Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 8/2015

01-08-2015 | Benign Prostatic Hyperplasia (K McVary, Section Editor)

Comparison of Patients Undergoing PVP Versus TURP for LUTS/BPH

Authors: Blake B. Anderson, Joseph J. Pariser, Brian T. Helfand

Published in: Current Urology Reports | Issue 8/2015

Login to get access

Abstract

Transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) are currently the two most commonly performed procedures for the treatment of benign prostatic hyperplasia (BPH). While each procedure has been shown to be efficacious, TURP or PVP may be preferred in certain clinical scenarios. A number of factors may influence the choice of which patients undergo PVP or TURP. This decision may take into account patient characteristics, such as age, co-morbidities, predominance of irritative symptoms, and/or ongoing anticoagulation. Additionally, balancing desired outcomes with possible risks is critical. Considerations should include possible effects on sexual function, rates of reoperation, cost, and need for tissue specimen in those at risk for prostate cancer. The primary objective of this article is to summarize the comparative research of PVP and TURP and the implications on differences between patients who undergo either procedure.
Literature
1.
McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793–803.PubMedCrossRef
2.
Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002;59:877–83.PubMedCrossRef
3.
AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: diagnosis and treatment recommendations. J Urol. 2003;170:530–47.CrossRef
4.
Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol. 2006;50:969–79. discussion 980.PubMedCrossRef
5.
Malek RS, Kuntzman RS, Barrett DM. High power potassium-titanyl-phosphate laser vaporization prostatectomy. J Urol. 2000;163:1730–3.PubMedCrossRef
6.
Hai MA, Malek RS. Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol. 2003;17:93–6.PubMedCrossRef
7.
Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012;79:1111–6.PubMedCentralPubMedCrossRef
8.
Tang Y, Li J, Pu C, Bai Y, Yuan H, Wei Q, et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol. 2014;28:1107–14.PubMedCrossRef
9.•
Cornu J-N, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A Systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2014. Large meta-analysis of both bipolar and monopolar TURP, HoLEP and PVP that compares outcomes such as safety and efficacy for each procedure.
10.••
Bachmann A, Tubaro A, Barber N, d’ Ancona F, Muir G, Witzsch U, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial—the GOLIATH study. Eur Urol. 2014;65:931–42. This represents a large, well-designed multi-center randomized controlled trial of TURP vs. PVP demonstrating comparable outcomes at 6 months.PubMedCrossRef
11.
Bachmann A, Tubaro A, Barber N, d’ Ancona F, Muir G, Witzsch U, et al. A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study. J Urol. 2015;193:570–8.PubMedCrossRef
12.
Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97.PubMedCrossRef
13.
Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F, et al. A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009;55:1345–57.PubMedCrossRef
14.••
Thangasamy IA, Chalasani V, Bachmann A, Woo HH. Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012. Eur Urol. 2012;62:315–23. This paper provides a great review and analysis of combined data from all available randomized controlled trials between TURP and PVP in the first decade of existence of PVP.PubMedCrossRef
15.
May A, Broggi E, Lorphelin H, Tabchouri N, Giretti G, Pereira H, et al. Comparison of the risk of postoperative infection between transurethral vaporesection and transurethral resection of the prostate. Lasers Surg Med. 2014;46:405–11.PubMedCrossRef
16.••
Guo S, Müller G, Lehmann K, Talimi S, Bonkat G, Püschel H, et al. 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. 2015;30:1147–51. This is an important study with long term (5 year) postoperative follow-up that demonstrated significantly higher reoperation rates with PVP (80-W KTP) compared to TURP.PubMedCrossRef
17.
Franco G, De Nunzio C, Federico G, Laurenti C. Evaluation of sexual activity after prostatic surgery for benign prostatic hyperplasia assessed by pre-operative and post-operative questionnaire. Minerva Urol Nefrol. 2005;57:331–4.PubMed
18.
Muntener M, Aellig S, Kuettel R, Gehrlach C, Sulser T, Strebel RT. Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol. 2007;52:510–5.PubMedCrossRef
19.
Jaidane M, Arfa NB, Hmida W, Hidoussi A, Slama A, Sorba NB, et al. Effect of transurethral resection of the prostate on erectile function: a prospective comparative study. Int J Impot Res. 2010;22:146–51.PubMedCrossRef
20.•
Becher EF, McVary KT. Surgical procedures for BPH/LUTS: impact on male sexual health: surgery for BPH/LUTS: impact on male sexual health. Sex Med Rev. 2014;2:47–55. This is an excellent review of the available literature comparing the impact of different surgical treatments for BPH, including PVP and TURP, on sexual function.CrossRef
21.
Bruyère F, Puichaud A, Pereira H, Faivre d’Arcier B, Rouanet A, Floc’h AP, et al. Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol. 2010;58:207–11.PubMedCrossRef
22.
Horasanli K, Silay MS, Altay B, Tanriverdi O, Sarica K, Miroglu C. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology. 2008;71:247–51.PubMedCrossRef
23.
Pereira-Correia JA, de Moraes Sousa KD, Santos JBP, de Morais PD, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPSTM 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110:1184–9.PubMedCrossRef
24.
Mohanty NK, Vasudeva P, Kumar A, Prakash S, Jain M, Arora RP. Photoselective vaporization of prostate vs. transurethral resection of prostate: a prospective, randomized study with one year follow-up. Indian J Urol. 2012;28:307–12.PubMedCentralPubMedCrossRef
25.
Lukacs B, Loeffler J, Bruyère F, Blanchet P, Gelet A, Coloby P, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol. 2012;61:1165–73.PubMedCrossRef
26.
Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, et al. Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int. 2013;111:129–36.PubMedCrossRef
27.
Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, et al. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int. 2013;112:109–20.PubMedCrossRef
28.
Sandhu JS, Ng C, Vanderbrink BA, Egan C, Kaplan SA, Te AE. High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates. Urology. 2004;64:1155–9.PubMedCrossRef
29.
De Nunzio C, Miano R, Trucchi A, Miano L, Franco G, Squillacciotti S, et al. Photoselective prostatic vaporization for bladder outlet obstruction: 12-month evaluation of storage and voiding symptoms. J Urol. 2010;183:1098–103.PubMedCrossRef
30.
Schroeck FR, Hollingsworth JM, Kaufman SR, Hollenbeck BK, Wei JT. Population based trends in the surgical treatment of benign prostatic hyperplasia. J Urol. 2012;188:1837–41.PubMedCentralPubMedCrossRef
31.
Strope SA, Yang L, Nepple KG, Andriole GL, Owens PL. Population based comparative effectiveness of transurethral resection of the prostate and laser therapy for benign prostatic hyperplasia. J Urol. 2012;187:1341–5.PubMedCentralPubMedCrossRef
32.••
Malik RD, Wang CE, Lapin B, Gerber GS, Helfand BT. Comparison of patients undergoing laser vaporization of the prostate versus TURP using the ACS-NSQIP database. Prostate Cancer Prostatic Dis. 2015;18:18–24. This is an important, recent study on types of patients treated with either PVP or TURP using large database sample, analysis over 2007-2012 allows observation of emerging trends as well.PubMedCrossRef
33.
Ruszat R, Wyler S, Forster T, Reich O, Stief CG, Gasser TC, et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol. 2007;51:1031–8. discussion 1038–41.PubMedCrossRef
34.
Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE. Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol. 2011;186:977–81.PubMedCrossRef
35.
Goh AC, Gonzalez RR. Photoselective laser vaporization prostatectomy versus transurethral prostate resection: a cost analysis. J Urol. 2010;183:1469–73.PubMedCrossRef
36.
Stovsky MD, Griffiths RI, Duff SB. A clinical outcomes and cost analysis comparing photoselective vaporization of the prostate to alternative minimally invasive therapies and transurethral prostate resection for the treatment of benign prostatic hyperplasia. J Urol. 2006;176:1500–6.PubMedCrossRef
37.
Whitty JA, Crosland P, Hewson K, Narula R, Nathan TR, Campbell PA, et al. A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia. BJU Int. 2014;113 Suppl 2:21–8.PubMedCrossRef
38.
Yin L, Teng J, Huang C-J, Zhang X, Xu D. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol. 2013;27:604–11.PubMedCrossRef
39.
Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160–6.PubMedCrossRef
40.
Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T. Common trend: move to enucleation—is there a case for GreenLight enucleation? Development and description of the technique. World J Urol. 2015;33:539–47.PubMedCentralPubMedCrossRef
41.
Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int. 2011;107:1030–43.PubMedCrossRef
42.
Gross AJ, Netsch C, Knipper S, Hölzel J, Bach T. Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution. Eur Urol. 2013;63:859–67.PubMedCrossRef
43.•
Cho HJ, Shin SC, Cho JM, Kang JY, Yoo TK. The role of transurethral resection of the prostate for patients with an elevated prostate-specific antigen. Prostate Int. 2014;2:196–202. This recent paper provides a timeline for monitoring of PSA after TURP.PubMedCentralPubMedCrossRef
44.
Henderson J, Ghani KR, Cook J, Fahey M, Schalken J, Thilagarajah R. The role of PCA3 testing in patients with a raised prostate-specific antigen level after Greenlight photoselective vaporization of the prostate. J Endourol Endourol Soc. 2010;24:1821–4.CrossRef
45.
Helfand BT, Anderson CB, Fought A, Kim DY, Vyas A, McVary KT. Postoperative PSA and PSA velocity identify presence of prostate cancer after various surgical interventions for benign prostatic hyperplasia. Urology. 2009;74:177–83.PubMedCrossRef
46.
Klausner AP, Anderson BB, Espy PG, Despradel VM, Grob BM. Long term prostate-specific antigen trends following subcapsular prostatectomy. Can J Urol. 2010;17:5442–6.
47.
Meeks JJ, Maschino AC, McVary KT, Sandhu JS. 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. 2013;189:111–5.
48.
Grimm P, Sylvester J. Advances in brachytherapy. Rev Urol. 2004;6 Suppl 4:S37–48.
49.
Kollmeier MA, Stock RG, Cesaretti J, Stone NN. Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy. J Urol. 2005;173:808–12.
50.
Flam TA, Peyromaure M, Chauveinc L, Thiounn N, Firmin F, Cosset J-M, et al. Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer. J Urol. 2004;172:108–11.
51.
Abelson B, Reddy CA, Ciezki JP, Angermeier K, Ulchaker J, Klein EA, et al. Outcomes after photoselective vaporization of the prostate and transurethral resection of the prostate in patients who develop prostatic obstruction after radiation therapy. Urology. 2014;83:422–7.
52.
No D, Osterberg EC, Otto B, Naftali I, Choi B. Evaluation of continence following 532 nm laser prostatectomy for patients previously treated with radiation therapy or brachytherapy. Lasers Surg Med. 2013;45:358–61.
53.
Hirshberg ED, Klotz LH. Post transurethral resection of prostate incontinence in previously radiated prostate cancer patients. Can J Urol. 1998;5:560–3.
Metadata
Title
Comparison of Patients Undergoing PVP Versus TURP for LUTS/BPH
Authors
Blake B. Anderson
Joseph J. Pariser
Brian T. Helfand
Publication date
01-08-2015
Publisher
Springer US
Published in
Current Urology Reports / Issue 8/2015
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-015-0525-7

Other articles of this Issue 8/2015

Current Urology Reports 8/2015 Go to the issue

Office Urology (N Shore, Section Editor)

Implementation of Multi-parametric Prostate MRI in Clinical Practice

Minimally Invasive Surgery (V Bird and M Desai, Section Editors)

Outcome-Based Comparison of Percutaneous Procedures for Urinary Lithiasis with Calibre of Instrumentation less than 12Fr

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Testosterone Replacement Therapy on the Natural History of Prostate Disease

MINIMALLY INVASIVE SURGERY (V BIRD AND M DESAI, SECTION EDITORS)

Role of Narrow Band Imaging in Management of Urothelial Carcinoma

Minimally Invasive Surgery (V Bird and M Desai, Section Editors)

Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

Men’s Health (R Carrion and C Yang, Section Editors)

Update on Testosterone Replacement Therapy in Hypogonadal Men