BACKGROUND AND PURPOSE: The 80-W potassium-titanyl-phosphate (KTP) laser photoselective vaporization of the prostate (PVP) is a minimally invasive surgical option for patients with symptomatic benign prostatic hyperplasia, although evidence of long-term efficacy is limited. We present the long-term outcomes from a heterogeneous patient population.
PATIENTS AND METHODS: We prospectively collected data for all patients who underwent 80-W KTP laser PVP treatment between 2004 and 2005. Evaluation occurred pr-operatively, and then at 3, 6, 12, and 60 months postoperatively. This included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual (PVR) volume, serum prostate-specific antigen measurement, and transrectal ultrasonography-estimated prostate volume.
RESULTS: A total of 115 patients were eligible for analysis, with a mean age of 77 years and mean prostate volume of 55.8 cc. Of these, 74% were operated on for lower urinary tract symptoms, 23% for acute urinary retention, and 3% for chronic retention; 30% of patients were American Society of Anesthesiologists score≥3, and 93% were treated as 23-hour stays. No patients needed blood transfusion, and there were no cases of transurethral resection syndrome. An initial trial-without catheter failed in 11 (9.6%), although 8 of these successfully voided after a further week. At 5-year follow-up, mean Qmax improved from 8.0±5.0 mL to 13.9±7.7 mL and mean IPSS improved from 22±5 to 9±7. There were no cases of urethral strictures, but there was a 3.3% rate of bladder neck stenosis and an overall re-treatment rate of 21% over 5 years.
CONCLUSION: We confirm the long-term durability of the 80-W KTP laser PVP with minimal perioperative morbidity. It is therefore a safe option for high-risk patients with medical comorbidities, although its high reoperation rate may limit its use to this specific patient population.
Written by:
Malde S, Rajagopalan A, Patel N, Simoes A, Choi W, Shrotri N Are you the author?
Department of Urology, Kent and Canterbury Hospital , Canterbury, United Kingdom
Reference: J Endourol. 2012 Jul;26(7):878-83
doi: 10.1089/end.2011.0370
PubMed Abstract
PMID: 22260554