In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives to transurethral resection of the prostate (the standard treatment modality for
benign prostatic hyperplasia) have been sought. Various types of
laser prostatectomy have been proposed. Interstitial
laser coagulation is performed by placing
laser-diffusing fibers directly in the hyperplastic
prostatic adenoma. The goal is to achieve coagulation
necrosis within the
adenoma, which causes the prostatic lobes to regress and thereby relieves the
bladder outlet obstruction. Either the transurethral cystoscopic approach or the perineal approach can be used for
laser application. Numerous published studies have shown that this
laser procedure safely and effectively decreases symptoms of
prostatism, increases the urinary flow rate, and reduces the volume of the prostate. Because of substantial tissue
edema after treatment,
catheter drainage may be necessary for 7 to 21 days. Although
retrograde ejaculation has occurred occasionally (affecting from 0 to 11.9% of patients in reported studies) and uncomplicated
urinary tract infections are common after interstitial
laser coagulation, no cases of
impotence or sustained incontinence have been described. Because interstitial
laser coagulation is not associated with blood loss or intravascular fluid shifts and, if necessary, can be performed with a combination of
local anesthesia and intravenous sedation, even high-risk patients are candidates for this procedure.