Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode‐laser system with temperature feedback

Rosette, Jean J.M.C.H. de la; Muschter, R.; López, Michele Antonio; Gillatt, David

doi:10.1046/j.1464-410x.1997.00369.x

Cited by 40 publications

(23 citation statements)

References 1 publication

(1 reference statement)

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“…The results in both groups are comparable with those reported by others [7,20,23,24]. Comparing TUMT and the control group, the standard operation was the most effective, as others report [13,17].…”

Section: Discussionsupporting

confidence: 88%

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Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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Objective To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/ TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. Results At 6 months the symptom scores and maximum urinary flow rate (Q max ) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group ( P > 0.05); the mean Q max was 20.6 mL/s in the control group, 16.2 in the ILC group ( P > 0.05 vs control) and 13.2 in the TUMT group ( P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Q max than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group.Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the control group were re-treated for BPH within the first 6 months. Conclusion In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.

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Section: Discussionsupporting

confidence: 88%

“…ILC has documented efficacy and an acceptable frequency of side-effects [4][5][6][7]. In some aspects ILC seems to offer an advantage over TURP; blood loss is minimal and the risk of TUR syndrome is eliminated, as saline rather than glycine is used as the irrigant.…”

Section: Introductionmentioning

confidence: 99%

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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“…18,19 The incidence of sexual dysfunction is negligible after TUNA; several studies reported no ED or retrograde ejaculation. 20 -22 Only one study, a prospective multicentre trial in the US, found less than 1 and 2% of retrograde ejaculation and ED, respectively.…”

Section: Minimally Invasive Therapiesmentioning

confidence: 99%

Impact of treatment of BPH on sexuality

Schulman

2001

Prostate Cancer Prostatic Dis

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Benign prostatic hyperplasia (BPH) can have a profound affect on a patient's quality of life and sexual function and is considered by patients to be one of the most important aspects affected by the disease. Different treatments can produce a variable response in terms of the patient's quality of life, including sexual activity and satisfaction. Varying rates of erectile dysfunction (ED) and retrograde ejaculation following surgery for BPH have been reported. In general, the incidence of these side-effects is less after minimally invasive therapies, such as interstitial laser coagulation and transurethral microwave therapy, but the data available are limited. The lowest rates of sexual dysfunction are reported with medical therapies. The 5a-reductase inhibitor, finasteride, can result in ED in 5 -9% of patients and ejaculation disorders in 0.8 -2.0%. With the exception of tamsulosin, a 1 blockers are associated with a low rate of sexual dysfunction. No cases of ED have been reported with alfuzosin and abnormal ejaculation with terazosin or alfuzosin is negligible. Indeed, early research suggests a beneficial effect of a 1 blockers on sexual function. In addition to information on the efficacy of a particular therapy, patients should be informed of side effects, in particular those relating to sexual function, in order that they can make informed treatment decisions. Prostate Cancer and Prostatic Diseases (2001) 4, Suppl 1, S12-S16.

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“…As the optimal temperature for coagulation is estimated to be about 85 C the aim of the treatment was to reach and maintain this temperature at the site of treatment during the entire treatment cycle. A temperature-triggered feedback system was built into the laser unit so that during treatment the temperature was monitored continuously, and the temperature and power output formed a feedback loop that sought to maintain a temperature of 85 C. 4 Suprapubic catheters were removed when adequate voiding was demonstrated at scheduled follow-up visits (1, 2 or 4 weeks).…”

Section: Laser Proceduresmentioning

confidence: 99%

“…We have also recently reported on the initial results using a diode laser system with temperature feedback. 4 Therefore we also report on long-term follow-up results using such a system.…”

Section: Introductionmentioning

confidence: 99%

Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology

Mårtenson

Rosette

1999

Prostate Cancer Prostatic Dis

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Interstitial laser coagulation (ILC) treatment is a recent technique in the treatment of BPH that is evolving rapidly. The results of a prospective randomised study vs transurethral resection of the prostate (TURP) is presented as well as results of patients treated with a temperature sensing laser system. The ®rst study included 44 patients treated in a prospective randomised study (randomisation ILC vs TURP 2 : 1) comparing changes in objective and subjective parameters. In the second part of the study the outcome of the treatment of 34 patients with BPH using ILC performed with a temperature-sensing laser system are presented. The clinical outcome at 12, 26, 52 and 104 weeks was evaluated with symptom scores, quality of life measures, changes in voided volume, post void residual, and peak¯ow rate. In addition changes in prostate volume and urodynamic parameters at half a year follow-up are presented.In this randomised study patients improved markedly at any time during follow-up. In the ILC group there was a signi®cant and persisting subjective improvement whereas the improvements in the TURP group were even more signi®cant. The changes in voiding parameters, including changes in pressureow parameters, are superior in the TURP group compared to the changes in the ILC group. The retreatment rate for the ILC group is 21% compared to 7% in the TURP group, no patient with incontinence was documented in either group, while only one patients in the TURP group developed a urethral stricture. In the second part of the study, the clinical improvements following laser therapy using the temperature sensing treatment mode were more pronounced in voiding parameters when compared to those of the randomised laser group.Lower energy interstitial laser treatment of the prostate results in a signi®cant improvement of all clinical parameters that are inferior to improvement following transurethral resection of the prostate. When using a temperature sensing system, the objective results of laser treatment improved and seem to be more durable.

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Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode‐laser system with temperature feedback

Cited by 40 publications

References 1 publication

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

Impact of treatment of BPH on sexuality

Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology

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