title: Potassium-titanyl-phosphate laser photoselective vaporization for benign prostatic hyperplasia: 5-year follow-up from a district general hospital.
abstract: OBJECTIVE
  The 80-W potassium-titanyl-phosphate (KTP) laser photoselective vaporization of the prostate (PVP) is a minimally invasive surgical option for patients with symptomatic benign prostatic hyperplasia, although evidence of long-term efficacy is limited. We present the long-term outcomes from a heterogeneous patient population.
  
  
  METHODS
  We prospectively collected data for all patients who underwent 80-W KTP laser PVP treatment between 2004 and 2005. Evaluation occurred pr-operatively, and then at 3, 6, 12, and 60 months postoperatively. This included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual (PVR) volume, serum prostate-specific antigen measurement, and transrectal ultrasonography-estimated prostate volume.
  
  
  RESULTS
  A total of 115 patients were eligible for analysis, with a mean age of 77 years and mean prostate volume of 55.8 cc. Of these, 74% were operated on for lower urinary tract symptoms, 23% for acute urinary retention, and 3% for chronic retention; 30% of patients were American Society of Anesthesiologists score ≥ 3, and 93% were treated as 23-hour stays. No patients needed blood transfusion, and there were no cases of transurethral resection syndrome. An initial trial-without catheter failed in 11 (9.6%), although 8 of these successfully voided after a further week. At 5-year follow-up, mean Qmax improved from 8.0 ± 5.0 mL to 13.9 ± 7.7 mL and mean IPSS improved from 22 ± 5 to 9 ± 7. There were no cases of urethral strictures, but there was a 3.3% rate of bladder neck stenosis and an overall re-treatment rate of 21% over 5 years.
  
  
  CONCLUSIONS
  We confirm the long-term durability of the 80-W KTP laser PVP with minimal perioperative morbidity. It is therefore a safe option for high-risk patients with medical comorbidities, although its high reoperation rate may limit its use to this specific patient population.
authors.affiliation: Department of Urology, Kent and Canterbury Hospital, Canterbury, United Kingdom. sachmalde@aol.com
authors.forename: Sachin
authors.initials: S
authors.lastname: Malde
authors.forename: Ananth
authors.initials: A
authors.lastname: Rajagopalan
authors.forename: Nimesh
authors.initials: N
authors.lastname: Patel
authors.forename: Adrian
authors.initials: A
authors.lastname: Simoes
authors.forename: William
authors.initials: W
authors.lastname: Choi
authors.forename: Nitin
authors.initials: N
authors.lastname: Shrotri
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014554:Urination
chemical_list: D017430:Prostate-Specific Antigen