A prospective, randomized trial comparing the use of KTP (GreenLight) laser versus electroresection-supplemented laser in the treatment of benign prostatic hyperplasia

Abstract

IntroductionPhotoselective laser vaporization of the prostate (PVP) is one of the most popular techniques of treatment of benign prostatic hyperplasia (BPH). The aim of this study was to assess the risk of thermal damage to the external urethral sphincter during PVP at distal part of prostatic urethra.Material and methods66 men submitted to PVP with 80-W Green Light Laser were randomly assigned to receive standard PVP only (group A) or PVP in proximal part followed by transurethral resection in distal part of prostatic urethra (group B). Primary end-points of the study assessed at baseline, 24 hours and 8 weeks after the surgery were: urinary continence, urinary flow (Qmax), post void urine retention (PVR), international prostate symptom score (IPSS), quality of life (QoL).ResultsPer protocol analysis was eventually performed in 60 patients. Study groups did not differ in age, preoperative continence, values of Qmax, PVR, IPSS, QoL, or the rate of complete urinary retention (p >0.05). During the 8-week follow-up no patient reported urinary incontinence, while decrease in IPSS (16.3 vs. 14.9, p >0.05), QoL improvement (4.7 vs. 4.7, p >0.05), increase in Qmax (18.2 vs. 17.4, p >0.05) were similar in both study groups. Patients assigned to group B were more likely to have bleeding complications (85.2% vs. 18.2%), including patients requiring transfusion (14.8% vs. 0%). Moreover, postoperative catheterization time was shorter in group A (29.1 hrs vs. 37.2 hrs, p = 0.04).ConclusionsLaser vaporization for treatment of BPH is safe and effective, with no significant effect on the risk of urinary incontinence in comparison to traditional methods.

Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience

“…Previous analysis by Bouchier-Hayes et al [6] confirmed lower capital costs for GL-XPS compared to TURP due to a shorter hospital stay and a stable low complication rate, which we could both confirm in our study. Our results even confirm a more efficient GL-XPS with the GL-XPS 180 W laser system compared to recent results of Eken et al[24], analyzing the 120 W and Torz et al [15] analyzing the 80 W laser system compared to TURP. They could show a similar hospital stay (median ≥1 day) and catheterization time (median 1 day) but an more insufficient symptom reduction in IPSS-QoL with median 8 + 3 (120 W) and median 14 + 2 (80 W) within a similar prostate volume collective with 59 mL (median; range 31–87) and 39 mL (median; range 15–82) [6, 15, 24].…”

“…Our results even confirm a more efficient GL-XPS with the GL-XPS 180 W laser system compared to recent results of Eken et al[24], analyzing the 120 W and Torz et al [15] analyzing the 80 W laser system compared to TURP. They could show a similar hospital stay (median ≥1 day) and catheterization time (median 1 day) but an more insufficient symptom reduction in IPSS-QoL with median 8 + 3 (120 W) and median 14 + 2 (80 W) within a similar prostate volume collective with 59 mL (median; range 31–87) and 39 mL (median; range 15–82) [6, 15, 24]. Stone et al [13] confirmed in an high prostate volume collective (median 202 mL; range 152–376) a constant hospital stay and catheterization time within 1 day and an efficient and durable symptom reduction in IPSS-QoL from 16 + 4 to 3.5 + 1 which confirms our results of a clear progress in OT with an efficient learning curve at a high volume center using GL-XPS with 180 W.…”

“…Despite remaining on anticoagulation with aspirin while performing GL-XPS, it had no impact on morbidity or AEs, defined as the need of at least a pharmacological treatment (Clavien-Dindo >2) [15, 22, 23]. Postoperative acute urine retention as one major postoperative AE decreased over the 5 year study period and is in line with recently published results by Bachmann et al [7, 8].…”

“…The significantly improved OT efficiency may be explained not only by growing experience at a high volume center for GL-XPS, but also by utilizing 180 W energy of GL-XPS leading to a faster and more efficient photoselective vaporization of the prostate compared to 80 W laser systems (median 80 min; range 60–120) before [14, 15]. …”