A. J. Costello

Second-generation delivery systems for laser prostatic ablation

OBJECTIVEnTo assess the effectiveness of a second-generation laser delivery system (Side-Fire) in the treatment of benign prostatic hyperplasia (BPH).nnnMETHODSnThirty-three patients with documented BPH were treated and evaluated pre- and post-operatively with a follow-up period of twelve to thirty-six weeks.nnnRESULTSnThere was marked improvement demonstrated at three months post lasing in all patient outcome parameters (symptom score, flow rate, and post-void residual volume) using the new Side-Fire right-angled delivery system.nnnCONCLUSIONnSide-Fire catheter laser ablation therapy produces an excellent transition zone ablation in established BPH.

Side-Firing Neodymium:YAG Laser Prostatectomy

Not until 1991 did laser therapy for benign prostatic hyperplasia become a feasible option for the practicing urologist. Prior to the development of side firing free beam laser delivery devices contact Neodymium:YAG, laser therapy for BPH was of limited applicability. Since 1991, refinements in laser device technology have allowed the urologist to expand the potential for Neodymium:YAG coagulative prostatectomy. Multiple studies over the past five years have demonstrated equivalence in efficacy and safety to conventional electrocautery TURP. Holmium:YAG laser technology may be a significant advance again on free beam side firing Neodymium:YAG laser prostatectomy.

Differential response of prostate specific antigen to testosterone surge after luteinizing hormone-releasing hormone analogue in prostate cancer and benign prostatic hyperplasia.

Objective To investigate any differences in changes in serum prostate specific antigen (PSA) levels in patients with benign and malignant prostatic disease in response to the testosterone surge after administering a luteinizing hormone‐releasing hormone (LHRH) analogue.

Histopathological Changes in Human Prostatic Adenoma Following Neodymium:Yag Laser Ablation Therapy

Transurethral laser ablation of the prostate is a procedure currently under evaluation as an alternative to transurethral resection of the prostate in the management of benign prostatic hyperplasia. Removal of prostatic tissue by endoscopic resection or open surgical techniques from 7 patients in whom prostatic laser ablation was previously attempted offered an opportunity to evaluate the sequential effects of such energy upon the human prostate at varying intervals after treatment. A progressive inflammatory and necrotic response, initially akin to that demonstrated after a thermal burn, together with evolving vascular changes within the residual viable prostatic tissue were demonstrated. Our study demonstrates the changes in the human prostate whereby neodymium:YAG laser energy causes a deep coagulative necrosis and arterial thrombosis in the prostatic adenoma. These changes differ significantly from those noted in canine studies. A slower cavitation effect is observed in the human compared with the canine, and this finding mirrors the continuing clinical improvement in voiding parameters with time.

Cost-Effectiveness of Laser Ablation of the Prostate: Premature Evaluation

A cost-effectiveness study compared visual laser ablation of the prostate (VLAP) with transurethral resection (TURP). Achieving equivalent outcomes, VLAP was more expensive than TURP. The result was sensitive to various assumptions, suggesting that VLAP might prove to be the preferred technology. Problems inherent in economic evaluation of emerging technologies are discussed.

Preliminary results of laser ablation of the prostate versus TURP: a randomized study

Preliminary results of a randomized study comparing laser ablation of the prostate (LAP) to transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic hyperplasia are reviewed. Forty-five men enrolled in the study had a minimum 6 week followup. Preoperative AUA symptom scores, peak urinary flow rates, and post-void residual urines (PVR) were compared to postoperative values. The TURP group (22 men) did better than its LAP cohort (23 men) with a mean decrease in symptom score of 70% versus 47%, a mean increase in flow rate of 83% versus 53%, and a mean decrease in PVR of 51% versus 28%, respectively, at 12 weeks. LAP patients had less complications associated with impotence and retrograde ejaculation, required urethral catheters for less time, and had shorter hospital stays. With the development of more durable and reflective fibers the difference in efficacy between TURP and LAP should diminish while the benefits of LAP are preserved.

Treatment of prostatic obstruction with neodymium:YAG laser

We have used the Neo dymium:YAG laser to treat 30 patients with prostatic obstruction. Laser ablation is used as an alternative to traditional electro cautery resection. The department has a 15 month experience in this new technology for prostatic destruction. With a prototype delivery system (Lateralase TM) obstructing prostatic adenoma was removed. This delivery system comprises a 600 micron fibre with terminal gold alloy tip. Treatment is virtually bloodless, speedy and performed with a standard urological instrument under direct vision. There are some advantages over the conventional endoscopic resection. Laser ablation therapy of benign prostatic adenoma may be a practical alternative to transurethral resection.

Lasers in urology

In the less than two decades that lasers have been available for urologic use, we have seen them become an important tool in our surgical arsenal. Laser therapy is now the preferred treatment for many cases of recurrent superficial bladder cancer; medically persistent condylomata; superficial penile cancer; superficial tumors of the upper urinary tract (ureter/ renal pelvis); and hemangiomas occurring throughout the genitourinary tract. In addition, laser photoirradiation has improved the quality of life for many patients suffering with interstitial cystitis and various proliferative cystitic conditions and has been fbund useful for treating stricture disease and for fragmenting urinary calculi. Nevertheless, in spite of the proven effectiveness of the laser, many urologists have been slow to embrace its use, preferring older, more familiar therapies while criticizing the technology for its complexities and expense. Fortunately, these attitudes are beginning to change, thanks to the encouraging results being reported for laser prostatectomy. Prospective randomized clinical trials have proven laser prostatectomy to be as good as, if not better than, conventional transurethral resection of the prostate (TURP) for treating benign prostatic hyperplasia (BPH) while significantly reducing patient morbidity and operative costs. Consequently, urologists who shunned the technology in the past are now eager to embrace its use today; with that in mind, we offer the following as a review, hoping that it may provide some light for those who would like an update on laser applications in urology. BLADDER LESIONS