Korean J Urol.  2009 Dec;50(12):1193-1197.

Potassium-Titanyl-Phosphate Laser Photoselective Vaporization of the Prostate in Patients with Benign Prostatic Hyperplasia with Detrusor Underactivity: Influence on Detrusor Pressure

• Park KS
• Cho YS
• Joo KJ

Abstract

PURPOSE
Potassium-titanyl-phosphate laser photoselective vaporization of the prostate (PVP) is a safe and effective treatment for patients with symptomatic benign prostatic hyperplasia (BPH). The aim of this study was to assess the influence and the effect of PVP in BPH patients with detrusor underactivity.
MATERIALS AND METHODS
We evaluated 21 patients with detrusor under-activity treated with PVP for BPH from January 2006 to December 2007. Detrusor underactivity was defined as detrusor pressure at maximal flow rate (Qmax) of less than 30 cmH2O and Qmax of less than 15 ml/s. Urodynamic studies were performed and international prostate symptom score (IPSS) and quality of life (QoL) scores were assessed preoperatively and at 6 months postoperatively.
RESULTS
There were significant improvements in Qmax, voiding urine volume, post-void residual urine volume, IPSS, and QoL scores at 6 months after PVP treatment. However, patients did not show significant changes in maximal bladder capacity, bladder compliance, or detrusor pressure at Qmax.
CONCLUSIONS
Even though BPH patients had detrusor underactivity, PVP was an effective surgical procedure. However, PVP did not make any significant difference on detrusor pressure at Qmax in 6 months.

Keyword

KTP laser; Prostatic hyperplasia; Urodynamics

MeSH Terms

Compliance
Humans
Lasers, Solid-State
Prostate
Prostatic Hyperplasia
Quality of Life
Urinary Bladder
Urodynamics
Volatilization

Figure

• 

  Fig. 1 Comparisons of clinical parameters (A: Qmax, B: Pdet at Qmax, C: PVR, D: IPSS) at pre- and postoperative. Qmax: maximal flow rate, Pdet at Qmax: detrusor pressure at maximal flow rate, PVR: post void residual, IPSS: International Prostate Symptom Score, a: comparisons of the variables before and after operation.

Reference

1. Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002. 59:877–883.

2. Stovsky MD, Rhee K, Hartke D. Medical therapy versus surgery and minimally invasive surgical therapies for lower urinary tract symptoms and benign prostatic hyperplasia: What makes better economic sense? Curr Urol Rep. 2007. 8:289–297.

3. Kumar SM. Photoselective vaporization of the prostate: a volume reduction analysis in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and carcinoma of the prostate. J Urol. 2005. 173:511–513.

4. Verger-Kuhnke AB, Reuter MA, Epple W, Ungemach G, Beccaria ML. Photoselective vaporization with the 80-watt KTP-laser (kalium-titanyl-phosphate) and low-hydraulic-pressure TURP in the treatment of BPH: our experience with 230 cases. Arch Esp Urol. 2007. 60:167–177.

5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003. 61:37–49.

6. Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999. 84:14–15.

7. Burnett AL, Wein AJ. Benign prostatic hyperplasia in primary care: what you need to know. J Urol. 2006. 175:S19–S24.

8. Kuntz RM. Laser treatment of benign prostatic hyperplasia. World J Urol. 2007. 25:241–247.

9. Alschibaja M, May F, Treiber U, Paul R, Hartung R. Transurethral resection for benign prostatic hyperplasia. current developments. Urologe A. 2005. 44:499–504.

10. Bouchier-Hayes DM, Anderson P, Van Appledorn S, Bugeja P, Costello AJ. KTP laser versus transurethral resection: early results of a randomized trial. J Endourol. 2006. 20:580–585.

11. Hwang EC, Joo JS, Min KD, Oh BR, Kang TW, Kwon DD, et al. A short-term comparative study on efficacy and safety of standard transurethral resection and high power (80W) potassium-titanyl-phosphate laser vaporization of the prostate. Korean J Urol. 2005. 46:1251–1255.

12. Hamann MF, Naumann CM, Seif C, van der Horst C, Jünemann KP, Braun PM. Functional outcome following photoselective vaporisation of the prostate (PVP): urodynamic findings within 12 months follow-up. Eur Urol. 2008. 54:902–907.

13. Rigatti L, Naspro R, Salonia A, Centemero A, Ghezzi M, Guazzoni G, et al. Urodynamics after TURP and HoLEP in urodynamically obstructed patients: Are there any differences at 1 year of follow-up? Urology. 2006. 67:1193–1198.

14. Buttyan R, Chen MW, Levin RM. Animal models of bladder outlet obstruction and molecular insights into the basis for the development of bladder dysfunction. Eur Urol. 1997. 32:Suppl 1. 32–39.

15. Taube M, Gajraj H. Trial without catheter following acute retention of urine. Br J Urol. 1989. 63:180–182.

16. Gabella G, Uvelius B. Reversal of muscle hypertrophy in the rat urinary bladder after removal of urethral obstruction. Cell Tissue Res. 1994. 277:333–339.

17. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int. 2005. 96:1301–1306.

18. Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol. 2006. 13:1398–1404.

19. Jeong YS, Lee SW, Lee KS. The effect of transurethral resection of the prostate in detrusor underactivity. Korean J Urol. 2006. 47:740–746.