A prospective randomized trial evaluating endoscopic Nd:YAG laser prostate ablation with or without potassium titanyl phosphate (KTP) laser bladder neck incision.
OBJECTIVE
To investigate whether performing a potassium titanyl phosphate (KTP) laser bladder neck incision (BNI) in conjunction with a Nd:YAG endoscopic ablation of the prostate (ELAP) compared with an ELAP alone, improves early post-operative voiding rates and clinical outcome.


METHODS
A prospective randomized trial that was both double-blind and power-determined (80%) compared 88 patients with benign prostatic enlargement undergoing ELAP and those undergoing KTP BNI and ELAP. A dual-wavelength KTP/532TM (Laserscope) laser was used with Add/Stat side-firing fibres. A urethral catheter was inserted post-operatively and was removed after 18 h. Patients unable to void at this stage were then re-catheterized, discharged and readmitted 2 weeks later for catheter removal. Patients were followed up at 3 month intervals.


RESULTS
Post-operatively, 80% of the patients undergoing KTP BNI and ELAP were able to void on catheter removal at 18 h, compared with only 57% of the patients undergoing ELAP alone (P < 0.05, chi-square). After 1 month, two patients from the former and four from the latter group failed to void and required further surgery. At 3 months, there was a significant improvement in the post-void residual volume, maximum flow rate, symptom and quality-of-life scores compared to the pre-operative values for both groups (P < 0.005). However, there was a greater improvement in the flow rate and symptom score in patients undergoing KTP BNI and ELAP (P < 0.05).


CONCLUSIONS
This study shows the benefit of performing a KTP BNI with ELAP in terms of early voiding rates and initial clinical outcome, and this treatment is recommended.
Langley
S E
SE
Royal United Hospital, Bath, UK.
Gallegos
C R
CR
Moisey
C U
CU
D000368:Aged; D004724:Endoscopy; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010710:Phosphates; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000601:surgery*; D014025:Titanium; D016896:Treatment Outcome; D014554:Urination
D010710:Phosphates; C064806:potassium titanylphosphate; D014025:Titanium