The simple reason why its time to seriously consider laser surgery as the potential new Gold-Standard is that the clinical outcomes are finally comparable to TURP (symptom score, peak flow rate, post void volume) while being as fast, reducing recovery, reducing or eliminating hospital time, reducing blood loss, and reducing other complications across the board.
Microwave, RF ablation, pharmaceuticals may still have a role, but their role is likely to diminish now that laser therapies can deliver on most of the same benefits as these “less-invasive alternatives” while not forcing the doctor or patient to compromise on clinical outcomes.
Consider this excerpt from a meta-analysis from a prospective randomized trial:
“TmLRP-TT was significantly superior to TURP in terms of catheterization time (45.7+/-25.8h vs. 87.4+/-33.8h, p<0.0001), hospital stay (115.1+/-25.5h vs. 161.1+/-33.8h, p<0.0001), and drop in hemoglobin (0.92+/-0.82 g/dl vs. 1.46+/-0.65 g/dl, p<0.001), whereas it required equivalent time to perform (46.3+/-16.2 vs. 50.4+/-20.7 min, p>0.05). TmLRP-TT and TURP resulted in a significant improvement from baseline in terms of subjective symptoms scoring and urodynamic finding, but no significant difference was found between the two groups. Late complications were also comparable. CONCLUSIONS: TmLRP-TT is an almost bloodless procedure with high efficacy and little perioperative morbidity. TmLRP-TT is superior to TURP in safety and is as efficacious as TURP in 1-yr follow-up. It is a promising technology in the clinical practice field.”
As we see from these results; the urodynamic outcomes were similar between the thulium laser prostatectomy and TURP, but the laser provided the additional benefits of; reduced catheterization time by 48%, hospital stay was reduced 29%, blood loss was reduced 37%, even treatment time was slightly less (8%).
As stated by Dr. Dubey regarding these and other published results showing the efficacy of lasers for treating BPH; “… [the] TURP is facing genuine competition and might be replaced as the gold-standard in minimally invasive surgery of the prostate.”