Visual Laser Ablation of the Prostate: Efficacy Evaluated by Urodynamics and Compared to TURP

Is transurethral resection of the prostate still justified?

“…The mean increase in Qmax after TURP in the 29 RCTs reviewed was 125%, with an absolute mean (SEM, SD, range 95% CI) improvement of 9.7 mL/s (1.2, 3.3, 2.8–20.8, 8.6–11.2; Fig. 1) [20–48]. Figure 2b compares improvements in Q max for the 29 TURP arms with that from the less‐invasive procedures; the improvement in Q max after TURP was superior to that after transurethral incision of the prostate (TUIP), VLAP, ILC, TUNA, low‐ and high‐energy TUMT, interstitial radiofrequency therapy (IRFT), balloon dilatation of the prostate (BDP) and WW.…”

“…Ahmed et al [43] compared the impact of high‐energy TUMT and TURP on BOO; on the Abrams‐Griffith nomogram, 27 of 30 (90%) patients undergoing TURP were classified as unobstructed after surgery, yet all patients remained urodynamically obstructed after high‐energy TUMT. For VLAP, Kabalin et al [34] reported an identical urodynamic efficacy to TURP, while Jung et al [36] observed a substantially reduced urodynamic effect compared with TURP.…”

“…In a large‐scale, multicentre study of patients undergoing TURP in Denmark ( n =27 911), England ( n =2171) and Canada ( n =8995) the rate of re‐intervention after TURP increased from 2.3% to 4.3% within a year after surgery, to 8.9–9.7% after 5 years and to 12.0–15.5% 8 years after surgery [14]. In the RCTs reviewed here, the mean (SEM, SD, 95% CI) rate of secondary intervention after TURP was 2.6% (2.0, 4.7, 0.5–4.7) with a mean follow‐up of 16 months, thus confirming previously published long‐term follow‐up studies [20–48].…”

“…The objective of this review is to determine the current status of TURP with particular reference to less invasive procedures and recent developments of transurethral electrosurgery. To reliably assess this issue, we reviewed the recent urological literature and, specifically, all 29 randomized clinical trials (RCTs) published between 1986 and 1998 comparing less‐invasive treatment options directly with TURP (Table 1) [20–48]. These 29 RCTs contain clinical information for a total of 3032 patients, 1480 being randomized to TURP, 1552 to less‐invasive treatment options, from ‘watchful waiting’ (WW) to holmium‐laser resection (Table 1).…”

The use of lasers in benign prostatic enlargement

“…Jung et al [38] reported that VLAP and TURP led to similar symptomatic responses but that VLAP only lowered the "obstructive grade" (measured by pressure flow studies) in those men with prostate size below 50 mL, whereas TURP was effective for all prostate sizes. Narayan et al [39] reported that size did not impact on the success of TUVP in their experience.…”