Abstract
The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14–44) for the PVP group and 36 months (range 25–47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16–27 + 3−5 vs. median 19 + 3; range 15−23 + 3−4; p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23; 16% vs. TURP group n = 2; 2%, p < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53–91) vs. 67 min (TURP group; range 46–85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7; 5% vs. n = 16; 14%; p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1–2 days; range 1–4) vs. the TURP group (median 2–4 days; range 2–5; both p < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6; 4% vs. n = 6; 5%; p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2–11 + 0−2 for both). There were no differences concerning urge (PVP group n = 3; 2% vs. TURP group n = 3; 3%; p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.
Highlights
The incidence of symptomatic benign prostate enlargement (BPE) increases in males in the later decades of life
The International Prostate Symptom Score (IPSS)-QoL was significantly higher in the photoselective vaporization of the prostate (PVP) group compared to the TURP group
There were no statistical differences in the preoperative catheterization in the PVP collective (n = 46; 33%) compared to the TURP collective (n = 40; 35%; p = 0.71), or in the preoperative post-void residual urine volume (PVP group median 60 mL; range 0–138 mL vs. TURP group median 65 mL; range 0–175 mL; p = 0.78)
Summary
The incidence of symptomatic benign prostate enlargement (BPE) increases in males in the later decades of life. Alternatives that provide a lower risk of bleeding are required, especially for older patients with cardiovascular diseases that are in need of a permanent anticoagulation treatment. PVP was added as one endourologic method to the European guidelines in 2010, and as a therapeutic recommendation to the American guidelines in 2018 [4,6,7]. The advantage of this method is that the 532 nm wavelength visible green light that is used is strongly absorbed by oxyhemoglobin and provides simultaneous vaporization and coagulation of the prostatic tissue [8]
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