Photoselective vaporization of the prostate with the potassium‐titanyl‐phosphate laser in men with prostates of >100 mL

OBJECTIVES To assess the efficacy of photoselective vaporization of the prostate (PVP) in men with prostates of >100 mL and causing bladder outlet obstruction (BOO), using the high‐power 80 W potassium‐titanyl‐phosphate laser (GreenLight PV®, Laserscope, San Jose, CA, USA), which offers rapid tissue ablation with minimal bleeding. PATIENTS AND METHODS We assessed 54 consecutive patients with prostates of >100 mL (mean 135, sd 42, range 100–300) who had PVP between May 2003 and August 2005. Evaluations before PVP included urine flowmetry, the International Prostate Symptom Score (IPSS), a quality‐of life (QoL) score, prostate‐specific antigen (PSA) level, and prostate volume measured by transrectal ultrasonography (TRUS). RESULTS The mean (sd, range) duration of PVP was 81.6 (22.9, 39–150) min, the mean energy used for PVP was 278 (60, 176–443) kJ and the mean duration of catheterization after PVP was 23.0 (17.1, 0–72) h. The mean (sd) maximum urinary flow rate improved from 8.0 (3.1) to 18.2 (8.1), 18.5 (9.2), 17.9 (7.8) and 19.3 (9.8) mL/s at 3, 6, 12 and 24 months, respectively. The IPSS and QoL scores showed similar improvements, and there was a statistically significant reduction in PSA level and prostate volume after PVP. There was no major complication and no patient had transurethral resection syndrome or a blood transfusion. CONCLUSIONS The 80 W KTP laser PVP offers rapid tissue ablation in patients with BOO caused by a large prostate. The short‐ and medium‐term outcomes show that this technique can be a viable alternative to open prostatectomy.