Urodynamic results of laser treatment in patients with benign prostatic hyperplasia. Can outlet obstruction be relieved?

[S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

The use of lasers in benign prostatic enlargement

This article reviews the laser techniques available for the treatment of lower urinary tract symptoms. Early data on short-term mortality, morbidity, complication rates, and outcome are available, but information on cost-effectiveness, long-term outcome, and patient preference are as yet unavailable. In the 8 years since laser methods became popular it has become clear that substantial and variably durable flow and symptomatic responses are achieved that do not quite match transurethral resection of the prostate (TURP). Less immediate physiologic stress is balanced by a delay before full response. Same-day surgery may be possible, but an extended period of catheterization may be necessary. Laser methods remain an option for treatment and are particularly applicable to the less fit man. Whether men will choose a less effective but less invasive treatment option for symptom relief is not yet obvious. Limited early data suggest the holmium laser technique most closely approaches the gold standard.