A bicentric comparative and prospective study between classic photovaporization and anatomical GreenLight laser vaporization for large-volume prostatic adenomas.

OBJECTIVE

Long-term outcome after prostate photovaporization (PVP) remains largely unknown, especially when performed on enlarged prostates. However, new vaporisation techniques (e.g., laser enucleation) are increasingly used. Our aim was to compare postoperative results after standard PVP to those of an anatomical technique.

MATERIALS AND METHODS

This bicentric prospective study included males treated for enlarged prostate caused by benign prostatic hyperplasia using a GreenLight laser. Patients were preoperatively assessed according to prostate volume, post-void residual volume (PVR), maximum urinary-flow rate (Qmax), prostatic specific antigens, and International prostate symptom score (IPSS). Peroperative data included vaporization time, energy delivered, and operative length. Postoperative data at 1, 3, 6 and 12 months were compared with initial data; all complications were recorded. Comparisons were made between the conventional vaporization technique versus anatomical vaporization, which initially differentiated the peripheral zone of the prostate using an enucleation technique but no morcellation.

RESULTS

Records from 106 surgical patients between December 2012 and December 2013 were analyzed. Operative length, vaporisation time, and energy used were greater in the anatomical PVP group. The average length of hospital stay (2.0 vs. 2.5 days), time with a catheter (1.3 vs. 1.9 days), IPSS (5.0 vs. 6.4), PVR (15.5 vs. 11.7mL), and Qmax (19.9 vs. 19.7mL/s) were comparable between the two groups. However, more complications occurred (27% vs. 37%), including stress urinary incontinence (0% vs. 8%) when using anatomic vaporization.

CONCLUSION

Despite comparable groups and similar functional results, anatomical PVP caused more stress incontinence. However, the learning curve between the two techniques may explain this difference.

LEVEL OF EVIDENCE