Randomised controlled trial comparing the effects of Nd:YAG prostate ablation with or without KTP laser bladder neck incision.

A randomized, double blind, power determined, prospective study compared patients with benign prostatic hyperplasia undergoing endoscopic laser ablation of prostate, ELAP, - Group 1 - to those with KTP bladder neck incision and ELAP - Group 2. A dual wavelength Laserscope KPT/532TM laser was used with Add/Stat side-firing fibres. Post-operatively a urethral catheter was inserted, which was removed at 18 hours. Patients unable to void at this stage were then re-catheterized, discharged and readmitted 2 weeks later for catheter removal. Patients were followed up at 3 month intervals. 88 patients were studied, pre-operatively there was no statistical difference between Group 1 and Group 2 in mean age, 68.0, 68.4yrs; prostate size 28, 29g; post void residual, PVR, 141, 126ml; max flow rate, Qmax, 9.8, 9.4ml/s; or AUA score 18.0, 20.4; respectively. Post-operatively 57% of Group 1 patients were able to void on catheter removal at 18 hours compared to 80% from Group 2; p<0.05, chi(2). After 1 month, 2 patients from Group 2 and 1 from Group 1 failed to void and required further surgery. At 6 months, data for Group 1 and 2 respectively: PVR = 78.7, 61.4ml, Qmax = 16.2, 18.1ml/s, AUA score = 9.6, 6.38, p<0.005 for each. Group 2 had a significantly greater improvement in AUA7 score than Group 1.