Interstitial laser therapy

Interstitial laser therapy (ILT), also called interstitial laser coagulation, destroys overgrown prostate tissue by directing laser energy at the inside of your enlarged prostate gland. This procedure is used less commonly than TUMT or TUNA.

What to expect. You may be given spinal or general anesthetics. Or, you may be given only a combination of local anesthetics in the urethra and intravenous sedation to control pain. During ILT, a small tube containing a laser fiber is inserted through a cystoscope into the prostate tissue by puncturing through the part of the urethra that's next to the prostate. Several punctures are usually needed to treat the entire prostate. Once the laser fiber is inside the prostate tissue, laser energy is activated to heat and destroy the tissue and shrink the gland. You may have small amounts of blood in your urine for a few days after treatment. Most men resume routine activities and sexual activity in a week or two.

Who it works best for. ILT works best for men whose prostate is normal sized to moderately enlarged and who don't have urinary retention or poor bladder function. ILT doesn't cause significant blood loss like surgery does. This procedure is sometimes used for men who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot (coagulate) normally.

Outcome. Symptom relief may take up to a few weeks because of tissue inflammation. Some men say their symptoms get slightly worse for a short while before they get better. ILT moderately increases your urinary flow rate and reduces the size of your prostate. It's comparable to transurethral microwave therapy (TUMT) in relieving overall symptoms, but it's not as effective as transurethral resection of the prostate (TURP).

Side effects. Tissue inflammation after treatment can block urine flow and require that you use a catheter for several days to a few weeks. Urinary tract infections are the most common complication and are more likely the longer you need a catheter. Risk of retrograde ejaculation or erection problems is low — similar to that of TUMT. Retrograde ejaculation is more likely if your middle lobe is treated.

Need for re-treatment. Some men who have this procedure require a second treatment for their symptoms after a year or two.