High-energy visual laser ablation of the prostate in men with urinary retention: Pressure-flow analysis

Objectives. To assess the efficacy of high-energy visual laser ablation of the prostate (VLAP) in men with urinary retention, using subjective and objective data. Methods. Seventeen men in urinary retention underwent high-energy VLAP. The mean patient age was 69 years, and the mean follow-up was 12 months. All men were urodynamically obstructed by pressure-flow analysis with a functioning detrusor muscle. Interviews assessed retrograde ejaculation and patient satisfaction. Results. The mean total energy applied was 71,088 J (range 27,556 to 110,294). The mean peak noninvasive urine flow rates increased from 2.1 to 18.1 cc/s, and the mean postvoid residual Volumes decreased from 550.0 to 39.0 cc. The mean detrusor pressure at peak flow decreased from 66.4 to 41.9 cm H2O, and the mean maximal detrusor pressure decreased from 72.2 to 49.2 cm H2O. Ten men (59%) voided to completion within 1 week post-VLAP. The mean postoperative International Prostate Symptom Score was 6. Nine men (53%) reported new retrograde ejaculation, and 14 men (82%) were satisfied with their outcome. Conclusions. High-energy VLAP is an effective procedure for relief of bladder-outlet obstruction in men with urinary retention.