GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis

Castellani, Daniele; Pirola, Giacomo Maria; Rubilotta, Emanuele; Gubbiotti, Marilena; Scarcella, Simone; Maggi, Martina; Gauhar, Vineet; Teoh, Jeremy Yuen‐Chun; Galosi, Andrea Benedetto

doi:10.2147/rru.s277482

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…One limitation is the challenge of completely vaporizing the transition zone in large-volume prostates. Although prostates > 80 ml can be treated with PVP, these cases are associated with a long operative time, extra fibers, and a high reoperation rate due to incomplete vaporization [3][4][5]. Moreover, there are no pathological specimens after PVP, which may lead to missed diagnosis of prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser versus photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia: a randomised controlled trial with 1-year followup results

et al. 2022

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Background We designed a new surgical procedure to treat benign prostatic hyperplasia(BPH). In order to verify its effectiveness and safety, we constructed this randomized controlled trial to compare the efficacy of our innovative enucleation technique- photoselective sharp enucleation of the prostate (PSEP), with a front-firing 532-nm laser and the traditional technique-photoselective vaporization of the prostate (PVP) in the treatment of BPH. Methods A total of 154 consecutive patients diagnosed with bladder outlet obstruction secondary to BPH in our center from June 2018 to April 2019 were randomly divided into the PSEP group (n = 77) and the PVP group (n = 77) and were treated surgically with either PSEP or PVP. All patients were assessed preoperatively and followed up at 1, 6, and 12 months postoperatively. The international prostate symptom score,quality-of-life score, postvoid residual urine volume, maximum urine flow rate, prostate volume, prostate-specific antigen, and adverse events were compared. Results The lower urinary tract symptoms in both groups were significantly improved compared with the baseline at 1, 6, and 12 months postoperatively. The PSEP and PVP groups had an equivalent International Prostate Symptom Score, quality-of-life score, postvoid residual urine volume, maximum urine flow rate, prostate-specific antigen at each follow-up (P > 0.05). The median operative time in the PSEP group was significantly shorter than that in the PVP group (35 min vs. 47 min, P < 0.001). At 6 and 12 months after surgery, the median PV in the PSEP group was smaller than that in the PVP group (P < 0.05). Complication rates were comparable between the groups. Conclusion Both PSEP and PVP can achieve good efficacy and safety in the treatment of BPH. PSEP can remove more tissue than PVP and is associated with higher efficiency. In addition, PSEP eliminates the problem of lack of tissue samples associated with PVP. Trial registration Chinese Clinical Trial Registry, identifie:ChiCTR1800015867, date:25/04/2018.

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Section: Introductionmentioning

confidence: 99%

Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser versus photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia: a randomised controlled trial with 1-year followup results

et al. 2022

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“…One study showed that the postoperative catheter insertion time and hospital stay were shorter and the risk of blood transfusion was lower in the PVP group compared to TURP, but the risk of dyspareunia and reoperation rates were higher in the PVP group, and there was no difference in the risk of urinary tract infection or risk of postoperative re-catheterisation between the two groups. Whereas in the postoperative follow-up included (IPSS, QoL, Qmax and PVR), the improvement in IPSS after TURP surgery was better than PVP in the early versus mid-term (2-year follow-up results), while QoL and Qmax were not significantly different, and PVR improved better than TURP after PVP surgery, and the 5th year follow-up showed that: the results of IPSS, QoL and Qmax TURP was better after surgery, while PVR was not significantly different between the two groups [9]. Lai et al showed that in perioperative terms (including bleeding-related transfusion, TUR syndrome, perforation of the peritoneum, clot retention, urinary tract infection and acute urinary retention), PVP had a lower incidence of transfusion, RR = 0.14 (p < 0.01) and clot retention (RR = 0.14, p < 0.01), TUR syndrome (RR = 0.19, p < 0.01) and perforation of the peritoneum ( RR = 0.09, p < 0.01) were lower, but PVP had a higher risk of mild to moderate voiding difficulties (RR = 1.76, 95% CI 1.17 to 2.65, p < 0.01), and there was no significant difference between PVP and TURP in terms of long-term complications (including bladder neck contracture, retrograde ejaculation, urethral stricture) [10].…”

Section: Green Lasermentioning

confidence: 79%

Advances in Minimally Invasive Treatment of Benign Prostatic Hyperplasia

Xie¹,

Liu²,

Zheng³

2022

JBM

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Benign prostatic hyperplasia (BPH) is a chronic condition that is more common in older men. BPH most commonly causes symptoms associated with LUTS and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) in men with BPH are a major cause of reduced quality of life in older men. If bladder outlet obstruction persists for a longer period of time, the contractility and voiding capacity of the detrusor muscle will gradually be affected by the obstructive factors, eventually leading to a loss of compensatory phase, characterised by a reduced electrical stimulation response, replacement of bladder muscle tissue by connective tissue, and a possible increase in voiding pressure, but a decrease in contractility of the detrusor muscle. As BOO progresses, it eventually leads to permanent contractile dysfunction of the detrusor muscle. Therefore, early initiation of surgical treatment in patients who are not well controlled by medication can reduce the complications associated with prostate enlargement. With the rise of minimally invasive treatment and the complications of open surgery, minimally invasive treatment of BPH has attracted increasing attention. Various emerging minimally invasive surgical modalities are being developed in clinical practice, and more and more minimally invasive techniques and concepts are focusing on safety, improving quality of life and reducing long-term complications to meet the different needs of different patients. Transurethral resection of the prostate (TURP) is currently the "gold standard" of minimally invasive surgical treatment, but with concerns about post-operative complications, the search for safer and more effective minimally invasive surgical options has become even more important. In recent years, with the increasing clinical application of new minimally invasive techniques such as various lasers, interventional treatments and implantable devices, there are more options for minimally invasive treatment of BPH. This article provides a brief review of research advances in the minimally invasive treatment of benign prostatic hyperplasia, with a view to informing clinical decisions.

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“…Most studies reported shorter hospitalization durations with PVP, ThuVARP, DiLEP, and HoLEP than with TURP [ 24 , 25 , 26 , 27 ]. Some smaller studies reported no significant differences in hospitalization duration between HoLEP and B-TURP [ 25 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study

Chen

Hsu

Wang

et al. 2022

JCM

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Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.

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GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 30 publications

Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser versus photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia: a randomised controlled trial with 1-year followup results

Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser versus photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia: a randomised controlled trial with 1-year followup results

Advances in Minimally Invasive Treatment of Benign Prostatic Hyperplasia

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study

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