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N30 Green laser vaporization of the prostate – 300 procedures experience

      Introduction and Objectives

      Therapeutic strategies for benign prostatic hyperplasia (BPH) are still innovative. Ideal is minimally invasive ambulatory procedure. The photoselective vaporization of the prostate by potassium titanyl phosphate (KTP-green) laser seems to be good tool for BPH treatment.

      Material and Methods

      From August 2003 to January 2009, a group of 301 men (16 with complete urinary retention) in age from 51 to 87 years with benign prostatic hyperplasia (BPH) who underwent KTP 80 watts laser prostatectomy were observed. Preoperative prostate volume estimated by TRUS ranged from 31 to 136 cc. International prostatic symptom score (IPSS) was in all over 21 points and QoL over 3 points. PSA range, estimated before treatment, has been normal in 238 pts. In 51 was over 4 and less than 10 ng/ml (4.41–9.23 ng/ml) with F/T PSA ratio over 20% and in 12 PSA was over10 ng/ml performed prostate biopsies were negative. Mean urine residual volume was 99.4 ml.

      Results

      Follow-up was from 4 to 268 weeks. The mean lasing time was 41 minutes (11–84 min). Mean delivered laser energy was 89 018 J (9425–221670 J). 284 pts were not catheterized at the finish of the procedure. In 17 (16 with urinary retention before treatment) catheter was removed 12 to 24 hours after treatment. All pts experienced few days of mild dysuria. Four pts required catheterization in the first day after treatment. In five pts increasing of body temperature to 38°C was observed in the first day after treatment. 24 hours after treatment haematuria required catheterization was observed in two pts. 7 days after treatment in 4 pts massive haematuria was observed (two required hospitalization without blood transfusion). In seven pts (prostate volume >120 cc) because of urinary retention (in one pts 4 weeks, in 6 pts 8 weeks after PVP) transurethral resection of the prostate was performed. In one pts urethral stricture was dissected. 4 weeks after PVP IPSS decreased after 12 weeks from 24 to 14 and after 52 weeks to 9. The mean peak urinary flow rate increased after 4 weeks from 8.3 ml/sec to 16.9 ml/sec and after 12 weeks to 18, 9 ml/sec. The mean prostate volume decreased by 37%. Mean postoperative residual volume has been estimated after 4 weeks (∼38.6 ml) and after 24 weeks (∼29.3 ml).

      Conclusions

      In over 90% of treated by PVP pts I-PSS and QoL decreased after 4weeks. Significant increase of Qmax was observed in pts after 4 weeks from PVP as well as significant decrease of post residual volume. In 95% of pts no sings of bacteriuria were observed. In some pts with prostate volume over 120 cc haematuria and incidents of urinary retention which caused TURP were observed.