PURPOSE: After the advent of the XPS (180W) 532nm-laser, Photoselective Vapo-Enucleation of the Prostate (PVEP) could compete with Holmium Laser Enucleation of the prostate (HoLEP) as a size independent procedure.
OBJECTIVE: To assess whether PVEP-XPS is not less effective than HoLEP for improvement of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH).
PATIENTS AND METHODS: A randomized controlled non-inferiority trial comparing HoLEP to PVEP- XPS 180W was conducted. International prostate symptoms score (IPSS), flow rate (Qmax), residual urine (PVR), prostate specific antigen (PSA) and prostate volume changes as well as perioperative and late adverse events were compared. Non-inferiority of IPSS at one year was evaluated using one-sided test at 5% level of significance. The statistical significance of other comparators was assessed at (two-sided) 5% level.
RESULTS: Fifty and 53 patients were included in the HoLEP and PVEP groups, respectively. Operating time, hospital stay and time to catheter removal were comparable between both groups. There was significant, comparable improvement of IPSS and PVR at 1, 4 and 12 months. After 4 months, prostate size reduction was significantly higher in the HoLEP group (74.3% vs. 43.1%, p=0.001). At 12-months, Qmax was significantly higher in the HoLEP group (26.4 ±11.5 vs. 18.4 ±7.5 mL/sec, p=0.03). Re-intervention was needed in 2 and 3 cases in HoLEP and PVEP groups respectively (p=1.0). The mean estimated cost per HoLEP procedure was significantly lower than per PVEP procedure.
CONCLUSIONS: Compared to HoLEP, Greenlight laser PVEP-XPS is safe, non-inferior and effective in treatment of BPH.
Written by:
Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM. Are you the author?
Urology department, McGill University, Montreal, Canada; Mansoura Urology and Nephrology center, Mansoura, Egypt; Urology department, Suez Canal University, Ismailia, Egypt.
Reference: J Urol. 2014 Sep 24. pii: S0022-5347(14)04551-0.
doi: 10.1016/j.juro.2014.09.097
PubMed Abstract
PMID: 25261801