The University of Tennessee experience with the Indigo 830e laser device for the minimally invasive treatment of benign prostatic hyperplasia: interim analysis

Abstract

Benign prostatic hyperplasia (BPH) is the most common benign tumor in men and is responsible for urinary symptoms in the majority of men older than 50 years of age. Although transurethral resection of the prostate (TURP) is the gold standard, its complications have impacted upon its utility. As a consequence, new pharmacologic and minimally invasive approaches to the management of BPH have been developed. One minimally invasive approach that employs interstitial laser coagulation by the Indigo 830e LaserOptic system heats the prostate to the point of irreversible necrosis while preserving the urethral lining, potentially resulting in fewer complications. To test the efficacy of this device we evaluated the interim results obtained in 25 patients treated for BPH. Parameters evaluated included the AUA symptom score, uroflowometry, post-void residual, and prostate size. Following treatment, patients were discharged home and the catheter was removed within 3-7 days. Patients were assessed at 1 month and at subsequent 3-month intervals following the procedure using a questionnaire, AUA symptom score, and uroflowometry. The results of the paired t-tests demonstrated a significant increase in the maximal and average flow rates from baseline. The mean baseline maximal flow rate was 8.3 ml/s and increased to 10, 12.7, 14.1, and 12.0 ml/s at 1, 3, 6, and 9 months, respectively, and the mean baseline average flow rate was 4.4 ml/s and increased to 5.3, 6.0, 6.6, and 6.2 ml/s at 1, 3, 6, and 9 months, respectively. The AUA symptom scores decreased from 20.2 to 9.8 at 9 months. There was no intraoperative complication. Six patients developed transient retention. No patient developed bladder neck contractures, urinary incontinence, impotence, or urinary tract infections. One patient developed retrograde ejaculation and one patient required retreatment by TURP. Hence, improvements in symptom scores and voiding parameters suggest that the laser interstitial coagulation prostatectomy is safe and effective for the treatment of BPH.

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

“…As for other complications, the present results are comparable with those reported by others [5,6,8,30]. Patients in the ILC group had no significant bleeding and none developed stress incontinence.…”

“…The variation in UTI rates probably partly reflects differences in antibiotic regimens, but also the aggressiveness of treatment may be important. In the two series with the lowest incidence of UTI fewer punctures per volume were used than in most others [6,30]. In both studies the effectiveness was comparable with the results in the present ILC group.…”

“…Only when adding prophylactic antibiotics for 4 weeks did the UTI rates decrease to acceptable levels; the overall complication rate was then comparable with that in the control group. The UTI rate in the present study was higher than usually reported [6,8,29,30] although rates up to 49-60% have been published [21,31]. The variation in UTI rates probably partly reflects differences in antibiotic regimens, but also the aggressiveness of treatment may be important.…”

“…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.…”

The use of lasers in benign prostatic enlargement

“…Visible changes through ultrasound during prostatic heating allows for control of the heating process and follow-up of response. In our study of 36 men, preoperative Association of University Anesthetists (AUA)-7 scores of 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) fell to 7.6 (0-25), and peak flow rates increased from 9.5 (4-14) to 14.5 mL/s (7-32) at 6 months. Patients were taught intermittent clean self-catheterization (ICSC) for an average of 3.7 days (0-7).…”