A PROSPECTIVE RANDOMIZED TRIAL EVALUATING ENDOSCOPIC ND-YAG LASER PROSTATE ABLATION WITH OR WITHOUT POTASSIUM TITANYL PHOSPHATE (KTP) LASERBLADDER NECK INCISION

Objective To investigate whether performing a potassium titanyl phosph ate (KTP) laser bladder neck incision (BNI) in conjunction with a Nd:Y AG endoscopic ablation of the prostate (ELAP) compared with an ELAP al one, improves early post-operative voiding rates and clinical outcome. Patients and methods A prospective randomized trial that was both dou ble-blind and power-determined (80%) compared 88 patients with benign prostatic enlargement undergoing ELAP and those undergoing KTP BNI and ELAP. A dual-wavelength KPT/532TM (Laserscope) laser was used with Ad d/Stat side-firing fibres. A urethral catheter was inserted post-opera tively and was removed after 18 h. Patients unable to void at this sta ge were then re-catheterized, discharged and readmitted 2 weeks later for catheter removal. Patients were followed up at 3 month intervals. Results Post-operatively, 80% of the patients undergoing KTP BNI and E LAP were able to void on catheter removal at 18 h, compared with only 57% of the patients undergoing ELAP alone (P < 0.05, chi-square). Afte r 1 month, two patients from the former and four from the latter group failed to void and required further surgery, At 3 months, there was a significant improvement in the post-void residual volume, maximum now rate, symptom and quality of-life scores compared to the pre-operativ e values for both groups (P < 0.005), However, there was a greater imp rovement in the flow rate and symptom score in patients undergoing KTP BNI and ELAP (P < 0.05). Conclusion This study shows the benefit of p erforming a KTP BM with ELAP in terms of early voiding rates and initi al clinical outcome, and this treatment is recommended.