No coin nor oath required. For personal study only.
Background and Objective: Photoselective vaporization of the prostate (PVP) utilizes high-power potassium titanyl phosphate (KTP) laser to vaporize obstructive benign prostatic hyperplasia (BPH). Personal experiences with the technique, pathophysiologic changes affecting outcomes, and long-term durability of PVP are presented. Study Design/Materials and Methods: Ninety-four men with obstructive BPH underwent PVP (60-80W power). Laser energy was delivered transurethrally by a side-firing fiber through a 22F continuous flow laser cystoscope under general or spinal anesthesia.
Results: The mean prostate volume was 45 ml (13-136). The mean operative time was 47 min (10-99). All 94 men were outpatients and all but one became catheter-free in 24 hr. Preoperative mean AUA symptom score and Qmax was 22 and 7.8 ml/S, respectively. Postoperatively, at 1, 2, 3, and 5 years they improved significantly* to 3.8, 3.7, 3.4, and 2.6 and to 27.1, 26.6, 23.6, and 22.2 ml/S, respectively; approximate sustained improvements of 80% and 170-250%, respectively. Mean QOL score improved from baseline of 4.5 to 0.4, 0.6, 0.4, and 0.1 at same postoperative intervals (*p < 0.0001). Complications were minor and included transient dysuria (6%), delayed hematuria (3%), 2-day retention (1%), and bladder neck stenosis (2%) but none developed incontinence or impotence or required reoperation; only 26% had retrograde ejaculation. Low-stage prostate cancer was detected in 4% by postoperative PSA surveillance. Conclusion: PVP is a safe, effective, and low-morbidity outpatient procedure. It offers considerable advantages over comparable therapies with excellent and durable outcomes.
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Tis but thy name that is my enemy; . . . . . . What's in a name? That which we call a rose