Efficacy and safety of laser prostatectomy techniques for treating symptomatic benign prostatic hype

Session number: 1070

Abstract title: Efficacy and safety of laser prostatectomy techniques for treating symptomatic benign prostatic hype

Author(s):
RM Hoffman - New Mexico VA Health Care System
TJ Wilt - Cochrane Prostate Diseases and Urologic Cancers Review Group Center for Chronic Diseases Outcomes Research Minneapolis VA Medical Center
R Macdonald - Cochrane Prostate Diseases and Urologic Cancers Review Group Center for Chronic Diseases Outcomes Research Minneapolis VA Medical Center
JW Slaton - Cochrane Prostate Diseases and Urologic Cancers Review Group Center for Chronic Diseases Outcomes Research Minneapolis VA Medical Center

Objectives: Minimally invasive laser techniques are being used to treat benign prostatic hyperplasia. We systematically reviewed the literature to compare the effectiveness of laser techniques with transurethral resection of the prostate (TURP) in improving urinary symptoms and urinary flow and to compare the incidence of adverse events.

Methods: Studies were identified through searching MEDLINE, EMBASE, the Cochrane library, and bibliographies of identified articles and reviews. We included randomized trials with 6-months or more of outcome data on urinary symptoms and/or urinary flow. There were no language restrictions. Two investigators independently extracted data on study design, subject characteristics, treatment characteristics, and treatment outcomes at 6 to 12 months. Main outcomes included changes in urologic symptom scores and urodynamic measurements. Secondary outcomes included the incidence of adverse effects, hospital length of stay, and rates of re-operation. Data were analyzed using Review Manager 4.1 software.

Results: We report on 16 studies comparing laser techniques with TURP, including 8 comparisons using contact lasers, 7 using non-contact lasers, and 3 using hybrid techniques. There were 1499 subjects, with a mean age of 67 years, an average symptom score of 21, and a peak urinary flow of 9.5 ml/s. Follow-up duration ranged from 6 to 36 months. Laser techniques and TURP both significantly improved symptoms and urinary flow. Some studies found statistically greater improvement with TURP. Laser subjects had fewer complications, including major bleeding and strictures, and shorter hospitalizations. Contact laser techniques had shorter catheter durations than TURP. Non-contact laser techniques required longer catheter duration and caused more dysuria than TURP. Overall, the rate of re-operation was higher following laser procedures.

Conclusions: Laser techniques have similar efficacy to TURP in improving urinary symptoms and peak urinary flow within one year of follow-up. Hospitalizations were shorter and laser subjects had fewer complications. However, laser techniques had more treatment failures.

Impact statement: Symptomatic benign prostatic hyperplasia is prevalent in the aging Veteran population. Our results suggest that laser techniques are an effective treatment alternative to TURP.