Photoselective Vaporization of the Enlarged Prostate with KTP Laser: Long-Term Results in 240 Patients

Abstract

To report the 1-year efficacy and safety of photoselective vaporization of the prostate (PVP) by KTP laser for symptomatic and obstructive benign prostatic hyperplasia (BPH). Between January 2004 and March 2005, 240 patients aged 49 to 80 years (mean 65.3 years) with a referring complaint of infravesical obstruction were treated with laser prostatectomy using KTP/532 laser energy at 80 W. The prostatic lobes were readily vaporized to the capsular fibers. All patients underwent standard urologic evaluation with the International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), ultrasound measurement of prostate volume and residual urine volume, assay of prostate specific antigen, and digital rectal examination. The mean prostatic volume was 52.1 cc (range 28-120 cc). The patients were reassessed at 6 and 12 months postoperatively for changes in these measures. The Mann- Whitney U test was used to determine statistical significance. The operating time ranged from 25 to 90 minutes with an average of 45 minutes. The maximum postoperative hospital stay was 24 hours, and the Foley catheters were removed in less than 24 hours with a mean catheterization time of 12.2+/-6.8 hours (range 6-24 hours). Following the laser prostatectomy, mean IPSS values decreased from 22.6+/-6.4 to 5.3+/-2.9 (76.6%) at 6 months and to 3.7+/-2.5 at 12 months (84%) (P<0.001). The mean peak urinary flow rate increased from 7.9+/-2.7 mL/sec to 26.1+/-10.1 mL/sec at 6 months and to 27.9+/-10.3 mL/sec at 12 months. The mean quality of life score improved from 4.7+/-0.8 to 0.6+/-0.6 (87.3%) (P<0.001), and the mean postvoiding residual volume decreased from 145.6+/-122.2 mL to 52.6+/-38.6 mL at 6-month follow-up and to 16.2+/-8.9 mL at 12 months (P<0.001) (82.3%). The mean prostate volume had decreased by 53% after 12 months. High-power photoselective KTP laser vaporization prostatectomy is feasible and appears to be safe and effective for immediate relief of the bladder-outlet obstruction secondary to benign hyperplasia. The system is a promising alternative in all, but especially in high-risk patients receiving anticoagulant therapy.