Transurethral resection of the prostate (TURP) with electrocautery is the most commonly performed procedure for the surgical management of symptomatic benign prostatic hyperplasia. Despite technical advancements, TURP with electrocautery remains morbid with a complication rate of up to 20%. Various laser ablative and vaporisation technology for the management of benign prostatic hyperplasia have been developed to reduce surgical morbidity without compromising clinical efficacy. This study aims to investigate the clinical efficacy and outcomes of one such technique, using the 980nm diode laser (EVOLVE prostatectomy) for the treatment of symptomatic benign prostatic hyperplasia.

A single centre retrospective study was conducted from 01 January 2008 - 31 December 2020 on men with moderate to severe lower urinary tract symptoms secondary to benign prostatic hypertrophy, who underwent EVOLVE laser prostatectomy at a single centre private hospital in Sydney, Australia. Patient demographics, pre- and post-operative measurements of peak urinary flow-rate (Qmax), post void residuals (PVR), International Prostate Symptom Score (IPSS), as well as peri- and post-operative complications were recorded. Data was analysed using IBM SPSS V27. Descriptive analyses were performed. Normally distributed data was analysed using independent t-tests and ANOVA where appropriate whilst categorical variables were analysed using Chi-square and Fisher’s exact tests as appropriate. P-values < 0.05 were considered significant.

Analysis of the overall cohort (n = 98) demonstrated a statistically significant difference in the pre- and post-operative peak urinary flow rate (mean improvement in Qmax of 14.94 mL/s (SD ± 8.19 mL/s), p < 0.0001) and post-void residual (mean reduction in PVR of 229.93 mL (SD ± 179.18 mL), p < 0.0001). 87 patients (89%) had a favourable categorical improvement in pre- and post-operative IPSS scores. 75% of catheter dependent patients were catheter free at 6 month post surgery. Short term post-operative complications included urinary tract infection (14%), mild haematuria (15%) and clot retention (2%). Emergency department representations requiring admission was 9% (7 patients for urinary tract infection, and 2 for clot retention). Long term complications included urethral stricture (2%) and bladder neck contractures (4%). No patients required peri-operative blood transfusions or emergency revision surgery.

In this small cohort, the EVOLVE laser prostatectomy appears to have similar efficacy in comparison to conventional electrocautery TURP. Complication rates are comparable to electrocautery TURP with a reduced risk of bleeding and clot retention.

Further assessment of EVOLVE’s long-term functional outcomes, as well as its haemostatic properties for patients on active anti-coagulation in randomised controlled trials is required.