OBJECTIVE: To assess the degree of postoperative storage symptoms after Greenlight laser photoselective vaporization of prostate (PVP) and Holmium laser enucleation of the prostate (HoLEP) for management of benign prostate hyperplasia (BPH) and its predictors.
METHODS: A retrospective review was performed for patients who underwent HoLEP or PVP for non-catheter dependent patients with BPH. Patients were followed-up at 1, 3, 6, and 12-months and then annually by international prostate symptoms score (IPSS), quality of life index, peak flow rate, residual urine volume and prostatic specific antigen (PSA). Moderate or severe storage symptoms were defined as IPSS storage subscore ≥9.
RESULTS: Out of 1673 laser procedures, a total of 1100 procedures met the inclusion criteria including 809 HoLEPs and 291 PVPs. HoLEP group had significantly preoperative larger prostates and longer operative time. In HoLEP group postoperative IPSS was significantly better than in PVP group at all follow up points (P< 0.05). Storage subscore was significantly higher after PVP and did not improve until 6-months postoperatively where it became comparable with that of HoLEP group. Number of patients with IPSS-storage score ≥9 were significantly higher in PVP group at 1 and 3-months follow-up (37.3% vs. 15.1%, p< 0.001) and (26.4% vs. 17.5%, p=0.004), respectively. XPS-180W was associated with the lowest storage symptoms among the three Greenlight generations at all follow-up visits. In multivariate analysis, baseline IPSS-storage subscore ≥9, prolonged operative time >100 minutes and lower percent of postoperative PSA reduction significantly predicted less improvement of postoperative storage symptoms regardless of the laser procedure.
CONCLUSION: Storage urinary symptoms significantly improved more after HoLEP compared to PVP, irrespective of the generation of Greenlight laser used. Recovery from storage urinary symptoms after prostate vaporization is time-dependent and baseline degree of storage symptoms, prolonged operative time and lower percent of postoperative PSA reduction negatively predicts postoperative improvement regardless of the laser procedure.
Written by:
Elkoushy MA, Elshal AM, Elhilali MM. Are you the author?
McGill University Health centre, Urology, 687 Pine Ave West, Suite S6.92, Montreal, Quebec, Canada, H3A 1A1.
Reference: J Endourol. 2015 Apr 23. Epub ahead of print.
doi: 10.1089/end.2015.0202
PubMed Abstract
PMID: 25905430