A comparative prospective study between interstitial laser ablation (Indigo), radiofrequency interstitial needle ablation (TUNA) and TURP in the treatment of BPH

Abstract

Introduction: A comparative prospective three-arm study was conducted to evaluate the efficacy and safety of interstitial energies (diode laser 830 nm vs. radiofrequency 460 kHz) to produce coagulation necrosis of prostatic adenoma against standard TURP. Patients and methods: From January 1997 to July 1997, 80 patients entered the study (mean age 62.5 years, range 55-90); their mean (range) prostatic weight was 59.5 (35-90) g. Thirty patients were treated using interstitial laser coagulation (ILC) with the Indigo 830e laser-optic system, 25 were treated using radiofrequency with the TUNA system, and 25 underwent a standard TURP using an Olympus continuous irrigating resectoscope. Patients were assessed using the IPSS, QOL, maximum flow rate (Qmax), post-void residual volume, TRUS, and measurements of PSA and creatinine. Results: The results during follow-up were; Method Mean (SD) at follow-up (months) Before. 1.5 3 6 ILC (n = 30); IPSS 25(7) 25(5) 10(3) 7.5(3)* QOL 4.5(1) 4.0(1) 2.5(1) 2.4(1) Q 7.2 (4) 14.6 (4) 14.2 (4) 14.8 (3)* TUNA® (n = 25); IPSS 20.3 (7) 12.7 (8) 9.8 (8) 7.4 (5)* QOL 4.6(1) 2.6(1) 2.8(1) 2.2(1) Qmax 7.0(3) 13.6(5) 13.8(4) 14.4(3)* TURP (n = 25); IPSS 28 (4) 5.2 (4) 7.3 (3) 3.8 (3)* QOL 5.1 (1) 2.3 (1) 1.6 (1) 1.5 (1)* Qmax7.0 (3) 23.6 (5) 28.1 (4) 27.6 (4)* *P < 0. 001 No sexual dysfunction was recorded after ILC or TUNA, compared with 68% after TURP. No blood transfusion was recorded during ILC or TUNA, compared with 8% during TURP. Retention after the first catheter trial at 48 h occurred in 15% after ILC, 12% after TUNA and none after TURP. The mean hospital stay for ILC and TUNA was 1.5 days and was 3.5 days for TURP. Conclusions: At 6 months of follow-up, both ILC and TUNA produced equivalent Improvements In IPSS, QOL, and Qmm. Morbidity was minimal, but ILC caused prolonged irritative symptoms. TURP caused retrograde ejaculation and a longer hospital stay.