Vaporization of prostates of > or =80 mL using a potassium-titanyl-phosphate laser: midterm-results and comparison with prostates of <80 mL.

OBJECTIVE: To compare the safety and outcome of potassium-titanyl-phosphate (KTP) Greenlight (Laserscope, AMS, Minnetonka, MN, USA) vaporization for treating benign prostatic hyperplasia (BPH) in prostates of > or =80 vs <80 mL.

PATIENTS AND METHODS: In all, 204 consecutive patients were enrolled into this prospective study; 31 were excluded from analysis for various reasons, thus 173 (median age 66.8 years; 39 with prostates of > or =80 mL) were evaluated for maximum urinary flow rate (Q(max)), postvoid residual urine (PVR), the International Prostate Symptom Score (IPSS), and quality-of-life (QoL) score. The median follow-up was 11.7 months. Of the 173 men, 26.6% were anaesthesiological high-risk patients and 32.4% took anticoagulants.

RESULTS: The Q(max) improved in prostates of > or =80 mL from 6.9 mL/s before to 15.3 mL/s immediately after catheter removal, and 23.4 mL/s after 3 months (P < 0.001). The improvement was similar to that in smaller prostates. There were equally effective changes in PVR (P < 0.001). The IPSS decreased from 19.0 before to 7.0, 4.0 and 5.5 at 3, 6 and 12 months after surgery (P < 0.001). Changes did not differ from those in smaller glands. The results were similar for QoL (P < 0.001). During surgery there was no major bleeding and no transurethral resection syndrome. There was acute urinary retention after catheter removal in 10.4% of men; 4.6% developed urinary tract infections, whereas the rate was higher in men with larger prostates (10.3%). The re-operation rate was higher in men with larger prostates, at 23.1% vs 10.4% (P = 0.09). CONCLUSION KTP laser vaporization is a safe and effective procedure for surgically treating BPH. The functional outcome in larger prostates is similar to that in smaller glands, but there was a serious trend to a higher re-operation rate in men with larger prostates.