Laser ablation of the prostate

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Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its ability to ablate hyperplastic tissue successfully. This therapy has emerged to challenge transurethral resection of the prostate (TURP), considered to be the 'gold standard' of prostatic surgery for at least 60 years. Three different techniques of laser energy delivery have been developed: transurethral ultrasound-guided laser-induced prostatectomy, visual endoscope-guided LAP, and interstitial transrectal ultrasound-guided ablation of the prostate. All three approaches appear effective and are relatively bloodless. The following discussion relates primarily to visual endoscopic LAP using 90* reflecting fibres. Urologists thus far have favoured this approach, which is simpler and more appealing because the visual endoscopic technique is more familiar than an ultrasound-guided system. Early results of randomized studies comparing LAP and TURP show equivalent short-term outcome when measured by symptom score, maximum flow rate, and residual urine volumes after voiding. The long-term outcome of laser prostatectomy will require further evaluation over several years to demonstrate equivalence to TURP.

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