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  • Title: Potassium-titanyl-phosphate laser photoselective vaporization for benign prostatic hyperplasia: 5-year follow-up from a district general hospital.
    Author: Malde S, Rajagopalan A, Patel N, Simoes A, Choi W, Shrotri N.
    Journal: J Endourol; 2012 Jul; 26(7):878-83. PubMed ID: 22260554.
    Abstract:
    BACKGROUND AND PURPOSE: The 80-W potassium-titanyl-phosphate (KTP) laser photoselective vaporization of the prostate (PVP) is a minimally invasive surgical option for patients with symptomatic benign prostatic hyperplasia, although evidence of long-term efficacy is limited. We present the long-term outcomes from a heterogeneous patient population. PATIENTS AND METHODS: We prospectively collected data for all patients who underwent 80-W KTP laser PVP treatment between 2004 and 2005. Evaluation occurred pr-operatively, and then at 3, 6, 12, and 60 months postoperatively. This included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual (PVR) volume, serum prostate-specific antigen measurement, and transrectal ultrasonography-estimated prostate volume. RESULTS: A total of 115 patients were eligible for analysis, with a mean age of 77 years and mean prostate volume of 55.8 cc. Of these, 74% were operated on for lower urinary tract symptoms, 23% for acute urinary retention, and 3% for chronic retention; 30% of patients were American Society of Anesthesiologists score ≥ 3, and 93% were treated as 23-hour stays. No patients needed blood transfusion, and there were no cases of transurethral resection syndrome. An initial trial-without catheter failed in 11 (9.6%), although 8 of these successfully voided after a further week. At 5-year follow-up, mean Qmax improved from 8.0 ± 5.0 mL to 13.9 ± 7.7 mL and mean IPSS improved from 22 ± 5 to 9 ± 7. There were no cases of urethral strictures, but there was a 3.3% rate of bladder neck stenosis and an overall re-treatment rate of 21% over 5 years. CONCLUSION: We confirm the long-term durability of the 80-W KTP laser PVP with minimal perioperative morbidity. It is therefore a safe option for high-risk patients with medical comorbidities, although its high reoperation rate may limit its use to this specific patient population.
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