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

Abstract

This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.

Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy

“…It can be postulated that HoLEP in AT patients is equally effective as in no AT patients. Moreover, it is of note that several studies [ 26 , 27 ] reported on ongoing improvements within the first 6 months after HoLEP and thus, these very early results at discharge will invariably be subject to further improvements.…”

<p>Comparison of the Safety and Efficacy of Photoselective Vaporization of the Prostate (PVP) and Transurethral Enucleation with a Bipolar System (TUEB): A Single-Center Retrospective Study</p>

“…Regarding objective parameters, Elmansy et al and Sun et al reported a significant improvement in Qmax after HoLEP in a comparison between PVP and HoLEP. 11,12 The present data showed that, although there was no difference in the improvement in Qmax between the two groups, the improvement in PVR in the TUEB group was superior to that in the PVP group. This supports the fact that enucleation is better than PVP for improving objective parameters.…”

“…A comparison between PVP and HoLEP reported that stress urinary incontinence was more frequently observed in the HoLEP group. 12 Stress urinary incontinence is considered to be a characteristic complication of enucleation. Stress urinary incontinence is usually caused by the weakness and stretching of the external sphincter due to an enlarged prostate.…”

Endoscopic enucleation vs endoscopic vaporization procedures for benign prostatic hyperplasia: how should we choose

“…The follow-up time ranged from 12 months to 60 months. Among the enrolled studies, 12 studies [ 10 – 13 , 15 – 18 , 20 , 22 , 23 , 25 ] (4392 patients) compared L-EEP and L-EVP.…”