title: High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients.
abstract: OBJECTIVE
  Men with lower urinary tract symptoms secondary to benign prostatic hyperplasia who are at high cardiopulmonary risk or on oral anticoagulation are often denied surgical treatment. Potassium-titanyl-phosphate (KTP) laser vaporization at 80 W is a novel, rapidly emerging technique that promises instant hemostatic tissue ablation. We evaluated the merits of this procedure in patients at high risk and those on long-term anticoagulation.
  
  
  METHODS
  The prospective study included 66 patients with severe lower urinary tract symptoms who underwent 80 W KTP laser vaporization of the prostate. All patients were at high cardiopulmonary risk, having presented with an American Society of Anesthesiology score of 3 or greater. Additionally, 29 patients were being treated with ongoing oral anticoagulant therapy (26) or had a severe bleeding disorder (3).
  
  
  RESULTS
  In all 66 patients KTP laser vaporization was performed successfully. Mean preoperative prostate volume +/- SD was 49 +/- 30 ml and mean operative time was 49 +/- 19 minutes. No major complication occurred intraoperatively or postoperatively and no blood transfusion was required. Postoperatively 48 of 62 catheterized patients (77%) did not require irrigation. Average catheterization time was 1.8 +/- 1.4 days. Two patients required reoperation due to recurrent urinary retention. At 1, 3, 6 and 12 months mean urinary peak flow increased from 6.7 +/- 2 ml per second preoperatively to 18.5 +/- 9, 18.9 +/- 10, 19.2 +/- 8 and 21.6 +/- 7 ml per second, respectively. Mean International Prostate Symptom Score decreased from 20.2 +/- 6 to 11.7 +/- 7, 7.9 +/- 7, 6.9 +/- 5 and 6.5 +/- 4, respectively.
  
  
  CONCLUSIONS
  Our initial experience indicates that 80 W KTP laser vaporization is a virtually bloodless and, hence, safe but effective treatment option in seriously ill patients or those on oral anticoagulants.
authors.affiliation: Departments of Urology, University-Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.forename: Michael
authors.initials: M
authors.lastname: Siebels
authors.forename: Alfons
authors.initials: A
authors.lastname: Hofstetter
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D006488:Hemostasis, Surgical; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010710:Phosphates; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000453:epidemiology / Q000601:surgery*; D014025:Titanium
chemical_list: D010710:Phosphates; C064806:potassium titanylphosphate; D014025:Titanium