Introduction

Given its proven long-term track record, transurethral resection of the prostate (TURP) is considered the gold standard for treating benign prostatic hyperplasia (BPH). Unfortunately, this procedure is associated with long hospitalization stays of 1 to 2 days, slow recovery times of 4 to 6 weeks, and risk of postoperative pain, discomfort, bleeding, urinary incontinence, retrograde ejaculation, and impotence.1

To overcome the disadvantages associated with TURP, alternative procedures for BPH, such as transurethral needle ablation, microwave therapy and various laser procedures have been introduced. Although less invasive than TURP, they do not offer quite the same efficacy as TURP in terms of improved symptom scores and uroflow rates.2,3 Long-term outcomes are currently unknown given their new statusin the marketplace.

In recent years, Dr. Reza Malek and colleagues at the Mayo Clinic have pioneered the use of a high-power Potassium-Titanyl-Phosphate (KTP) laser for photoselective vaporization of the prostate (PVP) to treat BPH. Their work was motivated by the limitations of the VLAP procedure that mainly used Nd:YAG lasers. The large optical penetration depth of the Nd:YAG laser radiation of 10 mm led to deep tissue coagulation, which was responsible for a broad spectrum of side effects. The researchers at the Mayo Clinic progressed to the use of high power KTP lasers with a wavelength of 532 nm, PVP. PVP is different from VLAP in that the KTP laser wavelength is highly absorbed by oxyhemoglobin and penetrates the prostatic tissue only 1 to 2 mm deep. These important characteristics allow the laser energy to be confined in a small volume of tissue eliminating the risks caused by excessive coagulation. The high power KTP laser instantly removes tissue by vaporization of cellular water. Only a thin 1- to 2-mm rim of coagulated tissue remains. The KTP laser is now available with 80 watts of average power and 240 watts of peak power, which allows for larger amounts of adenomatous tissue to be quickly vaporized and removed with minimal blood loss and coagulation. The KTP laser is available as the Niagara PV System from Laserscope, San Jose, California.

Practical experience with PVP ­ an interview with 4 leading urologists

The Niagara technology has been utilized investigationally for nearly 5 years and the first commercially available product, the Niagara PV System, began shipping in late January 2002. Clinical data supporting its use in treating BPH has been favorable, showing significant advantages over TURP. To help urologists obtain a better insight into the use of PVP and the Niagara PV System for the management of BPH, Drs. Reza Malek, Mahmood Hai, Unyime Nseyo, and Jeffrey Lapeyrolerie shared their thoughts about this procedure. Dr. Lapeyrolerie, who only recently began performing PVP, discussed his training and perceptions of the procedure's learning curve.