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Photoselective vaporization of prostate: Analysis of prostate adenoma volume reduction in patients with BPH (benign prostatic hyperplasia) in one-year observation
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Andrzej Sikorski, Marcin Ga³êski
Katerda i Klinika Urologii PAM w Szczecinie

summary

Introduction.

It is the transurethral electroresection (TUR-P) that remains the gold standard in treatment of symptomatic BPH. Considering the still substantial risk of complications after standard treatment, the searching for a less invasive method with comparable effectiveness is in progress. Photoselective vaporization of prostate (PVP) using KTP laser device of 80 W output power effectively and safely reduces the bladder outlet obstruction caused by BPH.

Objectives.

Evaluation of prostatic adenoma volume reduction using photoselective vaporization of prostate (PVP) based on the author’s own material gathered by him against a background of the treatment results.

Materials and methods.

As many as 56 procedures of PVP were carried out in patients with lower urinary tract symptoms (LUTS) secondary to BPH. The PVP was carried out using high-energy KTP laser of 80 W output power emitting laser beam of wavelength 532 nm at an angle of 70 degrees. The energy dose was ranging from 80 to 370 Watt. The prostate volume was measured immediately prior to the procedure and in the 12th month after the procedure by means of transabdominal ultrasonography (TAUS). For the procedure the flow cystoskope of diameter 23 Fr was used, into which the laser fibre of 600 μm was inserted as well as 30 – degree optics. The procedures were finished after achieving full haemostasis and vaporization of prostatic adenoma to a level of verum montanum. In case of small-sized adenomae (<40 cm3) the site of fibrous capsule level was achieved similar to that obtained during classical TUR-P, which was not achieved at bigger-sized adenomae.

Results.

The prostate adenoma volume in the patients undergoing the operating procedure was ranging from 25 to 149 cm3 (average 45 cm3). After 12 months from the procedure the prostate volume was reduced on average to 27 cm3 (from 25 to 69 cm3) thus reaching average reduction in the prostate volume by 40%. In the patients with the prostate adenoma volume exceeding 100 cm3 the reduction of the average prostate volume reached 55 %. During three-month stage of postoperative follow-up in most of the patients the irritation symptoms persisted. In case of four patients examined the haematuria occurred in the 2nd-3rd week after the procedure. The urine retention after micturition occurred in six patients examined. The same number of patients reported transient urge incontinence. In one case lithiasis of the site after adenoma occurred, which required radical electroresection of residal adenoma. After 12-month observation in none of the patient the urine retention after micturition occurred. Most
of the patients – reported nyckturia occurring up to two times. Two patients complained about urge urine incontinence and one complained about stress urine incontinence. Two patients informed about lack of subjective improvement after treatment.

Conclusions.

The prostate volume significantly decreased pending 12-month observation. The prostate adenoma volume reduction is particularly visible in patients with big volume of prostate. Our results are comparable with those that are achieved by us using standard TUR-P. The PVP is a method of comparable efficacy to that of TUR-P and, taking into account lower risk of intra- and post-operative complications, it can be considered as an alternative method of symptomatic treatement of BPH.