A 4‐year follow‐up of a randomized prospective study comparing transurethral electrovaporization of the prostate with neodymium: YAG laser therapy for treating benign prostatic hyperplasia
Authors: Abdel‐Khalek M. , El‐Hammady S. , Ibrahiem El‐H. 
Published: May 2003

The Department of Urology and Nephrology in Mansoura, Egypt has turned their attention to many facets of urological practice in a thorough and interesting way. They have been involved in several technological treatments for LUTS in recent years, and here they describe a 4‐year follow‐up study where patients were randomized to Nd:YAG laser treatment or TUVP. They confirmed the view that TUVP is associated with effective and durable results, whereas the laser treatment was not.

Authors from Sheffield describe a pilot study wherein they evaluate the acute effect of magnetic stimulation of the pelvic floor on involuntary detrusor activity during natural filling. They found a decrease in the amplitude of involuntary detrusor contractions and an increase in bladder capacity assessed by cystometry. They found a variable effect on overactive bladder symptoms, and felt that magnetic stimulation may not produce a lasting effect on these symptoms.

OBJECTIVE

To compare the safety, efficacy and durability of neodymium (Nd):YAG laser prostatectomy with transurethral electrovaporization of the prostate (TUVP) for treating benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

From March 1995 to March 1997, 180 patients with bladder outlet obstruction secondary to BPH were randomized equally either to Nd:YAG laser therapy or TUVP. Laser therapy combined two different techniques, side‐fire coagulation of the lateral lobes and contact vaporization of the median lobe. Before treatment the two groups had a comparable International Prostate Symptom Score (IPSS), quality‐of‐life score (QoL), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and prostate and adenoma volume. In all, 62 and 78 patients completed the 1, 2, 3 and 4‐year follow‐up from the laser and TUVP groups, respectively.

RESULTS

At each follow‐up, the IPSS, QoL, Qmax and PVR were significantly better and more durable in the TUVP than in the laser group. In the TUVP and laser groups respectively, at the 4‐year follow‐up the mean value of the IPSS was 3.7 vs 11.9, the QoL 1.3 vs 3.1, the Qmax 21.4 vs 13.6 mL/s and the PVR 25.1 vs 64.6 mL (all P < 0.001). The mean prostate and adenoma volume were significantly lower after TUVP than after laser therapy (P < 0.001) at the 1‐ and 4‐year follow‐up, with final values of 27.9 vs 35.9 and 11.7 vs 20 mL (both P < 0.001) for the TUVP and laser groups, respectively. Retrograde ejaculation was significantly more common after TUVP (63%) than after laser therapy (18%; P < 0.001). Impotence was reported in 8% of men after TUVP and in none after laser therapy (P = 0.040). The re‐operation rate was 12% after TUVP and 38% after laser treatment (P < 0.001).

CONCLUSION

These 4‐year follow‐up results confirm that TUVP is significantly more effective and durable than the Nd:YAG laser for treating BPH. Residual obstructing adenoma was the main cause of failure in the laser group, which reflects the inadequacy of laser therapy for removing the adenoma.