Transurethral ultrasound-guided laser-induced prostatectomy. Objective and subjective assessment of its efficacy for treating benign prostatic hyperplasia.

We describe our experience with transurethral ultrasound-guided laser-induced prostatectomy (TULIP), a new procedure to relieve bladder outlet obstruction caused by benign prostatic hyperplasia. This device is composed of a real-time 7.5 MHz ultrasound transducer coupled to a Nd:YAG laser that fires through an intraprostatic balloon. To date, we performed 16 TULIP procedures; all patients were evaluated from a subjective point of view by a questionnaire based on the Boyarsky scale. They all underwent complete urodynamic studies, including flowmetry with measurement of the residual volume (by catheter) and pressure/flow studies. Preoperative symptom score ranged between 7 and 14 (mean 11.4). Preoperative peak flow rates ranged between 0 and 13 ml/s (mean 6.8). Suprapubic drainage was kept for a mean of 11.6 days after the procedure (7-20 days). Postoperative acute retention was observed in 4 patients (25%) 5-7 days after the procedure. In 13 out of 16 patients, urodynamic obstruction was corrected by the procedure. Two patients kept a borderline obstruction. In 1 case transurethral resection of the prostate (TURP) was performed for persisting obstruction and in another case TURP was performed for persisting untreatable irritative symptoms. At 3 months after the operation, the Boyarsky symptom score (11 patients) ranged between 3 and 12 (mean 7.7) and peak flow rates ranged between 11 and 30 ml/s (mean 16.3). One patient is managed with a suprapubic tube. Retrograde ejaculation was observed in 2 out of 9 patients (22.2%). With a mean follow-up of 6.7 months, we did not observe any late complication.