Comparison of Techniques for Transurethral Laser Prostatectomy: Standard Photoselective Vaporization of the Prostate Versus Transurethral Laser Enucleation of the Prostate

Background and Purpose: Transurethral laser enucleation of the prostate (TLEP) using the potassium-titanylphosphate (KTP) laser offers an alternative technique to traditional photovaporization. The study objective was to determine the comparative efficacy between transurethral photovaporization of the prostate (PVP) with a TLEP technique using the 80W 532nm KTP laser. Patients and Methods: A series of 97 vs 170 patients who underwent PVP vs TLEP, respectively, with the KTP laser system at Weill Cornell Medical College from September 2001 to May 2009 was studied retrospectively. Outcome measures included laser time, prostate volume lased per unit time, International Prostate Symptom Score (IPSS), postvoid residual (PVR), and maximum flow rate (Qmax). Statistical analyses were performed using the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and unpaired t tests. Results: Baseline parameters were similar between groups, although volume was greater in the TLEP group (83 vs 63 cc, P= 0.04). Median laser time was longer in the TLEP group (90 vs 50min, P < 0.001) with a higher median energy used (308 vs 165 kJ, P < 0.001). The volume lased per unit time was shorter, however, for TLEP (0.92 cc/min) than for PVP (1.26 cc/min). A greater median number of fibers were used in TLEP (2.5 vs 2.0, P = 0.001). Improvements in median IPSS and PVR were seen in the TLEP group (5.0, P< 0.001; 55.5, P= 0.02, respectively) but not in the PVP group (P= 0.40 and 0.30). Median Qmax and prostate-specific antigen (PSA) level improved similarly in both groups. Final IPSS was lower for the TLEP group (P < 0.001), but other final parameters were statistically equivalent. Conclusions: In our series, both PVP and TLEP techniques were safe and effective. Although changes in Qmax and PSA were similar between the two techniques, improvement in urinary symptoms and PVR was superior with the TLEP technique. The TLEP technique was a more efficient method for laser prostatectomy.