th day. A total of 7 patients failed in initial voiding trials and required catheterization longer than 2weeks postoperatively. In 3 cases of seven patients who complained discomfort on voiding after 3months, necrotic tissue was present on cystoscopy. There were no severe complications.
CONCLUSIONS
It is concluded that the technique of transurethral laser-induced prostatectomy is effective and less invasive technique alterative than traditional transurethral resection of the prostate.