Photo-Selective KTP Laser Vaporization of Large ( Greater than 80 CC), Obstructive Prosatate: Four Years Experience
Sarah P. Psutka, M.D., Mohammad M. Siddiqui, M.D., Shahin Tabatabaei, MD.
Massachusetts General Hospital, Boston, MA, USA.
To study the safety and efficacy of potassium-titanyl-phosphate (KTP) photoselective laser vaporization of the prostate (PVP) in men with prostate volumes greater than 80 cm3.
Between September 2004 and September 2008, a total of 62 men with symptomatic benign prostatic hyperplasia and large-volume prostates underwent photoselective laser vaporization of the prostate. All these patients had failed medical therapy. 35 patients presented with urinary retention and they had failed several void trials. The preoperative evaluation included, post void residual urine volume, prostate volume assessment with transrectal ultrasound or pelvic CT scan, serum PSA, sodium, creatinine, and hematocrit, and AUA symptom score questionnaire.
PVP was performed transurethrally, with an 80 W KTP or 120 W Greenlight™ laser machines. 600 micron side-firing laser fiber was used through a 23F continuous-flow cystoscope with normal saline as the irrigant. The operative time, anesthesia type, length of stay, and when indicated, postoperative serum sodium, creatinine, and hematocrit were recorded. The AUA Symptom Score, and post void residual urine volume were measured at each follow-up visit.
The average preoperative prostate volume was 122 cc with the maximum volume of 378 cc. The mean operative time was 110. No transfusions were required. 56 of the 62 patients were discharged within 23 hours. The serum sodium level did not change significantly. Foley catheter was removed on average on post operative day 4. 50 patients passed the void trial on the first attempt. In twelve patients the Foley catheter was reinserted, temporarily. All patients passed the voiding trial by one week post operatively. The average AUA Symptom Score decreased from 28 preoperatively to 12, 7, 9, 6 and 7 at 1, 3, 6, 12, and 36 months postoperatively. The post void residual urine volume also decreased from 370 mL preoperatively to 205, 180, 65, 90 and 80 mL at 1, 3, 6, 12, and 36 months postoperatively.
KTP laser prostatectomy is safe and feasible in patients with large prostates who might not be candidates for conventional TURP. The procedure is less invasive than open prostatectomy and is associated with faster recovery and shorter indwelling foley catheterization, postoperatively.