KTP laser versus transurethral resection: early results of a randomized trial

Many technologies have been mooted as equal to transurethral resection of the prostate (TURP) without gaining widespread acceptance because of the lack of randomized trials. The Greenlight laser system (Laserscope, San Jose, Ca.), an 80 W system for photovaporization of the prostate (PVP), was compared with TURP in such a trial.

A series of 120 patients was randomized to undergo TURP or PVP after evaluation, which was repeated at 1, 3, 6, and 12 months after treatment. Irrigation use, length of catherization (LOC), length of hospital stay (LOS), postvoiding residual volume, sexual function, blood loss, cost, and operative time also were assessed.

To date, 76 patients are evaluable. Both groups showed a significant (P < 0.5) increase in maximum flow rate from baseline. In the TURP group, flow increased from 8.7 to 17.9 mL/sec (149%) and in the PVP group from 8.5 to 20.6 mL/sec (167%). The International Prostate Symptom Score decreased from 25.4 to 12.4(50.23%) in the TURP group and from 25.7 to 12.0 (49.83%) in the PVP group. Postvoiding residual volumes also showed significant decreases. Similar trends were seen in relation to bother and quality of life scores. There was no difference in sexual function as measured by a questionnaire. The LOC was significantly less in the PVP group (P < 0.001), the mean being 12.2 hours (range 0-24 hours) versus 44.5 hours for TURP (range 6-192 hours). A similar situation was seen in relation to LOS (P < 0.0001), with the mean of the PVP group being 1.08 days (range 1-2 days) and the mean for the TURP group being 3.4 days (range 3-9 days). Adverse events were less frequent in the PVP group, and the costs were 22% less.

This trial demonstrates that PVP is effective compared with TURP, producing equivalent improvements in flow rates and IPSS with markedly reduced LOS, LOC, and adverse events. Long-term follow- up is being undertaken to assess the durability of these results.