PTU - Polskie Towarzystwo Urologiczne
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New method of treatment of benign prostatic hyperplasia - photo selective vaporization with high-energy potassium-titanium-phosphate laser
Article published in Urologia Polska 2004/57/4.

authors

Marek Lipiński, Marek Jeromin, Leszek Jeromin
Klinika Urologii z Pracowni± Litotrypsji Uniwersytetu Medycznego w Łodzi
Kierownik kliniki: prof. dr hab. Leszek Jeromin

keywords

benign prostatic hyperplasia, treatment, laser vaporization

summary

introduction
Benign prostatic hyperplasia (BPH) affects about 70% of men aged more than 60 years. The "gold standard" treatment modality is transurethral resection of the prostate (TURP). One of the newest tool of BPH treatment is laser enriched with potassium-titanium-phosphoric crystal.
materials and methods
Between August 2003 and July 2004 58 men were treated with photo selective vaporization of the prostate with high-energy potassium-titanium-phosphoric laser. 32 patients with follow-up longer than 12 weeks (from 12 to 30 weeks) were included to the study. Prostate volume ranged from 31 to 136 cm3. All of them had International Prostatic Symptoms Score (I-PSS) exceeding 21 points and quality of life (QoL) of less than 3 points. Peak urinary flow before treatment ranged from 7,2 to 14 ,1 ml/s.
results
Mean operation duration was 17 minutes. All procedures were performed during intravenous anesthesia. Foley catheter was left after the procedure in 1 patients whereas 2 patients were additionally catheterized during the first 24 hours after the procedure. Increased body temperature mounted to 38 degrees was noted in 2 patients during the first 24 hours after the operation. Hematuria requiring catheterization occurred in one patent during the first day after the procedure. During the seventh day after the operation hematuria was observed in 4 patients (2 of them were hospitalized). ReTURP was performed in 1 patient 4 weeks after the operation. Four weeks after the procedure IPSS decreased by about middling 9 points, peak urinary flow ranged from 11,3 to 17,1 ml/s. 12 weeks after the procedure peak urinary flow ranged from 15,1 do 22,8 ml/s.
conclusions
Photo selective vaporization of the prostate decreased severity of obstructive symptoms in all 32 patients 12 weeks after the operation. Peak urinary flow was increased in analyzed men 12 weeks after the procedure. Short follow-up does not allow to create definitive conclusions, however presented results are encouraging and photo selective vaporization of the prostate should be continued.

references

  1. Borówka A: Zabiegowe nieoperacyjne leczenie łagodnego rozrostu stercza. Medycyna 2000 1993; 41/42: 24-31.
  2. R¶hrborn CG: Standard surgical interventions TUIP/TURP/OPSU. Textbook of Benign Prostatic Hyperplasia. Kirby R, Oxford, Isis Medical Media, 1996, 341-375.
  3. Borówka A: Łagodny rozrost stercza - uwarunkowania embriogenetyczne, aspekt strukturalny i etiologia choroby. Medycyna 2000 1993; 41/42: 4-8.
  4. Lepor H, Lowe FC: Evaluation and nonsurgical management of benign prostatic hyperplasia. Campbell`s Urology. 8th Edition, pod red: Walsh PC, Saunders Comp, 2002, Vol. 2, Chapter 39, 1337- 1378.
  5. Kunzman RS, Malek Rs, Barrett DM: High-power potassium titanyl phosphate laser vaporization prostatectomy. Mayo Clin Proc 1998; 73 (8): 798-801.
  6. Gibbons RP, Altwein JE, Bruskewitz RC at al: Surgical and Laser Treatment. In Proceedings The 3rd International Consultation on Benign Prostatic Hyperplasia (BPH). Monaco 1995, SCI Ltd. 1996, 469-486.
  7. Norby B, Nielsen HV, Frimodt-Moller PC: Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia. Brit J Urol Int 2002; 90: 853-862.
  8. Shingleton WB, Terrell F, Renfr¶ L et al: A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia. Urology 1999; 54 (6): 1017-1021.
  9. Mottet N, Anidjar M, Bourdon O et al: Randomized comparision of transurethral electroresection and holmium: YAG laser vaporisation for symptoms of benign prostatic hyperplasia. J Endourol 1999; 13 (2): 127-130.
  10. Hurie R, Vavassori I, Piccinelli A et al: Holmium laser enucleation of the prostate combined mechanical morcellation in 155 patients with benign prostatic hyperplasia. Urology 2002; 60 (3): 449-453.
  11. Malek RS, Barrett DM, Kuntzman RS: High power potassium-titanyl- phosphate (KTP/532) vaporisation prostatectomy: 24 hours later. Urology 1998; 51 (2): 254-256.
  12. Shingleton WB, Terrell F, Renfr¶ L et al: Low-power v high-power KTP laser: improved methods laser ablation of prostate. J Endourol 1999; 13 (61): 49-52.
  13. Hai MA, Malek RS: Photoselective vaporisation of the prostate: initial experience with a new 80 W KTP laser for the treatment benign prostatic hyperplasia. J Endourol 2003; 17 (2): 93-96.
  14. Malek RS, Kunzman RS, Barrett DM: Hihg power potassium-titanyl- phosphate vaporized prostatectomy. J Urol 2000; 163 (6): 1730- 1733.

correspondence

Marek Lipiński
Klinika Urologii z Pracownią Litotrypsji UM
ul. Pabianicka 62
93-513 Łódź