Photoselective vaporization of the prostate (PVP) with KTP laser in the treatment of patients with benign prostatic hyperplasia receiving anticoagulants
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Grzegorz Piotrowicz, Henryk Zieliński

Klinika Urologii CSK MON, Wojskowy Instytut Medyczny w Warszawie

summary

Introduction.

KTP laser differs from previous lasers used in urology (Nd:YAG, Ho:YAG, diode). As the532 nm laser beam is highly absorbed by oxyhaemoglobin and not by irrigant fluid, “green” laser is specially indicated for patients with high risk of bleeding, receiving anticoagulants.

Objectives.

The aim of the study was to evaluate the efficacy and safety of PVP in the treatment of patients with benign prostatic hyperplasia receiving anticoagulants.

Materials and methods.

From November2005 and June 2007 53 patients with benign prostatic hyperplasia (BPH) underwent PVP with the KTP laser (80W and 120W) in Urology Department of Military Institute of Medicine in Warsaw, Poland. 33(62,3%) patients were taking anticoagulants for cardiac diseases: 14 – acetylosalicylic acid, 19 – coumarine derivatives. The mean patients’ age was 68,9years (59-78) and the mean prostate size was 61,2 ml (45 - 100). We evaluated uroflowmetry parameters, the International Prostate Symptom Score (IPSS) and quality-of life (QoL) score before and 1 and 6 months after PVP. Duration of the procedure, time of catheterization and hospitalization as well as morphological and biochemical parameters and intra – and postoperative complications were assessed.

Results.

PVP was performed under general or spinal anesthesia. The mean duration of the procedure was 52 minutes (30-95). 3 patients required no catheterization, in 29 patients the catheter was left overnight, in 1 patient it was removed after 3 days. The mean catheterization time after PVP was 19 hours. The mean hospitalization

time after PVP was 1.42 days (1-4). There was no major complication during and after PVP. No significant change in morphological and electrolyte parameters was observed. Haematocrite level was 39.7% before and 38.9% after the procedure and no blood transfusion was necessary. IPSS decreased from 24.9 to 11.1 and 7.1 at 1 and 6 months, respectively. QoL score decreased from 4.87 to 2.31 and 1.75 at 1 and 6 months, respectively. The mean maximum urinary flow rate (Qmax) improved from 10.1 to 21.1 and 22.8 ml/s at 1 and 6 months, respectively. The mean post-voiding residual volume (PVR) decreased from 118.8 to 37.7 and 30.1 ml at 1 and 6 months, respectively. In 8 (24.2%) patients mild transient dysuria which resolved in less than 10 days appeared, in further 3(9.1%) it lasted for 3 weeks. In 5 (15.2%) patients mild hematuria was seen – it resolved without any specific treatment. One patient required recatheterization for 3 days due to urine retention. 5 out of 13 (38.5%) sexually active patients had

retrograde ejaculation.

Conclusions.

Photoselective vaporization of the prostate with KTP laser appears to be safe and effective method of treatment for patients with BPH on anticoagulants.