LASER PROSTATECTOMY - 2 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:YA G) laser prostatectomy alone or combined with potassium titanyl phosph ate (KTP/532) laser therapy. Methods. In 32 men with symptomatic bladd er outlet obstruction caused by benign prostatic hyperplasia, Nd:YAC l aser energy (40 W) was delivered to six or more locations on the prost atic lateral lobes acid one or more on the median robe. In a subgroup of 15 of these patients, the prostate was also incised and sculpted wi th KTP/532 laser to create a better channel. Results. In the 32 men, v oiding parameters improved: mean peak flow rate increased from 10 to 2 1 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 tr eated with the Nd:YAG laser alone, 12 (70.5%) required recatheterizati on, 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 prolon ged retention (14 to 60 days) in 4 patients (12.5%) with hypotonic bla dders, prolonged dysuria in 4 (12.5%), vesical neck contracture in 2 ( 6%), and significant hematuria in 1; none had incontinence. All 25 sex ually active men remained potent (100%), but among these patients retr ograde ejaculation developed in 5 (20%). Conclusions. Aggressive Nd:YA G 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 2 therapy apparently crea tes an unobstructed channel more quickly and reduces the rate of posto perative retention, but it does not alter other voiding parameters.