BACKGROUND: Patients with lower urinary tract symptoms with large prostates are usually not candidates for minimally invasive interventions. This is 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 90 cm3.
METHODS: Between September 2004 and December 2006, total of 35 men with symptomatic benign prostatic hyperplasia and large-volume prostates underwent photoselective laser vaporization of the prostate. All these patients had failed medical therapy. 18 patients presented with urinary retention and they had failed several void trials. The preoperative evaluation included, post void residual urine volume, flexible cystoscopy, prostate volume assessment with transrectal ultrasound or pelvic CT scan, serum sodium, creatinine, hematocrit, and AUA symptom score questionnaire.
PVP was performed transurethrally, with an 80 W KTP Greenlight™ laser machine. 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 postvoid residual urine volume were measured at each follow-up visit.
RESULTS: The average preoperative prostate volume was 152 cc with the maximum volume of 378 cc. The mean operative time was 150 +/- 50 minutes. No transfusions were required. 33 of the 35 patients were discharged within 23 hours. The serum sodium level did not change significantly. No significant complication occurred. Foley catheter was removed on average on post operative day two-four. 28 patients passed the void trial on the first attempt. In seven patients the foley catheter was reinserted temporarily. All patients passed the voiding trial by one week post operatively. The AUA Symptom Score decreased from 26 preoperatively to 10, 9, 5, and 6 at 1, 3, 6, and 12 months postoperatively. The postvoid residual urine volume also decreased from 249 mL preoperatively to 105, 98, 57, and 70 mL at 1, 3, 6, and 12 months postoperatively.
CONCLUSIONS: KTP laser prostatectomy is safe and feasible in patients with large prostates who might not be candidates for conventional TURP.