Prospective multicenter ProLase II clinical trial of neodymium:yttrium-aluminum-garnet laser prostatectomy.

OBJECTIVES: To assess the clinical efficacy of neodymium:yttrium-aluminum-garnet (YAG) laser coagulation prostatectomy using a broad-angle, divergent-beam, side-firing fiber. METHODS: Eighty adult men with voiding symptoms caused by benign prostatic hyperplasia were enrolled in a prospective multicenter study of free-beam neodymium:YAG laser prostatectomy performed with the ProLase II side-firing delivery fiber. Voiding outcomes were assessed at 3, 6, and 12 months postoperatively. RESULTS: At 1-year follow-up, peak urinary flow rates were increased by 105%, postvoid residual urine volumes had decreased by 38%, and the AUA symptom index had decreased by 60%. Serious treatment-related complications occurred in 3 of 80 patients (3.8%). The reoperation rate through 1-year follow-up was 2.7%. CONCLUSIONS: Neodymium:YAG laser prostatectomy performed with the ProLase II delivery fiber has proven safe and efficacious with durable results through 1 year in the relief of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia.

Management of urinary incontinence by bladder tube urethral lengthening and submucosal reimplantation.

We reviewed the first 25 urethral lengthening and reimplantation procedures done at our institution in 24 patients. All patients had failed to achieve dryness on medical or surgical therapy for total urinary incontinence. A total of 32 patients had neurogenic incontinence. The patients were followed for 1.5 to 7 years. Late complications included catheterization difficulties, vesicoureteral reflux, febrile urinary tract infection, calculi and peritonitis. Reoperations were required in 19 patients primarily because of our initial failure to recognize the necessity of providing a low pressure, high capacity reservoir. The reoperation rate on the continence mechanism was low. Of 24 patients 20 are continent and require no pads or diapers.