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

OBJECTIVES

The aim of this study was to evaluate patient outcome 1 to 2 1/2 years after aggressive neodymium: yttrium-aluminum-garnet (Nd:YAG) laser prostatectomy alone or combined with potassium titanyl phosphate (KTP/532) laser therapy.

METHODS

In 32 men with symptomatic bladder outlet obstruction caused by benign prostatic hyperplasia, Nd:YAG laser energy (40 W) was delivered to six or more locations on the prostatic lateral lobes and one or more on the median lobe. In a subgroup of 15 of these patients, the prostate was also incised and sculpted with KTP/532 laser to create a better channel.

RESULTS

In the 32 men, voiding parameters improved: mean peak flow rate increased from 10 to 21 mL/s (110%), residual volume decreased from 167 to 64 mL (62%), and American Urological Association (AUA) symptom score decreased from 24 to 9 (63%). Catheters were removed after 3 days. Of the 17 patients treated with the Nd:YAG laser alone, 12 (70.5%) required recatheterization, whereas only 5 of the 15 (33%) who received KTP/532 laser therapy after Nd:YAG treatment required recatheterization (P < 0.001). In the entire group of 32 patients, complications included predictably prolonged retention (14 to 60 days) in 4 patients (12.5%) with hypotonic bladders, prolonged dysuria in 4 (12.5%), vesical neck contracture in 2 (6%), and significant hematuria in 1; none had incontinence. All 25 sexually active men remained potent (100%), but among these patients retrograde ejaculation developed in 5 (20%).

CONCLUSIONS

Aggressive Nd:YAG laser prostatectomy is safe and effective for obstructive prostates up to 70 mL in volume and produces good results that are sustained for up to 2 1/2 years. Adjunctive KTP/532 laser therapy apparently creates an unobstructed channel more quickly and reduces the rate of postoperative retention, but it does not alter other voiding parameters.