Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies

Abstract

ObjectiveTo assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).DesignSystematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.Data sourcesPubMed, EMBASE, the Cochrane Library until October 2018.Eligibility criteriaRandomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.Data extraction and synthesisPerioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).Results22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=−0.08; 95% CI −0.13 to −0.02; p=0.007), and IPSS (MD = −0.10; 95% CI −0.15 to −0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant.ConclusionPVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.

A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP)

“…Photoselective vaporization of the prostate, using the KTP or LBO lasers (which have a 532 nm wavelength and are absorbed by haemoglobin), has also shown to be similar to TURP in improving micturition and quality of life (QoL). It allows reduced blood loss, complications (such as capsular perforation and TURS), catheterisation time and hospital stay [6].…”

Transurethral Resection of the Prostate at the Urology Department of Ignace Deen Hospital, Conakry, Guinea

“…Among these techniques is bipolar TURP which has the advantage of reproducing the same conditions as classical resection [10]. Several studies have compared monopolar TURP to bipolar TURP [17][18][19][20] or monopolar TURP with Bipolar prostatic vaporization [21] or Greenlight [22] or prostatic enucleation with Holmium Laser (HoLEP) [23].…”

Is Early Surgical Treatment for Benign Prostatic Hyperplasia Preferable to Prolonged Medical Therapy: Pros and Cons

“…Holmium laser enucleation of the prostate has reduced the risk of bleeding, hospitalization time and retreatment rate mainly for large prostates that would be managed traditionally with simple prostatectomy [ 18 ]. Photoselective vaporization of the prostate (greenlight laser) has eliminated the risk of TUR syndrome and significantly reduced the time of hospitalization and the risk of bleeding and blood transfusion in comparison to TURP [ 19 ]. New techniques such as water vapor therapy (rezume), prostatic urethral lift (Urolift) and water jet therapy (aquablation) have reduced the risk of sexual side effects (erectile dysfunction and retrograde ejaculation) which did not change pre- and post-operatively [ 20 , 21 , 22 ].…”