CEM 2012: are lasers replacing resectoscopes in BPE surgery?

The question whether the laser is steadily replacing the resectoscope on the treatment of benign prostate enlargement (BPE) was examined in a head-to-head debate at the 12th Central European Meeting (CEM) held in Dresden, Germany, eliciting some insights on the pros and cons of both emerging and traditional technologies. Prof. Oliver Hakenberg (Rostock, Germany) took the opposing stance while Dr. Anna Kolodziej (Wroclaw, Poland) defended the use of the laser as a reliable alternative that has become more widespread in recent years.

“In managing small/medium-sized prostates lasers are equivalent but not superior to transurethral resection of the prostate (TURP),“ said Kolodziej. “However lasers have definite advantages over TURP with regards to intra-operative safety- and are superior to TURP and should be considered for patients receiving anticoagulants and with cardiovascular diseases.”

Citing the rising number of older patients and the bigger sizes of prostates, Kolodziej added that aside from being less invasive, lasers offer a safe and effective minimally invasive treatment for patients with larger prostates and “…at the very least makes the need for open prostatectomy debatable.”

“Lasers offer tailored techniques to every patient,” she pointed out.

On the other hand, Hakenberg gave a succinct assessment of the impact of laser techniques in the treatment of BPE and noted that urologists should address the questions on what specific conditions they are treating and how the treatment impacts quality of life, sexual function, length of hospital stay and costs, among other factors.

“The problem with the evidence for medical devices are that the trials are usually underpowered, short-term and non-randomized. They are also non-comparative and the statistical analysis are often invalidated by interim analysis,” Hakenberg said. “Meta-analyses and the systemic review of poor trials produce very limited conclusions.

He also noted that TURP has evolved into a modern tool with a proven long-term efficacy and benefits, and that there are several indications where the laser cannot cope with. Hakenberg finally anchored his critique regarding lasers on the current EAU guidelines and mentioned the following points:

• Laser vaporisation resection or enucleation are alternative treatment options
• TURP remains the standard for small and medium-sized prostates, and
• Open prostatectomy remains the standard for large prostates.