Potassium-titanyl-phosphate laser photoselective vaporization for benign prostatic hyperplasia: 5-year follow-up from a district general hospital.

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.

Potassium-titanyl-phosphate laser vaporization of the prostate: a case series of an unusual complication.

Abstract Despite its increasing use in the management of symptomatic benign prostatic hyperplasia, the long-term complications after potassium-titanyl-phosphate photoselective vaporization of the prostate are poorly reported. We describe a rare complication of this technology-calculi formation in the prostatic urethra. All patients presented with visible hematuria and variable lower urinary tract symptoms up to 5 years after the original surgery. In all cases, the calculi were successfully removed endoscopically. Possible causes for this unusual complication are discussed, and the importance of warning patients about this potential long-term complication are highlighted.