Potassium-titanyl-phosphate laser photoselective vaporisation for benign prostatic hyperplasia: 5 year follow-up from a District General Hospital
Malde S, Rajagopalan A, Patel N, Simoes A, Choi W, Shrotri N.SourceJ Endourol. 2012 Jan 19. [Epub ahead of print]

Kent and Canterbury Hospital, Urology, Ethelbert Road, Canterbury, United Kingdom, CT1 3NG; sachmalde@aol.com.

Abstract

Purpose: The 80-W potassium-titanyl-phosphate (KTP) laser photoselective vaporisation of the prostate (PVP) is a minimally-invasive surgical option for patients with symptomatic BPH, 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 pre-operatively, and then at 3, 6, 12 and 60 months post-operatively. This included IPSS, peak urinary flow rate (Qmax), post void residual volume (PVR), serum PSA measurement, and TRUS-estimated prostate volume. Results: A total of 115 patients were eligible for analysis, with a mean age of 77 and mean prostate volume of 55.8 grams. 74% were operated on for LUTS, 23% for acute urinary retention, and 3% for chronic retention. 30% of patients were ASA ≥ 3, and 93% were treated as 23 hour stays. No patients required blood transfusion and there were no cases of TUR-syndrome. Eleven patients (9.6%) failed an initial trial-without-catheter, although 8 of these successfully voided after a further week. At 5-year follow-up, mean Qmax improved from 8.0 ± 5.0ml to 13.9 ± 7.7ml and mean IPSS improved from 22 ± 5 to 9 ± 7. There were no cases of urethral strictures, but 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 co-morbidities, although its high re-operation rate may limit its use to this specific patient population.