Combination of interstitial laser coagulation and transurethral resection of the prostate: ex vivo evaluations.

OBJECTIVES: To evaluate the combination of interstitial laser coagulation (ILC) and transurethral resection of the prostate (TURP) in an ex vivo model. Perioperative bleeding is still regarded as the main complication of conventional TURP. The minimally invasive procedure ILC and the highly effective TURP seem to be a promising concept to improve hemostasis.

METHODS: Isolated blood-perfused porcine kidneys were used to determine hemostatic efficacy of different interstitial laser procedures (neodymium:yttrium-aluminum-garnet [Nd:YAG], 1064 nm; and holmium:YAG [Ho:YAG], 2100 nm) in combination with conventional TURP. Bleeding could thus be quantified in relation to tissue ablation for the different techniques. Additionally, the specimens were evaluated histologically.

RESULTS: A combination of Nd:YAG ILC, followed by TURP, resulted in significantly (P <0.001) reduced bleeding compared with TURP alone for a standardized ablation volume of 16 cm(3) of perfused kidney tissue (5.1 mL/min versus 24.1 mL/min). Similarly, significantly (P <0.001) better hemostasis was demonstrated with the combination of Ho:YAG ILC compared with TURP alone (4.8 mL/min versus 24.1 mL/min). The differences between the two laser procedures were not significant. The histologic examinations revealed significantly larger coagulation zones for the groups pretreated with Nd:YAG ILC or Ho:YAG ILC compared with TURP alone.

CONCLUSIONS: ILC before conventional TURP leads, ex vivo, to a significantly superior hemostasis compared with TURP alone. The hemostatic effects of Nd:YAG and Ho:YAG laser treatments seem comparable.