Laser prostatectomy: two and a half years' experience with aggressive multifocal therapy

Area of Science:

• Urology
• Laser Surgery
• Benign Prostatic Hyperplasia Management

Background:

• Benign prostatic hyperplasia (BPH) causes symptomatic bladder outlet obstruction.
• Laser prostatectomy offers a minimally invasive treatment option for BPH.

Purpose of the Study:

• To evaluate patient outcomes after neodymium:yttrium-aluminum-garnet (Nd:YAG) laser prostatectomy, alone or with potassium titanyl phosphate (KTP/532) laser therapy.
• To assess the long-term efficacy and safety of these laser procedures for BPH.

Main Methods:

• 32 men with symptomatic BPH underwent Nd:YAG laser prostatectomy.
• A subgroup of 15 patients also received adjunctive KTP/532 laser therapy for prostatic incision and sculpting.
• Patient outcomes were assessed 1 to 2.5 years post-procedure.

Main Results:

• Significant improvements in voiding parameters were observed: peak flow rate increased by 110%, residual volume decreased by 62%, and AUA symptom score decreased by 63%.
• Adjunctive KTP/532 laser therapy significantly reduced the need for recatheterization (33% vs 70.5%, P < 0.001).
• Complications included prolonged retention (12.5%), dysuria (12.5%), and vesical neck contracture (6%); no patients experienced incontinence. Potency was preserved in 100% of sexually active men, with 20% experiencing retrograde ejaculation.

Conclusions:

• Aggressive Nd:YAG laser prostatectomy is a safe and effective treatment for obstructive prostates up to 70 mL, with durable results up to 2.5 years.
• Adjunctive KTP/532 laser therapy facilitates quicker channel creation and lowers postoperative retention rates without affecting other voiding parameters.