Photovaporization of the Prostate (PVP) with KTP Laser is one of the latest innovations in the treatment of benign prostate hyperplasia (BPH). It is a minimally invasive technique that offers significant advantages over conventional treatments such as transurethral resection and open surgery.
¿What is PVP and what symptoms does it produce?
Hyperplasia is a benign prostate disease characterised by a growth of the gland that compresses the urethra, the conduit that leads urine from the bladder to outside your body, passing through the prostate. An obstruction of the urethra causes problems to males when they attempt to empty their bladders, with the following common symptoms:
PVP affects one in four males over 50 years of age, one out of every 2 over 60 and nearly all males over 80. 30% of males require surgery for this disease at some point in their lives, and most of those who do not operate will require treatment with prostate drugs.
How is PVP treated?
There are currently several effective treatments with drugs for PVP; however, an increasingly large number of patients (due to the increase in life expectancy) will require surgery to solve their problems when urinating.
Until recently, there were two surgical techniques to treat PVP. The first was open surgery (adenomectomy), which is over 100 years old, and which consists in making an incision in the belly below the navel, through which the benign prostate tumour is extracted. This technique requires being in hospital for 5 to 7 days, it requires a transfusion in 10-20% of patients when it produces bleeding, it may cause total or partial urinary incontinence in 5-8% of patients, and sexual impotence in 10-15% of patients. The second technique is transurethral resection, which was pioneered in the 1950s and which consists in inserting an apparatus through the urethra (resector) which cuts the prostate into small pieces which are then sucked through a large syringe. This technique is less aggressive than open surgery, though patients must remain in hospital for 3 to 5 days, it also causes bleeding during surgery, requiring blood transfusions in 5-15% of cases, between 3 and 5% of patients suffer from partial or total urinary incontinence, and around 5% experience sexual impotence.
What is KTP laser?
In order to reduce this percentage of complications, in 1996, new research was started in Mayo Clinic, USA, with a new type of laser, KTP/532 (Potassium-titanyl-phosphate). The first studies were carried out on dogs, as these animals suffer from PVP very similarly to humans. In 1998, the first results on human patients were published, and since then tens of scientific papers have been published , confirming the excellent results obtained through this technique up to 5 years after treatment. The fibre of the KTP laser works with a light beam with a wavelength of 532 nanometres, and it has a high affinity with the pigment of haemoglobin, leading it to be selectively absorbed by blood, preventing significant bleeding during surgery.
The laser penetrates 2 mm in the prostate tissue, thus avoiding problems there were with other types of laser that were user previously, in which tissue penetration was 7mm, causing severe burns that led to them being discontinued.
How is KTP laser applied?
KTP laser is applied through a 22F cystoscope (smaller than the one used for RTU, 26F) entered through the urethra. The irrigating fluid is sterile water, which avoids the complications caused by the absorption of glycine (the irrigation liquid used for RTU). The KTP laser causes the evaporation of 1-2 grams of prostate tissue per minute, which means that this minimally invasive technique allows the treatment of large glands (over 100 grams) that could previously only be treated with open surgery.
What happens to the prostate during photovaporization with the KTP?
When the KTP laser is applied to the prostate, the heat generated causes the tissue to become water vapour that is eliminated through a system of continuous irrigation. At the same time, the blood vessels are closed, thus avoiding bleeding.
Which patients can benefit from KTP?
KTP laser can be used on any patient who can be anaesthetised with general or spinal (local) anaesthesia. Nevertheless, it is the technique of choice for patients with severe diseases in other organs (heart, lungs, etc.) or who are undergoing treatment with blood thinners (Sintrom, Heparine, etc.) or with antiplatelet drugs (Aspirine®, Adiro®, Tromalyt®, etc.), or for patients whose religious beliefs forbid blood transfusions (Jehovah’s Witnesses).
Results of treatment with KTP laser
Several scientific papers have been published analysing the results 5 years after treatment with KTP laser. To this day, 95% of patients are very satisfied with the procedure. The score on the symptom scale improved 87% compared to scores prior to photovaporization. Urinary flow increased 200% and was maintained over the years. No patients suffered from sexual impotence or incontinence, and none of them had to be treated again with KTP laser or any other alternative techniques. Se han publicado varios artículos científicos que analizan los resultados después de 5 años del tratamiento con láser KTP.
Advantages of KTP laser over previous PVP treatments
If you would like more information about this treatment, please contact:
PROSTATE INSTITUTE BARCELONA
Phone number : +34 93 176 76 08