Korean J Urol.  2010 May;51(5):330-336.

The Efficacy and Safety of Photoselective Vaporization of the Prostate with a Potassium-titanyl-phosphate Laser for Symptomatic Benign Prostatic Hyperplasia according to Prostate Size: 2-Year Surgical Outcomes

• Kim HS
• Cho MC
• Ku JH
• Kim SW
• Paick JS

Abstract

PURPOSE
We investigated 2-year follow-up outcomes of patients who underwent potassium-titanyl-phosphate (KTP)-photoselective vaporization of the prostate (PVP) laser therapy for symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Of a total of 169 patients who underwent 80 W KTP-PVP by a single surgeon, we retrospectively analyzed the clinical data of 74 patients who completed 2 years of follow-up. The efficacy of the PVP was assessed at 1, 3, 6, 12, and 24 months postoperatively by use of the International Prostate Symptom Score (IPSS) and uroflowmetry with postvoid residual urine volume (PVR). Safety, including complications, was evaluated at each visit. RESULTS: Mean preoperative total prostate and transitional zone volumes were 42.3 ml (range, 34.0-59.0 ml) and 18.6 ml (range, 10.1-28.6 ml) respectively. According to both IPSS and uroflowmetry, compared with baseline, the improvement in each parameter was sustained significantly at both 1 and 2 years postoperatively (p<0.05). There were no serious intraoperative complications, such as massive hemorrhage requiring transfusion or transurethral resection syndrome. Transient gross hematuria occurred in 16 (21.6%) cases, urgency incontinence in 6 (8.1%) cases, bladder neck contracture (BNC) in 3 (4.1%) cases, and urethral stricture in 1 (2.7%) case. The cases of urethral stricture and BNC developed only in the group with a prostate size of less than 45 ml. No cases required reoperation due to re-growing prostatic tissue. CONCLUSIONS: PVP seems to be a safe and effective procedure for the surgical treatment of symptomatic BPH. After PVP, the subjective and objective improvements in the micturition parameters were sustainable up to 2 years, with minimal complications.

Keyword

Laser therapy; Potassium titanylphosphate; Prostatic hyperplasia

MeSH Terms

Contracture
Follow-Up Studies
Hematuria
Hemorrhage
Humans
Intraoperative Complications
Laser Therapy
Neck
Phosphates
Prostate
Prostatic Hyperplasia
Reoperation
Retrospective Studies
Titanium
Urethral Stricture
Urinary Bladder
Urination
Volatilization
Phosphates
Titanium

Figure

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  FIG. 1 Severe pin-point type BNC developed at 1 year after the PVP. After one endoscopic ureterotomy, there was no recurrence of BNC. BNC: bladder neck contracture, PVP: photoselective vaporization of the prostate.

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  FIG. 2 BNC with an impacted urethral stone developed at 3 months after PVP (A). At 6 months after endoscopic urethrotomy and stone removal, a pin-point type BNC recurred (B). At 14 months after the 2nd endoscopic urethrotomy, multiple penile urethral strictures occurred (C). BNC: bladder neck contracture, PVP: photoselective vaporization of the prostate.

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  FIG. 3 Mild BNC occurred at 6 months after the PVP. The contracture was resolved after two urethral soundation. BNC: bladder neck contracture, PVP: photoselective vaporization of the prostate.

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