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A clinical and economic evaluation of contact laser surgery in the prostate.

Keoghane, Stephen Richard; (1997) A clinical and economic evaluation of contact laser surgery in the prostate. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Contact laser prostatectomy is an exciting new surgical technique, that in theory, can produce clinical results comparable to those obtainable with standard transurethral resection. This thesis has rigorously evaluated this technology in the context of a pragmatic, double blind randomised controlled clinical trial looking at traditional physiological outcome parameters, more subjective measures, as well as the increasingly important economic side of new technology. One hundred and forty eight patients with lower urinary tract symptoms attributable to benign prostatic enlargement were randomised to either transurethral resection (TURP) or contact laser prostatectomy; one year data were available on 126. Symptom score was the defined primary outcome measure, which statistically favoured the TURP arm throughout. However, when considering the clinically more important absolute change in symptoms, there was no difference between the two treatment arms of the study. Rigorous economic analysis has shown TURP to be less expensive, unless length of hospital stay following laser surgery is reduced to one night. Little change in quality of life as measured by the Short Form 36 generic health questionnaire between baseline and one year. In conclusion, contact laser vaporisation of the prostate can produce similar results to TURP in terms of symptomatic improvement, with less primary and reactionary haemorrhage but in this study, at a cost of a higher rate of failing trial without catheter and an increased re-operation rate. Interestingly, prostatectomy by whichever method has led to little improvement in general health status one year following surgery.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: A clinical and economic evaluation of contact laser surgery in the prostate.
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
URI: https://discovery.ucl.ac.uk/id/eprint/10105164
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