Vaporization of prostates of ≥80 mL using a potassium‐titanyl‐phosphate laser: midterm‐results and comparison with prostates of <80 mL

Abstract

OBJECTIVETo compare the safety and outcome of potassium‐titanyl‐phosphate (KTP) GreenlightTM (Laserscope, AMS, Minnetonka, MN, USA) vaporization for treating benign prostatic hyperplasia (BPH) in prostates of ≥80 vs &lt;80 mL.PATIENTS AND METHODSIn all, 204 consecutive patients were enrolled into this prospective study; 31 were excluded from analysis for various reasons, thus 173 (median age 66.8 years; 39 with prostates of ≥80 mL) were evaluated for maximum urinary flow rate (Qmax), postvoid residual urine (PVR), the International Prostate Symptom Score (IPSS), and quality‐of‐life (QoL) score. The median follow‐up was 11.7 months. Of the 173 men, 26.6% were anaesthesiological high‐risk patients and 32.4% took anticoagulants.RESULTSThe Qmax improved in prostates of ≥80 mL from 6.9 mL/s before to 15.3 mL/s immediately after catheter removal, and 23.4 mL/s after 3 months (P &lt; 0.001). The improvement was similar to that in smaller prostates. There were equally effective changes in PVR (P &lt; 0.001). The IPSS decreased from 19.0 before to 7.0, 4.0 and 5.5 at 3, 6 and 12 months after surgery (P &lt; 0.001). Changes did not differ from those in smaller glands. The results were similar for QoL (P &lt; 0.001). During surgery there was no major bleeding and no transurethral resection syndrome. There was acute urinary retention after catheter removal in 10.4% of men; 4.6% developed urinary tract infections, whereas the rate was higher in men with larger prostates (10.3%). The re‐operation rate was higher in men with larger prostates, at 23.1% vs 10.4% (P = 0.09).CONCLUSIONKTP laser vaporization is a safe and effective procedure for surgically treating BPH. The functional outcome in larger prostates is similar to that in smaller glands, but there was a serious trend to a higher re‐operation rate in men with larger prostates.

KTP laser photoselective vaporization of the prostate: an initial experience

“…[12,13] The role of KTP laser vaporization is still controversial in cases of large-volume prostates. In their study, with a median follow-up of 11.7 months, Pfitzenmaier et al [14] found similar functional outcomes in terms of improvements in QMax, IPSS, and QOL scores, but a serious trend toward a higher reoperation rate, 23.1% vs. 10.4%, in larger prostates (>80 mL) compared with that in smaller glands (<80 mL). In our study, only 4 (13.3%) patients had a prostate volume greater than 80 mL, but we did not see any difference in efficacy or reoperation rate.…”

Can We Predict the Outcome of 532 nm Laser Photoselective Vaporization of the Prostate? Time to Event Analysis

“…Table 5 shows reoperation rates for recurrent obstruction in different contemporary series. 4,8,9,13,14,16,18,20,21 The reoperation rate for recurrent or residual adenoma was 2% to 13% with more association with larger glands, early training and intraoperative bleeding. In our series the reoperation rate for recurrent or residual adenoma was 2.1%, commonly in glands greater than 50 ml.…”

“…1 At 80 W PVP with the KTP laser could become laborious when performed on large prostates, and lead to incomplete tissue removal. [2][3][4] Thus, the more powerful 120 W, 532 nm, quasicontinuous wave GreenLight HPS laser generator was introduced. 5, 6 The HPS uses an LBO crystal and delivers the same green 532 nm wavelength through the same 70-degree deflecting, side firing, silica fiber delivery device but by an 88% more collimated beam and smaller spot size, resulting in much higher irradiance or power density in W/cm 2 than its predecessor with a beam divergence of 8 vs 15 degrees.…”

Laser Treatment of Benign Prostatic Hyperplasia in Patients on Oral Anticoagulant Therapy

“…Pfitzenmaier et al [22] compared the safety and outcome of KTP for treating BPH in prostates of greater than or equal to 80 mL versus less than 80 mL. Out of 173 patients included in the analysis, 56 were on OA.…”