High-Power Potassium-Titanyl-Phosphate Laser Photoselective Vaporization Prostatectomy for Symptomatic Benign Prostatic Hyperplasia

Abstract

Potassium-titanyl-phosphate (KTP) laser photoselective vaporization prostatectomy (PVP) is a relatively new technology for the management of lower urinary-tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We review our initial experience. We prospectively evaluated our initial 12-month experience with 80 W KTP laser PVP. All had American Urological Association symptom score (AUASS), American Society of Anesthesiologists (ASA) risk score, serum prostate-specific antigen (PSA), maximum flow rate (Qmax), and postvoid residual (PVR) determinations and transrectal ultrasonography. There were 160 consecutive patients identified, with a mean age of 69.7 years (range 34-88 yrs) and a mean ASA score of 2.4 (range 1-4). The mean prostate volume was 72.3 cm(3) (range 20.3-261 cm(3)), with a mean PSA level of 2.2 ng/mL (range 0.1-17.9 ng/mL). Mean laser time and energy usage were 33.4 minutes (range 4-165 min) and 99.0 kJ (range 11.3-524 kJ), respectively. All were outpatient procedures with 96 (60%) patients catheter-free at discharge. Twenty-eight patients need catheter drainage for 1 week. Urinary-tract infections developed in 13 patients. Fourteen patients had clinically insignificant hematuria for more than 1 week. Bladder neck contractures that necessitated intervention developed in three patients. Three patients had persistent urinary retention. No urethral strictures or urinary incontinence were noted. Mean AUASS decreased significantly from 23 to 13, 9, 8, 7, and 6 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Qmax and PVR values also showed statistically significant improvement. Our initial results demonstrate that KTP laser PVP is safe and effective for the management of LUTS secondary to BPH.