High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients.

OBJECTIVE

Men with lower urinary tract symptoms secondary to benign prostatic hyperplasia who are at high cardiopulmonary risk or on oral anticoagulation are often denied surgical treatment. Potassium-titanyl-phosphate (KTP) laser vaporization at 80 W is a novel, rapidly emerging technique that promises instant hemostatic tissue ablation. We evaluated the merits of this procedure in patients at high risk and those on long-term anticoagulation.

METHODS

The prospective study included 66 patients with severe lower urinary tract symptoms who underwent 80 W KTP laser vaporization of the prostate. All patients were at high cardiopulmonary risk, having presented with an American Society of Anesthesiology score of 3 or greater. Additionally, 29 patients were being treated with ongoing oral anticoagulant therapy (26) or had a severe bleeding disorder (3).

RESULTS

In all 66 patients KTP laser vaporization was performed successfully. Mean preoperative prostate volume +/- SD was 49 +/- 30 ml and mean operative time was 49 +/- 19 minutes. No major complication occurred intraoperatively or postoperatively and no blood transfusion was required. Postoperatively 48 of 62 catheterized patients (77%) did not require irrigation. Average catheterization time was 1.8 +/- 1.4 days. Two patients required reoperation due to recurrent urinary retention. At 1, 3, 6 and 12 months mean urinary peak flow increased from 6.7 +/- 2 ml per second preoperatively to 18.5 +/- 9, 18.9 +/- 10, 19.2 +/- 8 and 21.6 +/- 7 ml per second, respectively. Mean International Prostate Symptom Score decreased from 20.2 +/- 6 to 11.7 +/- 7, 7.9 +/- 7, 6.9 +/- 5 and 6.5 +/- 4, respectively.

CONCLUSIONS

Our initial experience indicates that 80 W KTP laser vaporization is a virtually bloodless and, hence, safe but effective treatment option in seriously ill patients or those on oral anticoagulants.