Contact laser prostatectomy

Summary

Laser prostatectomy is a recent technique that is evolving rapidly. As new techniques develop, it is important to discriminate between those that merely coagulate the prostate, those that vaporise the prostate and those that do a combination of both. Coagulation of the prostate alone results in prolonged obstruction and an increased incidence of urinary tract infection and post-operative dysuria. Vaporisation alone can result in much more rapid dis-obstruction but the procedure is relatively slow. For small prostates this is the treatment of choice. It has not been compared with transurethral incision of the prostate to date. This trial is indeed indicated. Hybrid procedures are increasing in popularity because they have the potential to combine the best aspects of both coagulation and vaporisation. There is relatively rapid coagulation of the bulk of the tissue but the vaporised channel allows more rapid dis-obstruction. This allows the patient to void more rapidly, thereby reducing the catheter time. The duration of dysuria appears to be reduced. These distinctions in the techniques of laser application and the treatment of prostatic outflow obstruction are important.