Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials

Abstract

The aim of this study is to assess the overall efficacy and safety of photoselective vaporization of the prostate (PVP) with GreenLight 120-W laser versus transurethral resection of the prostate (TURP) for treating patients of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). We performed a literature search of The Cochrane Library and the electronic databases, including Embase, Medline, and Web of Science. Manual searches were conducted of the conference proceedings, including European Association of Urology and American Urological Association (2007 to 2012). Outcomes reviewed included clinical baseline characteristics, perioperative data, complications, and postoperative functional results, such as postvoid residual (PVR), international prostate symptom score (IPSS), quality of life (QoL), and maximum flow rate (Qmax). Six randomized controlled trials (RCTs) were enrolled. Three hundred and forty-seven patients undergone 120-W PVP, and 350 patients were treated with TURP in the RCTs. There were no significant differences for clinical characteristics in these trials. In perioperative data, catheterization time and length of hospital stay were shorter in the PVP group. However, the operation time was shorter in the TURP group. Capsular perforation, blood transfusion, clot retention, and macroscopic hematuria were markedly less likely in PVP-treated subjects. The other complications between PVP and TURP did not demonstrate a statistic difference. There were no significant differences in QoL, PVR, IPSS, and Qmax in the 1, 3, 6, 12, and 24 months of postoperative follow-up. There was no significant difference at postoperation follow-up of functional outcomes including IPSS, PVR, Qmax, and QoL between the TURP-treated subjects and PVP-treated subjects. Owing to a shorter catheterization time, reduced hospital duration and less complication, PVP could be used as an alternative and a promising minimal invasive surgical procedure for the treatment of BPH.

Population‐based assessment of re‐treatment and healthcare utilisation after photoselective vaporisation of the prostate or electrosurgical transurethral resection of the prostate

“…Consistent with published meta-analyses and clinical trials, we found that PVP was associated with a shorter length of stay and a lower risk of blood transfusion [5][6][7][8]. This is also a relevant finding that confirms some of the benefits that have been attributed to PVP procedures.…”

“…PVP using a potassium‐titanyl‐phosphate laser (also known as GreenLight, first used in 1998) has gained considerable popularity due to the lower risk of bleeding and shorter hospital stay . Several meta‐analyses of randomised trials comparing PVP to electrosurgical‐TURP have been published ; generally they demonstrate similar functional outcomes; however, the long‐term follow‐up of these patients is not commonly reported, and often many patients are lost to follow‐up. High‐quality randomised controlled trials (such as the GOLIATH study ) have shown equivalent re‐treatment rates between GreenLight PVP and electrosurgical‐TURP at 2 years.…”

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

“…Because LUTS strongly influences QoL negatively 2,4 , one of the goals for the treatment of BPH was focused on improving QoL 16 . Laser surgery for BPH has been expected to be alternatives to the gold standard of BPH surgery (TURP or open prostatectomy) because, compared with TURP, it showed comparable efficacy and lower postoperative morbidity as mentioned above 11,17 . Specifically, Xue et al .…”

Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM)

“…The overall level of symptom severity on IPSS was 18.94, which is slightly low compared with studies of surgical interventions, probably because the study baseline is taken from the start of the secondary care diagnostic pathway, rather than at the time of intervention. For example, the range of mean baseline IPSSs from four surgery meta-analyses were 15.80 to 27.90 [21][22][23][24].…”