[5-year follow-up to transurethral vaporesection of the prostate using the 2 micron continuous wave laser for the treatment of benign prostatic hyperplasia].

OBJECTIVE: To summarize the 5-year follow-up to 2 micron continuous wave laser vaporesection for the treatment of patients with low urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), and evaluate the safety and clinical effects of the treatment.

METHODS: From October 2006 to September 2007, 236 cases with low urinary tract symptom secondary to BPH were treated transurethrally under epidural or general anesthesia using the 70 Watt 2 micron laser system. Vaporesection of the prostate was performed with the traditional "U" or the "dividing" method. The 210 cases who met the inclusion criteria in this study were selected for further observation. Baseline and perioperative data were recorded and evaluated in resection time, transfusion rate, catheter-time, improvements in maximal urinary flow rate (Qmax), international prostate symptom scores (IPSS), quality of life (QoL), and post voiding residual volume (PVR).

RESULTS: Out of the 210 cases, 179 cases were followed up to 5 years finally. All the surgical procedures were successfully conducted under epidural or general anesthesia. Mean operation time was (80 ± 22) minutes, and mean retrieved prostatic tissue was (24.9 ± 4.2) g. Resected prostatic tissues could be easily flashed out of the bladder. There were no significant differences in serum sodium concentrations and hemoglobin levels before and after the surgery. Mean catheter time and hospital stay was (114 ± 35) hours and (5.7 ± 1.9) days respectively. Only one postoperative secondary hemorrhage was found and treated with blood transfusion. During the 5-year follow-up, Qmax increased from (8.6 ± 3.5) ml/s preoperatively to (23.6 ± 4.2) ml/s by the end of the follow-up (P < 0.01), IPSS and QoL-Score improved from 25.3 ± 5.2 and 4.1 ± 1.3 to 6.1 ± 3.0 and 1.4 ± 0.8 respectively (P < 0.01), and PVR decreased from (248 ± 89) ml to (15 ± 13) ml. The 3 patients developed urinary incontinence and recovered 3 months later through functional exercises with the help of acupuncture. Five patients were found to have urethral stricture 3 months after the surgery and recovered with the treatment of urethral dilatation (3 cases) or internal urethrotomy (2 cases) respectively.

CONCLUSIONS: Transurethral vaporesection of prostate using the 2 micron continuous wave laser system is a safe and effective treatment for benign prostatic hyperplasia with obvious improvements in subjective and objective voiding parameters, which were evident at 3 months after the surgery and were sustained throughout the 5-year long-term follow-up.