Laser Surgery of the Prostate: A Review of the Current Options

A quarter of the male population above 40 and 43% of men between 60-69 years, have lower urinary tract symptoms (LUTS) in the presence of a reduced urinary flow rate and an enlarged prostate. 1 Approximately 10-15% of the UK male population will be considered for prostatic surgery at some point in their lives2. Men of 40 years of age in the United States in 1990 appeared to have a 30-40% chance of undergoing prostatectomy if they survived to 80 3 though age-adjusted rates of TURP reached a peak in 1987 and have dropped substantially since as a result of alternative treatments and the onset of “managed care”4. TURP is regarded as the gold standard in the treatment of bladder outlet obstruction (BOO) secondary to BEP. Immediate relief of symptoms is usual, morbidity acceptable and mortality low5. However, TURP may be associated with long term cardiovascular side effects6 and complications such as impotence7,8and retrograde ejaculation. Consequently there has been growing interest in alternative methods of treatment. This began with microwave therapy and advanced with the development of laser methods. There has now been a return to thermoelectric methods (electro vaporisation) utilising much higher energy levels than used for TURP.