KTP laser photoselective vaporization of the prostate: an initial experience

Abstract

Objective: To review the initial experience of potassium-titanyl-phosphate (KTP) laser photoselective vaporization of the prostate (PVP). Materials and methods:Thirty patients with benign prostatic enlargement who underwent PVP at our institution between March 2007 and June 2009 were prospectively analyzed. The efficacy of the procedure was assessed using the International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, maximum flow rate (QMax), and post-void residual volume (PVR) at 3, 6, and 12 months after surgery and then annually thereafter. Operative time, laser energy and fiber use, and any procedural or postoperative complications were noted.Results: Fourteen (47%) patients opted for PVP by choice, and 16 (53%) underwent PVP because they were at high-risk for transurethral resection of the prostate (TURP), KTP laser PVP was successfully performed in all patients without any intraoperative complications. The median prostate volume was 47 g (range 25-136 g). Median operative time, laser energy, and hospital stay were 84 min (range 66-109 min), 126.1 kJ (range 27.6-235.5 kJ), and 2 days (range 1-9 days), respectively. IPSS, QoL score, QMax, and PVR improved from preoperative median values of 22, 04, 09 mL/sec, and 206 mL to 03, 01, 19.7 mL/sec, and 30.5 mL, respectively, postoperatively. No patient required blood transfusion or had TURP syndrome. Urethral stricture developed in only 2 (6.6%) patients in our study. Conclusion:Although the financial cost of laser installation is difficult to justify in developing countries, our initial results demonstrate that KTP laser PVP is a treatment method that can be adopted to treat patients with benign prostatic hyperplasia safely and effectively, especially those patients with significant systemic comorbidities. Bulgular: Ondört (%47) hasta için PVP uygulaması tercih edilirken, 16 (%53) hastaya transurethral resection of the prostate (TURP) için yüksek riskli olmaları nedeniyle PVP uygulandı. KTP lazer PVP tüm hastalarda herhangi bir intraoperatif komplikasyon olmaksızın başarıyla uygulandı. Ortanca prostat hacmi 47 gr (dağılım 25-136 gr) idi. Ortanca cerrahi süresi, lazer enerjisi ve hastanede kalış sırasıyla 84 dakika (dağılım 66-109 dakika), 126.1 kJ (dağılım 27.6-235.5 kJ), ve 2 gün (dağılım 1-9 gün) idi. IPSS, QoL skoru, QMax ve PVR, preoperatif ortanca değerler olan sırasıyla 22, 04, 09 mL/dakika ve 206 mL'den postoperatif 03, 01, 19.7 mL/dakika ve 30.5 mL değerlerine düzelme gösterdi. Hiçbir hastada kan transfüzyonu ya da TURP sendromu kaydedilmedi. Uretral darlık sadece 2 (%6.6) hastada gelişti. Sonuç:Gelişmekte olan ülkelerde lazer instalasyonunun finansal maliyetinin karşılanması zor olmakla birlikte, ilk sonuçlarımız KTP lazer PVP uygulamasının benign prostat hiperplazili hastaların, özellikle belirgin sistemik komorbiditesi olanların, tedavisinde güvenli ve etkili olarak kullanılabileceğini göstermektedir.Anahtar sözcükler: Benign prostat hiperplazisi; KTP lazer; prostat.