High-power (60-watt) potassium-titanyl-phosphate laser vaporization prostatectomy in living canines and in human and canine cadavers (original) (raw)
Related papers
Outcomes of 80 W KTP Laser Vaporization of the Large Prostate
Urologia Internationalis, 2007
Purpose: We evaluated the safety and efficacy of 80 W potassium-titanyl-phosphate (KTP) laser vaporization of the prostate in men with prostate volumes >70 ml. Materials and Methods: Laser vaporization of the prostate with an 80 W KTP laser was applied between September 2003 and April 2005. Preoperative evaluation of 100 patients included the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), prostate volume, serum sodium, creatinine, hemoglobin, prostate-specific antigen and urinalysis. Results: The mean age of the patients, mean volume of the prostates, mean operative time and mean energy delivery were 67.0 ± 7.9 (53–90) years, 98.2 ± 18.9 (74–170) ml, 150.1 ± 22.7 (100–240) min and 246.1 ± 77.8 (100–500) kJ, respectively. The serum sodium, creatinine and hemoglobin levels did not change significantly. Urinary retention requiring recatheterization was detected in 10 patients. There was moderate dysuria in 22 pati...
BJU International, 2008
Symptom Score (IPSS), and quality-of-life (QoL) score. The median follow-up was 11.7 months. Of the 173 men, 26.6% were anaesthesiological high-risk patients and 32.4% took anticoagulants. RESULTS The Q max improved in prostates of ≥ 80 mL from 6.9 mL/s before to 15.3 mL/s immediately after catheter removal, and 23.4 mL/s after 3 months (P < 0.001). The improvement was similar to that in smaller prostates. There were equally effective changes in PVR (P < 0.001). The IPSS decreased from 19.0 before to 7.0, 4.0 and 5.5 at 3, 6 and 12 months after surgery (P < 0.001). Changes did not differ from those in smaller glands. The results were similar for QoL (P < 0.001). During surgery there was no major bleeding and no transurethral resection syndrome. There was acute urinary retention after catheter removal in 10.4% of men; 4.6% developed urinary tract infections, whereas the rate was higher in men with larger prostates (10.3%). The re-operation rate was higher in men with larger prostates, at 23.1% vs 10.4% (P = 0.09). CONCLUSION KTP laser vaporization is a safe and effective procedure for surgically treating BPH. The functional outcome in larger prostates is similar to that in smaller glands, but there was a serious trend to a higher re-operation rate in men with larger prostates.
Journal of Endourology, 2005
Patients and Methods: Between January 2004 and March 2005, 240 patients aged 49 to 80 years (mean 65.3 years) with a referring complaint of infravesical obstruction were treated with laser prostatectomy using KTP/532 laser energy at 80 W. The prostatic lobes were readily vaporized to the capsular fibers. All patients underwent standard urologic evaluation with the International Prostate Symptom Score (IPSS), peak urinary flow rate (Q max ), ultrasound measurement of prostate volume and residual urine volume, assay of prostate specific antigen, and digital rectal examination. The mean prostatic volume was 52.1 cc (range 28-120 cc). The patients were reassessed at 6 and 12 months postoperatively for changes in these measures. The Mann-Whitney U test was used to determine statistical significance Results: The operating time ranged from 25 to 90 minutes with an average of 45 minutes. The maximum postoperative hospital stay was 24 hours, and the Foley catheters were removed in less than 24 hours with a mean catheterization time of 12.2 ؎ 6.8 hours (range 6-24 hours). Following the laser prostatectomy, mean IPSS values decreased from 22.6 ؎ 6.4 to 5.3 ؎ 2.9 (76.6%) at 6 months and to 3.7. ؎ 2.5 at 12 months (84%) (P Ͻ 0.001). The mean peak urinary flow rate increased from 7.9 ؎ 2.7 mL/sec to 26.1 ؎ 10.1 mL/sec at 6 months and to 27.9 ؎ 10.3 mL/sec at 12 months. The mean quality of life score improved from 4.7 ؎ 0.8 to 0.6 ؎ 0.6 (87.3%) (P Ͻ 0.001), and the mean postvoiding residual volume decreased from 145.6 ؎ 122.2 mL to 52.6 ؎ 38.6 mL at 6-month follow-up and to 16.2 ؎ 8.9 mL at 12 months (P Ͻ 0.001) (82.3%). The mean prostate volume had decreased by 53% after 12 months.
The Evolution of KTP Laser Vaporization of the Prostate
Yonsei Medical Journal, 2008
The search for a minimally invasive approach to the treatment of Lower Urinary Tract Symptoms (LUTS) suggestive of Benign Prostatic Hyperplasia (BPH) is probably as old as Transurethral Resection of the Prostate (TURP). In an effort to overcome the limitations and morbidities of TURP, and in light of evidence suggesting that medical treatment for BPH has a limited lifespan , laser-based treatments have emerged during the last decade. Photoselective Vaporization of the Prostate (PVP) by the "GreenLight" KTP laser is considered one of the most promising options, one that is constantly evolving new technologies in prostate surgery. In this overview of KTP laser usage in BPH treatment, we will briefly discuss the evolution of this modality since it was first introduced and focus on the available evidence regarding safety, efficacy and cost parameters of its application.
Urology, 2010
OBJECTIVES To evaluate the efficacy and safety of a 200-W high-intensity diode laser in the treatment of benign prostatic hyperplasia. METHODS The prostate was vaporized by using a side-firing laser fiber (diode laser: power, 150-200 W; wavelength, 980 nm; Limmer, Germany). The following parameters were assessed at baseline, and after a follow-up period of 1-and 6 months: International Prostate Symptom Score, maximum uroflow rate, postvoid residual urine volume, and quality of life score. Prostate volume and prostate-specific antigen levels were assessed at baseline and 6 months postoperatively. RESULTS This study included 55 patients diagnosed with lower urinary tract symptoms secondary to BPH, who were treated between December 2007 and July 2008. The recatheterization rate was 10.9%. None of these patients required a blood transfusion or had transurethral resection syndrome. Statistically significant improvements (P Ͻ .001) were observed in the values of International Prostate Symptom Score, Q max , postvoid residual urine volume, and quality of life score at 1-and 6 months of follow-up as compared with the respective baseline values. Transient urge incontinence was noted in 8 patients (8/55, 14.5%).Sloughing of necrotic tissues was observed on cystoscopy in 8 patients within several weeks or months after the operation. The retreatment rate (secondary transurethral resection of the prostate) was 7.3%. CONCLUSIONS From our preliminary data, it was evident that diode laser prostatectomy can achieve excellent hemostasis, and provide immediate relief from obstructive voiding symptoms. However, the postoperative irritative symptoms and sloughing of necrotic tissues remained to be an important issue that needed to be resolved. UROLOGY 75: 658-663, 2010.
BJU International, 2008
To evaluate the intermediate-term clinical efficacy and the rate of complications in 80 W photoselective vaporization of the prostate (PVP) with the potassium-titanyl-phosphate laser (Greenlight, (AMS, Minnetonka, MN, USA) compared with transurethral resection of the prostate (TURP) in a prospective non-randomised two-centre study. From December 2003 to August 2006, 396 patients (PVP 269, TURP 127) with lower urinary tract symptoms secondary to benign prostatic hyperplasia were included in the study. There was a significant difference in mean age (72 years for PVP vs 68 for TURP, P = 0.001). Patients were therefore stratified in age categories (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;70, 70-80, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;80 years) and compared for perioperative variables, functional outcome and complications, with a follow-up of up to 24 months. The mean prostate size was greater (overall, 62 vs 48 mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and mean operative duration longer (overall 72 vs 53 min; P = 0.001) for PVP in all age categories. The rate of intraoperative bleeding (3% vs 11%), blood transfusions (0% vs 5.5%) and capsule perforations (0.4% vs 6.3%), and early postoperative clot retention (0.4% vs 3.9%) was significantly lower for PVP. Hospitalization time was significantly shorter in the PVP group for patients aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;70 years (3.0 vs 4.7 days) and 70-80 years (4.0 vs 5.0 days; P = 0.001). The improvement of peak urinary flow rate was higher after TURP for any age category. The International Prostate Symptom Score and postvoid residual volume during the follow-up showed no significant difference. After 12 months the overall prostate size reduction was 63% (-30 mL) after TURP and 44% (-27 mL) after PVP. The rate of repeat TURP/PVP was higher in the PVP group (6.7% vs 3.9%, not significant) within the follow-up of up to 2 years. The incidence of urethral and bladder neck strictures was comparable. PVP was more favourable in terms of perioperative safety. Although patients assigned for PVP were older and had larger prostates, PVP resulted in a similar functional outcome. Further follow-up is needed to draw final conclusions about the long-term efficacy of PVP.