Early experience photoselective vaporisation of the prostate using the 180W lithium triborate and comparison with the 120W lithium triborate laser

PURPOSE: There is a paucity of information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the 180W lithium triborate (LBO) laser. We report on initial outcomes of PVP with the 180W laser, comparing the first 50 cases with the last 50 cases performed with the 120W LBO laser. METHODS: All cases performed by a single surgeon (HHW) have been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 to June 2011). Patient variables were recorded preoperatively and at 3 months postoperatively. Perioperative data was also recorded. RESULTS: The 180W cases had a larger median transrectal ultrasound prostate volume (68 mL vs. 51 mL, P<0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (not significant [NS] at P=0.22), lasering time 49.6 and 54.6 minutes (NS, P=0.30) and energy utilisation 477.6 kJ and 377.9 kJ (P<0.05) respectively. When compared per gram of prostate tissue lasered, the 180W is quicker at 0.67 min/g vs. 1.0 min/g for the 120W laser. Complications using the Clavien-Dindo classification included 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser. The 120 W LBO laser had 4 grade 1 complications and 1 grade 2. CONCLUSIONS: There is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times.