Does Endoscopic Laser Ablation Of The Prostate Stand The Test Of Time? Five-Year Results From A Multicentre Randomized Controlled Trial Of Endoscopic Laser Ablation Against Transurethral Resection Of The Prostate

Objective To determine the long-term objective and subjective outcome of patients with benign prostatic enlargement (BPE) treated by endoscopic laser ablation of the prostate (ELAP). as part of a multicentre randomized controlled trial of ELAP against TURF.Patients and methods initially, 151 patients with BPE were randomized to undergo either ELAP or TURF, starting in March 1992. ELAP was performed using the Urolase(TM) fibre (Bard, Covington, GA, USA) in conjunction with a Nd:YAG laser source. All patients who had originally participated in the study were approached 5 years later to obtain a urological history, American Urological Association (AUA) symptom score and two measurements of urinary flow rate, with an ultrasonographic assessment of the postvoid residual urine volume (PVR).Results The mean duration of follow-up was 61 months; 109 patients were traced, comprising 69 who were alive and well, and had undergone no further bladder outlet surgery, 26 who had required revision surgery, 12 who were dead or terminally ill and three who had dementia, Both ELAP and TURF produced sustained improvements in mean AUA score, maximum flow rate and PVR, with respective values at 5 years of 6.3, 17.8 mL/s and 76 mt, and 6.5, 20.0 mL/s and 55 mL. Eighteen of 47 ELAP patients (38%) and eight of 51 (16%) TURF patients underwent revision surgery within the follow-up.Conclusion ELAP and TURF produced similar subjective and objective outcomes at 5 years. The re-operation rate after ELAP was more than double that after TURF and suggests that ELAP should not be used routinely in the management of men with BPE.