Visual laser ablation of the prostate (VLAP) with bare fiber in conjunction with laser bladder neck incision in the treatment of patients with benign prostatic hyperplasia (BPH)

The objective of this paper was to assess the effectiveness of visual laser ablation of the prostate (VLAP) using a bare fiber with simultaneous laser incision of the bladder neck for patients with symptomatic benign prostatic hyperplasia. Sixty-seven patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia were entered into a prospective trial where VLAP was done with neodymium:YAG laser, while the bladder neck incision was done with KTP laser. The laser was delivered using a bare fiber. There was marked improvement demonstrated at three months post-lasing in symptom score and flow rate. No significant changes were noticed in the subsequent follow-up. However, the addition of the bladder neck incision increased the rate of retrograde ejaculation without appreciable improvement in symptom score or flow rate when compared to other published data. None of the patients developed bladder neck contracture. VLAP, using a bare fiber, in conjunction with laser bladder neck incision, produces durable improvement in urine flow rate and symptom score in patients with symptomatic benign prostatic hyperplasia without the development of bladder neck contracture. This method will reduce the costs of laser prostatectomy.