Funktionelle Ergebnisse nach Laservaporisation der Prostata mit dem KTP-Laser

Impact of preoperative haemoglobin concentrations on the efficiency of KTP-laser vaporization of the prostate

PURPOSE

The potassium-titanyl-phoshate laser (KTP laser) device produces light (wavelength of 532 nm) that is absorbed by haemoglobin, thus releasing thermal energy. This reaction causes vaporization of the tissue. We tested whether preoperative haemoglobin concentrations (Hb) affect the efficiency of the 80 W KTP laser, thus affecting the energy applied.

METHODS

We assessed 164 patients undergoing KTP-laser vaporization for benign prostate hyperplasia from January 2005 to July 2006 at Heidelberg University Hospital. We prospectively collected data on patients' demographics, urodynamics, Hb, prostate volume, and energy applied. We calculated the correlation between preoperative Hb and surgery energy applied and we adjusted it for prostate volume. We further compared the postoperative urinary flow and residual volume results in non-low-Hb and in low-Hb patients.

RESULTS

The mean age was 68.8 (+/-8.8 years), the median prostate volume 50.0 mL (interquartile range 40-80), the median preoperative urinary flow 10.1 mL/s (interquartile range 7.1-14.0), the median surgery duration 70.0 min (interquartile range 50-92.75), the median preoperative Hb 144.5 g/L (interquartile range 132-151), and the median applied energy 209.5 kJ (interquartile range 156.5-272.75). The unadjusted correlation between preoperative Hb and applied energy was -0.089 (P < 0.05). After adjustment for prostate volume this correlation was not significant (Pearson r = -0.180, P > 0.05). Functional results did not differ between low-Hb and non-low-Hb patients (P > 0.05 for urinary flow and postvoid volume).

CONCLUSIONS

Haemoglobin concentrations, in the range of clinically encountered values, do not affect the efficiency of 80 W KTP-laser vaporization of the prostate. This laser technique is thus applicable in patients with low haemoglobin concentrations without concerns about efficiency.

Greenlight laser in benign prostatic hyperplasia: turning green into gold

PURPOSE OF REVIEW

The purpose of this review is to present recent clinical data published upon the photoselective vaporization of the prostate procedure and introduce new ideas about the future influence of this new technology upon the treatment of benign prostatic hyperplasia.

RECENT FINDINGS

Published studies have provided significant evidence that the photoselective vaporization of the prostate laser procedure is efficient, safe, easy to learn and early results show that it can compete with transurethral resection of the prostate. The major advantages of this technique are that it is a bloodless procedure, the patient goes home after a few hours and it can be applied to all patient categories. The cost of the photoselective vaporization of the prostate procedure is being investigated and a few studies addressing this issue seem to conclude that this surgical option is a cost effective decision. Lately, thoughts about early surgical intervention with the photoselective vaporization of the prostate laser are being expressed but properly designed studies are needed.

SUMMARY

The photoselective vaporization of the prostate laser procedure is getting worldwide fast recognition and it is the first time that transurethral resection of the prostate and open prostatectomy are being threatened. The cost of this procedure is being examined but it is difficult to draw solid conclusions since reimbursement strategies differ between various countries.

[Laser vaporization of the prostate: all as it should be?]

Laser vaporization of the prostate currently occupies a prominent place among the surgical options for treatment of benign prostatic syndrome. Particularly the so-called GreenLight laser vaporization with the KTP (80 W) or LBO (120 W) laser has become remarkably widespread throughout the world. There are already 100 of these GreenLight laser systems in use in Germany alone. The introduction of a separate DRG for "laser vaporization" is expected to further increase the significance of this surgical technique. The aim of this study is to evaluate laser vaporization as a whole and to identify possible differences between the different lasers.