Introduction: Despite technical advancements, conventional transurethral resection of the prostate (TURP) with electrocautery remains morbid, with a 20% complication rate. Various laser ablative technologies for the management of benign prostatic hyperplasia (BPH) have been developed to reduce surgical morbidity without compromising clinical efficacy. We investigated the clinical efficacy and outcomes of the 980 nm diode laser for symptomatic BPH.

Methods: A single-center, retrospective study was conducted between 2008 and 2020 on men with moderate to severe lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), who underwent 980 nm (EVOLVE) diode laser prostatectomy at North Shore Private Hospital, Sydney, Australia. Patient demographics, anticoagulation status, pre- and postoperative measurements of peak urinary flow rate (Qmax), postvoid residuals (PVR), and  International Prostate Symptom Score (IPSS), as well as peri- and postoperative complications were recorded. 

Results: The overall cohort (n=98) demonstrated a statistically significant improvement in the pre- and postoperative Qmax (14.94±8.19 mL/s, p<0.0001) and PVR (229.93±179.18 mL, p<0.0001). Eighty-seven patients (89%) had a categorical improvement in pre- and postoperative IPSS. Short-term postoperative complications included urinary tract infection (14%), mild hematuria (15%), and clot retention (2%). The emergency representation rate was 9%. Long-term complications included urethral stricture (2%) and bladder neck contractures (4%). No patients required blood transfusion or emergency surgery.

Conclusions: In this small cohort, the 980 nm diode laser is similar in efficacy and complication rates to conventional TURP with a smaller risk of bleeding and clot retention. Further assessment of its hemostatic properties for patients on active anti-coagulation, as well as long-term functional outcomes in head-to-head trials are required.