Visual Laser Ablation of the Prostate (VLAP) with Bare Fiber in Conjunction with Laser Bladder Neck Incision in The Treatment of Patients with Benign Prostatic Hyperplasia (BPH)

Abstract

The objective of this paper was to assess the effectiveness of visual laser ablation of the prostate (VLAP) using a bare fiber with simultaneous laser incision of the bladder neck for patients with symptomatic benign prostatic hyperplasia. Sixty-seven patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia were entered into a prospective trial where VLAP was done with neodymium:YAG laser, while the bladder neck incision was done with KTP laser. The laser was delivered using a bare fiber. There was marked improvement demonstrated at three months post-lasing in symptom score and flow rate. No significant changes were noticed in the subsequent follow-up. However, the addition of the bladder neck incision increased the rate of retrograde ejaculation without appreciable improvement in symptom score or flow rate when compared to other published data. None of the patients developed bladder neck contracture. VLAP, using a bare fiber, in conjunction with laser bladder neck incision, produces durable improvement in urine flow rate and symptom score in patients with symptomatic benign prostatic hyperplasia without the development of bladder neck contracture. This method will reduce the costs of laser prostatectomy. Ann Saudi Med 1997;17(2):191-194. HMA Farsi, HA Mosl, MF Alzemaity, A Bahnas, Visual Laser Ablation of the Prostate (Vlap) with Bare Fiber in Conjunction with Laser Bladder Neck Incision in the Treatment of Patients with Benign Prostatic Hyperplasia (Bph). 1997; 17(2): 191-194Benign prostatic hyperplasia (BPH) is one of the most common disease processes in men. For more than 50 years, the gold standard of treatment for patients seeking surgical therapy from this disease has been transurethral prostatectomy. It is estimated that nearly 400,000 transurethral prostatic resections (TURP) are performed each year in the United States.1 Transurethral incision of the prostate (TUIP) was recommended as an alternative to TURP in a small prostate.2 Visual laser ablation of the prostate (VLAP) is a new modality being evaluated for the treatment of BPH. A pilot study was performed using VLAP in 17 male patients by Costello et al., which showed a significant improvement in postoperative flow rates and Madsen-Iversen symptom score.3 Many different treatment methods are currently evolving. Free-beam side-fire fibers, noncontact side-fire, contact vaporization, bare fiber, interstitial laser and ultrasound-guided laser prostatectomy have been reported. 4,[5][6][7][8][9] One disadvantage of VLAP is the expense of both the initial capital and the running cost. The single most expensive recurrent cost is the laser fiber. Recently, many companies have presented different side-firing laser devices. These are usually recommended for one use only and cost about 3000 to 5000 Saudi riyals. To assess the value of VLAP using a bare fiber in conjunction with bladder neck incision, a prospective study was designed. Eligibility criteria included a patient's age being greater than 50 years and significant voidi...