Background: Photoselective laser vaporization of the prostate has been shown to be a promising alternative for the surgical management of BPH. Our initial experience suggested a higher incidence of post-procedural irritative symptoms than expected. We reviewed our population to determine whether a patient’s post-operative symptomatology could be predicted.
Methods: Nineteen men with symptomatic BPH underwent photoselective laser vaporization prostatectomy (PVP) at our institution between June 2004 and May 2005. Preoperative evaluation consisted of International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and ultrasound prostate volume. PVP was performed using an 80W KTP side-firing laser (Laserscope, San Jose, CA). Total energy and procedure times were noted. At 1, 3 and 6 months post-op, Qmax and IPSS were monitored.
Results: The mean age was 69.7 (range 53-83). The mean prostate volume was 50.1 cm³ (range 21.5 to 70). The mean energy used was 100,805 joules range (29210 to177,734). At one-month follow-up, 32% complained of significant urgency, frequency and dysuria. This number improved at six months of follow-up to 21% with two patients requiring management with anticholinergics. The mean IPSS score prior to surgical intervention was 19.4 (range 3-31). At 1, 3 and 6-month follow-up, the mean IPSS improved by 12.2, 9.8 and 6.3 points respectively. Similarly, the overall bother score improved from a mean of 4.3 to 2.8, 2.3 and 1.5 at 1, 3, and 6 months respectively. 15 of 19 patients underwent a uroflow at the time of follow-up. An improvement from a mean of 6.8 ml/sec to 17.3 ml/sec was noted. A correlation between post-procedural irritative voiding symptoms and age, amount of laser energy utilized, volume of treated prostate gland or length of procedure was not observed. Additionally, the pre-procedural IPSS was not a good predictor of post-procedural symptoms.
Conclusions: Irritative voiding symptoms are not uncommon following PVP. Thus, despite a clear therapeutic benefit of PVP, patients may have a persistence of these symptoms. This information can be used to effectively counsel patients with regard to both the therapeutic objective and realistic expectations related to this procedure.

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