Noncontact sidefire laser ablation of the prostate.

Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has shown encouraging results. Thus far, of the 198 patients treated with the 60 W/60 seconds technique since October 1990, a total of 74 were available for long-term evaluation (69 at 12 months and 29 at 24 months). The AUA Symptom Scores, Qmax (peak uroflow rates), and postvoiding residual urine volumes demonstrated marked improvement. The complications included 16 instances of recurrent obstructive symptoms necessitating revision. Three patients suffered urinary tract infections, two patients developed bladder neck stenosis, four anticoagulated patients with clot retention required blood transfusions, and three patients had epididymoorchitis. Follow-up at 12 and 24 months showed sustained reduction in AUA Symptom Scores and maintained improvement of the peak flow rates and residual volumes. These results demonstrate the safety and clinical applicability of laser ablation of the prostate and its potential usefulness as a less invasive therapy for benign hyperplasia.

Transurethral laser ablation of the prostate--long-term results.

Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months of follow-up, respectively. The American Urological Association (AUA) symptom scores, peak uroflow (Qmax) rates and post-void residual urinary volumes show marked improvement. Following laser ablation of the prostate (LAP), complications have included 16 patients with post-procedural recurrent obstructive symptoms requiring revision. Three patients developed urinary tract infection, two developed bladder-neck stenosis, four fully anticoagulated patients with clot retention required blood transfusion and three patients had epididymo-orchitis. The results show a sustained reduction in AUA symptom scores and maintained improvement in peak flow rates and residual volumes, with stabilization of the above-mentioned parameters occurring within 12-36 months. The results demonstrate the continued durability of the outcome of LAP.

Ureteral meatotomy with local-prototype urethrotome in the management of lower ureteral stones.

Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-prototype visual urethrotome was evaluated for the management of submucosal vesicoureteral stones and as an aid in the removal of a Dormia basket with an entrapped stone impacted in the submucosa of the vesical portion of the ureter. A total of 14 male and 11 female adult patients were included. Fifteen patients required ureteral meatotomy to release the stone. Transurethral ureteral meatotomy is a precise and safe procedure associated with minimal complications when carefully done. Our local-prototype instrument proved to be a simple, economical, and valuable tool.