Top

Published in:

01-12-2023 | Transurethral Prostate Resection | Review Article

A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml

Authors: Shangjing Liu, Hongquan Liu, Huibao Yao, Fengze Sun, Jitao Wu, Zhongbao Zhou

Published in: Lasers in Medical Science | Issue 1/2023

Abstract

We conducted a meta-analysis to evaluate the efficacy and safety of photo selective vaporisation of the prostate (PVP) with the GreenLight Laser versus transurethral resection of the prostate (TURP) for the treatment of small-volume benign prostatic hyperplasia (BPH). As of July 2022, relevant literature in online databases such as Cochrane Library, PubMed, and Embase was searched, including studies published on or before that date, and there were 9 studies in total, including 5 RCTs and 4 non-RCTs. In total 1525 patients were included to compare the efficacy of PVP and TURP in treating BPH. The Cochrane Collaboration criteria were used to evaluate the risk of bias. The software was used for random effect meta-analysis with RevMan 5.3. Data extraction included: clinical baseline characteristics, perioperative parameters, complication rates, International Prostate Symptom Score (IPSS), prostate specific antigen (PSA), post-void residual urine (PVR), maximum flow rate (Qmax), and quality of life (QoL). The pooled analysis showed that PVP was associated with reduced blood loss, blood transfusion, clot retention, catheterization time, definitive catheter removal, and hospital stay, but was associated with longer operative time and more severe dysuria (all p < 0.05). The results of this meta-analysis show that PVP as a technique for the treatment of benign prostatic hyperplasia with a volume of less than 80 cc has similar efficacy to standard TURP in IPSS, PSA, PVR, Qmax and QoL, and is an effective alternative. It outperformed TURP in terms of blood transfusion, catheterization time and hospital stay, while TURP is superior to PVP in terms of operation time.

Available only for authorised users

Hirayama A et al (2002) Comparison of parameters to determine the cause of urinary disturbance in men with prostate volume less than 20 milliliters. Int J Urol 9(10):554–9 (discussion 560)PubMed

Irwin DE et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50(6):1306–14 (discussion 1314-5)PubMed

Tao W et al (2017) The efficacy and safety of 2-μm continuous laser in the treatment of high-risk patients with benign prostatic hyperplasia. Lasers Med Sci 32(2):351–356PubMed

Lerner LB et al (2021) Management of lower urinary tract symptoms attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management. J Urol 206(4):806–817PubMed

Michel MC et al (1998) Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol 160(3 Pt 1):784–791PubMed

Pirozzi L et al (2015) Current pharmacological treatment for male LUTS due to BPH: Dutasteride or finasteride? Curr Drug Targets 16(11):1165–1171PubMed

Roehrborn CG (2008) BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int 101(Suppl 3):17–21PubMed

Cantiello F et al (2021) Mechanical and ablative minimally invasive techniques for male LUTS due to Benign prostatic obstruction: A systematic review according to BPH-6 evaluation. Urol Int 105(9–10):858–868PubMed

Thomas D et al (2017) Emerging drugs for the treatment of benign prostatic hyperplasia. Expert Opin Emerg Drugs 22(3):201–212PubMed

10.

Lokeshwar SD et al (2019) Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol 8(5):529–539PubMedPubMedCentral

11.

Hueber PA, Al-Asker A, Zorn KC (2011) Monopolar vs. bipolar TURP: assessing their clinical advantages. Can Urol Assoc J 5(6):390–1PubMedPubMedCentral

12.

Méndez-Probst CE et al (2011) A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate. Can Urol Assoc J 5(6):385–389PubMedPubMedCentral

13.

Reich O et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180(1):246–249PubMed

14.

Rassweiler J et al (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–79 (discussion 980)PubMed

15.

Madersbacher S, Roehrborn CG, Oelke M (2020) The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU Int 126(3):317–326PubMed

16.

Rieken M, Herrmann TRW, Füllhase C (2019) Surgical treatment of benign prostatic hyperplasia-resection, vaporization or enucleation? Urologe A 58(3):263–270PubMed

17.

Oelke M et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140PubMed

18.

Meng QQ et al (2019) Tranexamic acid is beneficial for reducing perioperative blood loss in transurethral resection of the prostate. Exp Ther Med 17(1):943–947PubMed

19.

Kuntzman RS et al (1996) Potassium-titanyl-phosphate laser vaporization of the prostate: a comparative functional and pathologic study in canines. Urology 48(4):575–583PubMed

20.

Kuntzman RS et al (1997) High-power (60-watt) potassium-titanyl-phosphate laser vaporization prostatectomy in living canines and in human and canine cadavers. Urology 49(5):703–708PubMed

21.

Lee R, Gonzalez RR, Te AE (2006) The evolution of photoselective vaporization prostatectomy (PVP): advancing the surgical treatment of benign prostatic hyperplasia. World J Urol 24(4):405–409PubMed

22.

Malek RS, Kuntzman RS, Barrett DM (2005) Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 174(4 Pt 1):1344–1348PubMed

23.

Ghobrial FK et al (2020) A randomized trial comparing bipolar transurethral vaporization of the prostate with GreenLight laser (xps-180watt) photoselective vaporization of the prostate for treatment of small to moderate benign prostatic obstruction: outcomes after 2 years. BJU Int 125(1):144–152PubMed

24.

Guo S et al (2015) The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study. Lasers Med Sci 30(3):1147–1151PubMed

25.

Kumar N et al (2016) Prospective randomized comparison of monopolar TURP, Bipolar TURP and Photoselective vaporization of the prostate in patients with benign prostatic obstruction: 36 months outcome. Low Urin Tract Symptoms 10(1):17–20PubMed

26.

Mattevi D et al (2020) Comparison of GreenLight 180-W XPS laser vaporization versus transurethral resection of the prostate: Outcomes of a single regional center. Arch Ital Urol Androl 92(3). https://doi.org/10.4081/aiua.2020.3.169

27.

Mordasini L et al (2018) 80-W greenlight laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic obstruction: 5-year outcomes of a single-center prospective randomized trial. Urology 116:144–149PubMed

28.

Pereira-Correia JA et al (2012) GreenLight HPS™ 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int 110(8):1184–1189PubMed

29.

Reimann M et al (2020) Outcome of photoselective vaporization of the prostate with the GreenLight-XPS 180 watt system compared to transurethral resection of the prostate. J Clin Med 8(7):1004.

30.

Telli O et al (2015) A prospective, randomized comparative study of monopolar transurethral resection of the prostate versus photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc. Ther Adv Urol 7(1):3–8PubMedPubMedCentral

31.

Thomas JA et al (2015) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of Benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol 69(1):94–102PubMed

32.

Tugcu V et al (2008) Comparison of photoselective vaporization of the prostate and transurethral resection of the prostate: a prospective nonrandomized bicenter trial with 2-year follow-up. J Endourol 22(7):1519–1525PubMed

33.

Ene C, Geavlete P, Geavlete B (2020) What’s New in Bipolar TURP for Surgical Management of BPH? Chirurgia (Bucur) 115(3):307–313PubMed

34.

Michalak J, Tzou D, Funk J (2015) HoLEP: the gold standard for the surgical management of BPH in the 21(st) century. Am J Clin Exp Urol 3(1):36–42PubMedPubMedCentral

35.

Fried NM, Murray KE (2005) High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 19(1):25–31PubMed

36.

Zhu Y et al (2015) Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol 33(4):509–515PubMed

37.

Bozzini G et al (2023) Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences? World J Urol 41(1):143–150PubMed

38.

Xue B et al (2013) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a prospective randomized trial. J Xray Sci Technol 21(1):125–132PubMed

39.

Bachmann A et al (2005) Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol 48(6):965–71 (discussion 972)PubMed

40.

Castellani D et al (2021) GreenLight Laser™ Photovaporization versus transurethral resection of the prostate: a systematic review and meta-analysis. Res Rep Urol 13:263–271PubMedPubMedCentral

41.

Tao W et al (2019) Application of 180W XPS GreenLight laser vaporization of the prostate for treatment of benign prostatic hyperplasia. J Xray Sci Technol 27(6):1121–1129PubMed

42.

Zhou Y et al (2016) Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials. Lasers Med Sci 31(3):485–495PubMed

43.

Yang TK et al (2015) Body mass index and age are predictors for symptom improvement after high-power laser vaporization for benign prostatic hyperplasia. J Formos Med Assoc 114(3):268–273PubMed

44.

Anderson BB, Pariser JJ, Helfand BT (2015) Comparison of patients undergoing PVP Versus TURP for LUTS/BPH. Curr Urol Rep 16(8):55PubMed

45.

Meeks JJ et al (2013) Clinically significant prostate cancer is rarely missed by ablative procedures of the prostate in men with prostate specific antigen less than 4 ng/ml. J Urol 189(1):111–115PubMed

46.

Tao W et al (2019) Comparison of vaporization using 120-W GreenLight laser versus 2-micrometer continuous laser for treating benign prostatic hyperplasia: A 24-month follow-up study of a single center. J Xray Sci Technol 27(4):755–764PubMed

47.

Te AE (2006) The next generation in laser treatments and the role of the greenlight high-performance system laser. Rev Urol 8 Suppl 3(Suppl 3):S24-30PubMed

48.

Rieken M, Kaplan SA (2018) Enucleation, vaporization, and resection: how to choose the best surgical treatment option for a patient with male lower urinary tract symptoms. Eur Urol Focus 4(1):8–10PubMed

49.

Wroclawski ML et al (2021) Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis. World J Urol 39(10):3711–3720PubMed

50.

Al-Ansari A et al (2010) 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. Eur Urol 58(3):349–355PubMed

Title: A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml
Authors: Shangjing Liu
Hongquan Liu
Huibao Yao
Fengze Sun
Jitao Wu
Zhongbao Zhou
Publication date: 01-12-2023
Publisher: Springer London
Keywords: Transurethral Prostate Resection
Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy
Laser
Published in: Lasers in Medical Science / Issue 1/2023
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-023-03794-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2023

Towards phase-sensitive optical coherence tomography in smart laser osteotomy: temperature feedback

Effects of photobiomodulation on oxidative stress in rats with type 2 diabetes mellitus

Evaluation of the effect of high-intensity laser therapy (HILT) on function, muscle strength, range of motion, pain level, and femoral cartilage thickness in knee osteoarthritis: randomized controlled study

Monitoring of minerals level in dialysate during hemodialysis treatment of kidney patients using LIBS technique

Effects of low level laser on periodontal tissue remodeling in hPDLCs under tensile stress

In vitro comparative study between adhesion forces obtained on zirconia ceramic micromechanically treated with femtosecond laser (1027 nm), carbon dioxide laser (10,600 nm), and aluminum-oxide particles