Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction:: treatment under sedoanalgesia with pressure-flow evaluation

Objectives To evaluate the effects on lower urinary tract symptoms and pressure-Bow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo(TM) diode laser system (Indigo, Palo Alto, USA). Patients and methods Forty-nine men (median age 68 years, range 52-80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63-72) underwent pressure-flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient depart ment using sedoanalgesia. Results The International Prostate Symptom Score decreased from 22 to II at 12 months after ILC. The peak urinary flow (Q(max) )was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure-flow recordings. 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Q(max) increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Q(max) decreased from 68 to 51 cmH(2)O and the Abrams-Griffiths number decreased from 54 to 29 (P < 0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of > 40 mL had a greater decrease in the Abrams-Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1-2 weeks. The re-treatment rate was 15% within the first year. Conclusion Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1-2 weeks in most cases. A long-term follow-up is necessary to determine the role of ILC.