Photoselective vaporization of the prostate in men with a history of chronic oral anti-coagulation.

PURPOSE: A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy. MATERIALS AND METHODS: A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W. RESULTS: The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 +/- 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53% at 6 months. CONCLUSIONS: High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy.

Photoselective vaporization of the enlarged prostate with KTP laser: long-term results in 240 patients.

PURPOSE: To report the 1-year efficacy and safety of photoselective vaporization of the prostate (PVP) by KTP laser for symptomatic and obstructive benign prostatic hyperplasia (BPH). 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 (Qmax), 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<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<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<0.001) (82.3%). The mean prostate volume had decreased by 53% after 12 months. CONCLUSIONS: High-power photoselective KTP laser vaporization prostatectomy is feasible and appears to be safe and effective for immediate relief of the bladder-outlet obstruction secondary to benign hyperplasia. The system is a promising alternative in all, but especially in high-risk patients receiving anticoagulant therapy.

120-W GreenLight laser photoselective vaporization of prostate for benign prostatic hyperplasia: midterm outcomes.

OBJECTIVES: To evaluate the safety and efficacy of 120-W high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) in the treatment of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. METHODS: Two experienced surgeons performed 120-W HPS laser PVP. The baseline characteristics, perioperative data, complications, and postoperative outcomes were evaluated at 3, 6, 12, 24, and 36 months postoperatively. RESULTS: A total of 550 consecutive patients, with a mean age of 67.6 years, underwent PVP with a 120-W HPS laser. The mean prostate volume was 72.93 cm3, with a mean prostate-specific antigen level of 3.57 ng/mL. The mean operative duration and the mean applied energy was 61.3 minutes and 164.06 kJ, respectively. No major complication occurred intraoperatively or postoperatively. The mean follow-up was 17.80 months. Significant improvements were observed postoperatively in the mean International Prostate Symptom Score, quality of life score, maximal urinary flow rate, and postvoid residual urine volume. The mean catheterization time was 18.5 hours. The complications included delayed hematuria in 26 (4.8%), recatheterization in 24 (4.4%), reoperation owing to residual prostatic adenoma in 46 (8.5%), urethral stricture in 19 (3.5%), and bladder neck contracture in 6 (1.1%) patients. CONCLUSIONS: PVP with a 120-W HPS laser for benign prostatic hyperplasia has been proved to be a safe and effective procedure for our patients, including those treated with oral anticoagulants. The functional outcome in larger prostates was similar to that in smaller glands.

Photoselective vaporization of the prostate in men with a history of chronic oral anti-coagulation

PURPOSE: A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy. MATERIALS AND METHODS: A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W. RESULTS: The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 ± 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53 percent at 6 months. CONCLUSIONS: High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy.