GreenLight HPS 120-W Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia: A Randomized Clinical Trial with Midterm Follow-up

Al‐Ansari, Abdulla; Younes, Nagy; Sampige, Venkataramana Pai; Al-Rumaihi, Khalid; Ghafouri, Ardalan; Gul, Tawiz; Shokeir, Ahmed A.

doi:10.1016/j.eururo.2010.05.026

Cited by 270 publications

(208 citation statements)

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“…Many alternative procedures have been proposed and tried with variable success. In this study and similar to the findings of others, [3][4][5] there was no difference between TURP and PVP in the change in IPSS at 6 months, nor was there a difference in flow rates, HRQoL or sexual function. PVP is a painless, essentially bloodless procedure which can safely be performed in an outpatient setting.…”

Section: Discussionsupporting

confidence: 77%

“…However, recent innovations in energy-based interventions have provided alternative treatment options for patients with BPH and may have clinical and economic benefits when compared to TURP. 1,2 Among these technologies, the potassium-titanyl-phosphate laser, which permits the photoselective vaporization of the prostate (PVP), has the potential to be cost-effective compared to TURP; it appears to provide similar outcomes [3][4][5] at a lesser cost 2,6,7 and can be performed in an outpatient setting. Due to the potential benefits associated with this technology and upon review of the evidence, in 2007 the Ontario Health Technology Advisory Committee (OHTAC) 8 recommended that "a registry study be conducted to establish longer term effectiveness and complication rates for PVP given the likelihood of increasing diffusion of this technology."…”

Section: Introductionmentioning

confidence: 99%

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A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada

Whelan

Bowen²,

Burke³

et al. 2013

CUAJ

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Background: Photoselective vaporization of the prostate (PVP) is a bloodless, relatively painless alternative to transurethral resection of the prostate (TURP) for relief of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). Objective: We compare the effectiveness, safety and cost-effectiveness of Greenlight Laser PVP (HPS-120) and TURP. Methods: We conducted a prospective, non-randomized trial in 3 Ontario centres from March 2008 to February 2011. Assessments were completed at baseline, 1 and 6 months following surgery at the physicians' offices and at 12 and 24 months by phone. The primary outcome was the change in International Prostate Symptoms Score (IPSS) score at 6 months versus baseline. Secondary outcomes were changes in flow rate, postvoid residual (PVR), prostate-specific antigen (PSA) and sexual health inventory for men (SHIM) scores. Adverse events, health-related quality of life (HRQoL), resource utilization and productivity losses were collected. Results: Although the IPSS decreased in both arms (n = 140 for PVP and n = 24 for TURP) between baseline and 6 months, the difference in change over time between the groups was not statistically significant (p = 0.718). Other outcomes improved equally from baseline and 6 months (Qmax, SHIM, PSA and HRQoL), with only changes in PVR favouring PVP (p = 0.018). There were no statistical differences in serious adverse events. In total, 130 of 140 PVP patients were outpatients, all TURP subjects were inpatients. PVP was less costly than TURP ($3891 vs. $4863; p < 0.001) with similar quality-adjusted life years (0.448 vs. 0.441; p = 0.658). Conclusion: Greenlight Laser PVP (HPS-120) is a safe and costeffective alternative to TURP for outpatient treatment of LUTS and can be completed as an outpatient with minimal blood loss.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada

Whelan

Bowen²,

Burke³

et al. 2013

CUAJ

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“…Following study assessment, we identified 11 trials [10][11][12][19][20][21][22][23][24][25][26] including six RCTs and five prospective casecontrolled studies (CCSs) that met our including criteria ( Table 1). Two trials of 128 patients were not available because we were unable to obtain the data for inclusion in this meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Although only two RCTs 10,12 were adequate in sequence generation and incomplete outcome data but inadequate in allocation concealment and blinding and three RCTs 11,19,20 were adequate in sequence generation, allocation concealment and incomplete outcome data but inadequate in blinding, they were regarded as high quality because of the limitation of ethics factor and the characteristics of the surgery studies. One RCT 22 reported only randomisation but inadequate allocation concealment, blinding and incomplete outcome data and was regarded as low quality.…”

Section: Resultsmentioning

confidence: 99%

“…[9][10][11][12][13] PVP uses a high-powered potassium-titanyl-phosphate laser or a lithium triborate laser that emits light at a wavelength of 532 nm, which is in the green portion of the light spectrum. 9,10,14 Because this wavelength is absorbed strongly by haemoglobin but not by water when it is applied to vascularized prostatic tissue, the laser light is absorbed instantly by the blood, which is then quickly vaporized and removed, thus creating a prostate cavity with minimal blood loss, postoperative discomfort and hospital stay. 15,16 However, to date, there has been no systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs to determine the effectiveness and safety of PVP vs. TURP for BPH.…”

Section: Introductionmentioning

confidence: 99%

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Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis

Ding¹,

Du²,

Lu³

et al. 2012

Asian J Androl

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This study sought to evaluate the efficacy and safety of photoselective vaporisation (PVP) vs. transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH). Eligible studies were identified from electronic databases (Cochrane Library, PubMed and EMBASE). The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy (primary outcomes: maximum urinary flow rate (Q max ), international prostate symptom score (IPSS), postvoid residual urine (PVR) and quality of life (QoL); secondary outcomes: operative time, hospital time and catheter removal time) and safety (complications, such as transfusion and capsular perforation) were explored by using Review Manager 5.0. Six randomized controlled trials (RCTs) and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in IPSS, Q max , QoL or PVR between PVP and TURP (mean difference (MD): prostate sizes ,70 ml, Q max at 24 months, MD50.01, P50.97; IPSS at 12 months, MD50.18, P50.64; QoL at 12 months, MD520.00, P50.96; PVR at 12 months, MD50.52, P50.43; prostate sizes .70 ml, Q max at 6 months, MD523.46, P50.33; IPSS at 6 months, MD53.11, P50.36; PVR at 6 months, MD525.50, P50.39). PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes ,70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes ,70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes. INTRODUCTIONBenign prostatic hyperplasia (BPH) is a major cause of lower urinary tract symptoms (LUTSs) in men, especially in individuals over the age of 50 years. 1 LUTS secondary to BPH is typically characterized as voiding symptoms, such as weak stream, hesitancy, intermittency and incomplete emptying, storage symptoms, such as urgency, frequency and nocturia, and postmicturition symptoms. 2,3 Currently, the main treatment options for BPH include pharmacological therapy, such as a-adrenergic blockers and 5a-reductase inhibitors, or surgery, such as transurethral resection of the prostate (TURP), transurethral incision of the prostate and open simple prostatectomy. 4 Although TURP is the current 'gold standard' treatment for moderate-to-severe LUTS secondary to BPH, 5,6 the procedure has some limitations. Several studies 7,8 have demonstrated that the rate of complications following TURP, including transfusions, infections, urethral strictures, sexual dysfunction, urinary incontinence, urinary retention

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Benign Prostatic Hyperplasia

and

Chughtai

2014

Male Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

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donation during the early years of the AIDS epidemic. The demand for autologous transfusion has decreased as patients have become less concerned over the safety of transfusion, primarily because of improved testing for viral agents such as HIV and hepatitis. Other concepts that spare blood transfusion Erythropoietin, the red cell production hormone, can reduce the need for transfusion in stable medical patients with cancer and premature newborn infants. It can also be used to reduce the need for allogeneic transfusion in surgical patients, with or without concomitant autologous collection. 18 19 Perioperative anaemia and blood loss can also be dealt with by reducing the amount of blood lost at surgery through improving mechanical haemostasis, using antifibrinolytics such as aprotinin, limiting phlebotomy to essential diagnostic tests, and using microsample laboratory techniques. 20 Autologous transfusions also form part of a new concept of blood management called bloodless medicine and surgery. 21 This includes the use of erythropoietin, surgical techniques that minimise blood loss, and drugs that inhibit fibrinolysis; greater degrees of anaemia are tolerated, and phlebotomy undertaken for diagnostic testing is minimal. 20 Some of these methods are neither technically demanding nor expensive and may be adaptable to medical practice in less developed settings. The excellent results obtained in patients who are Jehovah's Witnesses, who refuse allogeneic transfusions, and the potential advantage of using fewer transfusions in patients in critical care support the promise of this concept for allogeneic transfusion. 22 Competing interests: NB has received lecture honorariums and consulting fees from Ortho Biotech.

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GreenLight HPS 120-W Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia: A Randomized Clinical Trial with Midterm Follow-up

Cited by 270 publications

References 19 publications

A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada

A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada

Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis

Benign Prostatic Hyperplasia

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