Interstitial Laser Coagulation Treatment of Benign Prostatic Hyperplasia: Is It to Be Recommended?

Abstract

Purpose

: To update the clinical data on the treatment of benign prostatic hyperplasia (BPH) by interstitial laser coagulation (ILC).

Material and Methods

: In addition to recent review articles, original papers published during the last 2 years were surveyed. The focus was on prospective, particularly randomized, trials and on those with long-term follow-up.

Results

: Interstitial laser coagulation is feasible, although considerable variability is observed in the results. Operative complications are minimal, but the postoperative catheterization time is relatively long. Irritative symptoms can last for a long time, and the rate of urinary infections is as high as 35%. There also is significant variability in the urodynamic results. The technique seems to be more effective in patients with mild bladder outlet obstruction at baseline. The retreatment rate at 1 year is as high as 15%, and higher rates, as much as 40%, are described at 3 years. When compared in a randomized fashion with transurethral resection of the prostate (TURP), the postoperative period is shorter after TURP and the retreatment rate (early and late) is higher after ILC.

Conclusions

: Interstitial laser coagulation is superior to TURP in terms of operative morbidity, but postoperative morbidity is higher after ILC. Long-term durability has not been properly documented, and randomized studies show a higher retreatment rate after ILC than after TURP. The technique is recommended for those patients with bleeding disorders necessitating an interventional therapy.