Low-power v high-power KTP laser: improved method of laser ablation of prostate.

BACKGROUND AND OBJECTIVE: Current treatment technique for laser prostatectomy involve Nd:YAG wavelength at 60 to 80 W. Use of the KTP wavelength in addition to Nd:YAG allows for vaporization of more tissue, decreasing the amount undergoing coagulation necrosis. In this study, we compared 20 W and 40 W of KTP laser energy in conjunction with the Nd:YAG wavelength for the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND MATERIALS: A total of 50 consecutive patients underwent laser ablation of the prostate, with 38 patients (Group I) receiving treatment with 20 W of the KTP and 60 W of the Nd:YAG wavelengths. The other 12 patients (Group II) underwent treatment with 40 W of KTP and 60 W of Nd:YAG laser energy. The patients had an initial evaluation consisting of American Urological Association (AUA) Symptom Score, uroflowmetry, transrectal ultrasonography for prostate volume measurement, and assay of prostate specific antigen (PSA) serum level. The patients were seen in follow-up at 1, 3, and 6 months. RESULTS: The mean symptom score decreased from 23.4 to 8.9 from Group I and from 18.2 to 3.5 for Group II at the 6-month follow-up. The mean peak urinary flow rate increased from 8.4 to 15.4 mL/sec Group I and from 8.3 to 16.5 mL/sec in Group II at the 6-month follow-up. CONCLUSIONS: The patients treated with the 40 W of KTP laser energy experienced a more rapid and sustained improvement in symptom score than those treated at 20 W. The improvement in peak urinary flow rate was approximately the same in the two groups.

A randomized prospective study of transurethral electrovaporization vs laser ablation of the prostate in men with benign prostatic hypertrophy.

OBJECTIVE: A prospective randomized study comparing transurethral electrovaporization (TVP) vs laser ablation of the prostate was undertaken to compare the efficacy and safety of the procedures. METHODS: A total of 31 patients underwent treatment, with 20 patients receiving electrovaporization surgery and 11 patients undergoing laser treatment. Patients underwent initial evaluation consisting of an American Urological Association (AUA) symptom score, prostate specific antigen (PSA), uroflowometry, pressure flow, and transrectal ultrasound for prostate volume. Patients were seen in follow-up at 1, 3 and 6 months. RESULTS: A total of 31 patients with a 2:1 randomization of TVP to laser treatment were enrolled. The laser patients had a mean pre-operative AUA symptom score of 19.0 and scores of 9.0, 6.0 and 5.0 at 1-, 3- and 6-month follow-up. The TVP patients had a mean pre-operative symptom score of 22.0 and scores of 7.0, 8.0 and 5.0 at 1-, 3- and 6-month follow-up. Mean peak uroflow (PF) rate pre-operative was 10.7 for the laser group and 7.7 for the TVP group. At 1-, 3- and 6-month follow-up, mean PF rates of 13.3, 17.6 and 16.5 were present for the laser patients and 15.0, 17.5 and 14.2 for the TVP group. The differences were not statistically significant. There were 6 complications in the laser patients and 7 complications in the TVP group. Operative time was a mean of 27 min for the laser patients and 46 min for the TVP group, and the difference in operative time was statistically significant. CONCLUSION: At 6-month follow-up the improvement in symptoms score and peak flow rate are comparable in both treatment groups. The electrovaporization procedure required significantly longer to perform than the laser procedure. Long-term follow-up is required to see if these results remain sustainable for electrovaporization therapy.