Laser prostatectomy: where are we now, and where should we be going?

Sidefire coagulation of the prostate has been a very successful introduction of laser technology to the treatment of prostate disease. Although bleeding has been reduced, the delayed relief of urinary obstruction and the postoperative dysuria are of concern. Laser vaporization, on the other hand, is probably as good as electrical incision of the bladder neck and is less likely to produce bleeding. The hybrid technique, a combination of vaporization of the gland substance with laser prostatotomies and coagulation, provides early disobstruction with later bulk removal of prostatic tissue. Interstitial coagulation seems to be effective in treating a greater bulk of gland tissue. Urologists need to subdivide prostates according to their size and configuration for a series of clinical trials of various types of laser prostatectomy and comparison with established treatments.