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Araki M., Lam P., Culkin D., Fox P., Sulley G., Wong C.
Presented on March 22, 2007
INTRODUCTION & OBJECTIVES: We evaluated the safety and efficacy of catheter free KTP laser PVP for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).
MATERIAL & METHODS: We prospectively evaluated our initial 12 month KTP laser PVP experience. Transurethral PVP was performed using an 80 W KTP side-firing laser system. Voiding trials were performed two hours post surgery, with confirmation of volitional voiding using bladder ultrasonography. If unable to void, a urethral catheter was replaced. Patients were divided into two groups, those who were discharged with (C+) or without (C-) urethral catheters. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post void residual (PVR) were measured preoperatively and at 1, 4, 12, 24 and 52 weeks post surgery.
RESULTS: 160 consecutive patients were identified. 92 (58%) were discharged without a catheter (C-) and 68 (42%) were discharged with a catheter (C+). Of patients who were discharged with a catheter (C+), 33/68 (49%) had their catheter removed the morning after surgery. Preoperative Qmax was higher in C- (12 ± 6 vs. 10 ± 5 cc/sec, p=0.04). There were no significant differences in other preoperative parameters, including age (C-: 69 ± 9 vs. C+: 71 ± 9 years), American Society of Anesthesiologists risk score (C-: 2.3 ± 0.7 vs. C+: 2.5 ± 0.6), IPSS (C-: 27 ± 7 vs. C+: 27 ± 7), PVR (C-: 113 ± 126 vs. C+: 104 ± 150 cc) and prostate volume (C-: 68 ± 47 vs. C+: 79 ± 52 cm3). There were no significant differences in the parameters of laser utilization (C-: 30 ± 27 vs. C+: 38 ± 34 min) and energy usage (C-: 90 ± 77 vs. C+: 111 ± 104 kJ). IPSS, Qmax and PVR values showed significant improvement within each group (* p<0.05), but there were no significant differences between the two groups. All were outpatient procedures. 6/92 (7%) patients required catheter reinsertion in C-. The overall incidence of adverse events (C- and C+) was low (13 urinary tract infections, 14 hematuria over a week, 3 bladder neck contractures, 9 retrograde ejaculation) and did not differ between the two groups.
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Mean
AUASS
|
Preop
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1 W
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4 W
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12 W
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24 W
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52 W
|
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C-
(N)
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23 ± 6
(92)
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12 ± 6*
(90)
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9 ± 6*
(77)
|
8 ± 6*
(63)
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6 ± 5*
(35)
|
7 ± 5*
(11)
|
|
C+
(N)
|
24 ± 6
(68)
|
14 ± 7*
(67)
|
10 ± 5*
(63)
|
8 ± 5*
(52)
|
8 ± 5*
(30)
|
6 ± 3*
(5)
|
CONCLUSIONS: Our experience suggests that catheter free PVP is safe and effective for the treatment of LUTS secondary to BPH.
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