Early Clinical Experience of Interstitial Laser Coagulation(ILC) for the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Variable modalities, with more comfortable and less incidence of post-operative complications over TURP, have been used for the treatment of benign prostatic hyperplasia(BPH) with bladder outlet obstruction. Recently, we performed Interstitial Laser Coagulation(ILC) with the 830nm diode laser, which is considered as a method of minimally invasive treatments for BPH, to assess the efficacy and safety of the device, and to evaluate its capability of replacing TURP for managing BPH. MATERIALS AND METHODS: We analysed 16 patients, who had suffered from symptomatic BPH, treated with ILC using diode laser retrospectively from April 1996 to January 1997. Mean age of the patients was 71.7(52-84) years old and mean size of prostates before the treatments was 52.2(26.8-100.7)gm. Treatment outcome was estimated by comparing IPSS, QOL, Qmax, Qave and residual urine before the operations with them of first and second month after the operations. Post-operative transrectal ultrasonography was able to several cooperative cases and they were compared with them of pre-operative volumes, too, although it was unavailable to evaluate statistically. RESULTS: The operation were performed under epidural or spinal anesthesia with average time of 62 minutes and with 10 days of post-operative catheterization. IPSS reduced from 22.25(+/-4.82), mean value before the operation, to 11.00(+/-5.58) and 5.00(+/-3.10) at first and second month after ILC. QOL was gradually decreased from 4.44(+/-0.51) to 2.31(+/-1.20) and 1.19(+/-0.91), too. In terms of Qmax, mean was 12.29(+/-5.55)ml/sec before the operation and it was increased to 15.94(+/-7.38)ml/sec and 20.75(+/-8.48)ml/sec. Average flow rate was also increased from 6.98(+/-2.05)ml/sec to 10.38(+/-3.72)ml/sec and 14.93(+/-4.37)ml/sec. Significant reduction was observed in residual urine volume from 98.13(+/-91.72)ml to 33.19(+/-36.58)ml and 9.56(+/-11.24)ml respectively. Minimal hematuria and mild bladder irritations were common symptoms after the procedure, and possible significant complications as like anemia, electrolyte imbalance(post-TUR syndrome), epididymoorchitis, erectile dysfunction, urethral stricture, retrograde ejaculation had not found in our experience, but 1 patient was retreated with TURP because of continued bladder outlet obstruction. CONCLUSIONS: Our initial results with ILC showed that it is a relatively simple and minimally invasive method with minimal occurrence of bleeding and no electrolyte imbalance. We concluded that ILC is a safe and efficacious treatment modality, and it can be used even for elder patients with co-morbidity illness as well as patients with too large prostate to perform TURP.