Use of bare fiber with siderfiring Albarran bridge in laser therapy of the prostate.

Laser coagulation of the prostate has been performed using a bare fiber passed through a sidefiring Albarran bridge containing a distal gold-plated reflector with a deflecting mechanism. The system and the fiber can be used for several dozen treatments. Transurethral laser coagulation with the new Albarran bridge and the noncontact Nd:YAG laser was performed on 45 patients for obstructive symptoms caused by benign prostatic hyperplasia. The dosimetry was 1000 J per 1 cc of prostatic tissue at 60 W for 60 seconds. Successful results were obtained in 38 patients (85%). A significant reduction in obstructive symptoms from a mean AUA-6 Symptom Score of 21.2 preoperatively to 9.1 at 3 months and 7.6 at 6 months was associated with an increase in the peak urine flow rate from 6.1 mL/sec preoperatively to 13.1 mL/sec at 3 months and 15.7 mL/sec at 6 months. The residual urine volume averaged 190 mL preoperatively and 35 mL at 6 months. Transurethral laser coagulation of the prostate represents a useful alternative to transurethral resection, especially in the high-risk patient with an enlarged median lobe or a small prostate. The treatment is bloodless and, with the aid of the modified Albarran bridge, can be performed with a standard urologic Nd:YAG laser. The new Albarran bridge also can reduce the cost of laser treatment.