A prospective randomized trial evaluating endoscopic Nd:YAG laser prostate ablation with or without potassium titanyl phosphate (KTP) laser bladder neck incision

Abstract

Objective: To investigate whether performing a potassium titanyl phosphate (KTP) laser bladder neck incision (BNI) in conjunction with a Nd:YAG endoscopic ablation of the prostate (ELAP) compared with an ELAP alone, improves early post-operative voiding rates and clinical outcome.

Patients and methods: A prospective randomized trial that was both double-blind and power-determined (80%) compared 88 patients with benign prostatic enlargement undergoing ELAP and those undergoing KTP BNI and ELAP. A dual-wavelength KTP/532TM (Laserscope) laser was used with Add/Stat side-firing fibres. A urethral catheter was inserted post-operatively and was removed after 18 h. Patients unable to void at this stage 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 ELAP 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). After 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 flow rate, symptom and quality-of-life scores compared to the pre-operative values for both groups (P < 0.005). However, there was a greater improvement in the flow rate and symptom score in patients undergoing KTP BNI and ELAP (P < 0.05).

Conclusion: This study shows the benefit of performing a KTP BNI with ELAP in terms of early voiding rates and initial clinical outcome, and this treatment is recommended.