A prospective randomized controlled trial of hybrid laser treatment or transurethral resection of the prostate, with a 1‐year follow‐up

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Abstract
Objective: To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP).Patients and methods: A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a ‘free‐paint’ application of 60 W Nd:YAG coagulation energy. Patients were re‐assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods.Results: In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P<0.001) in favour of the TURP group. At 6 months and one year this difference had disappeared. Similar numbers of patients in each group complained of bothersome postoperative urinary symptoms (23% vs 19%). Blood transfusions (5% vs none) and urethral strictures (9% vs 2%) were more common after TURP, whereas more early infective complications occurred after hybrid laser treatment (24% vs 5%). Only one patient in each group required re‐operation because of poor resolution of symptoms.Conclusions: At one year, hybrid KTP/Nd:YAG laser treatment of the prostate was equivalent to TURP in the improvements in IPSS, maximum urinary flow rate and post‐void residual urine.