Holmium; YAG TUIP (transurethral incision of the prostate) vs. green light (532-nm-laser) PVP (photoselective vaporization of the prostate) for treatment of BPH (benign prostatic hyperplasia) less than 40ml; Long-term evaluation
Elshal AM, Elkoushy MA, Elmansy HM, Sampalis J, Elhilali MM.J Urol. 2013 Jul 8. pii: S0022-5347(13)04855-6. doi: 10.1016/j.juro.2013.06.113. [Epub ahead of print]


Division of Urology, department of surgery, McGill University health center, Montreal, QC, Canada; Urology and nephrology center, Mansoura University, Mansoura, Egypt.



To assess the perioperative, short and long term functional outcome of treating bladder outlet obstruction (BOO) secondary to small sized prostates by one of two laser techniques.


A retrospective review through a prospectively maintained database was performed for patients who were treated for BOO secondary to prostates<40ml. Patients who were treated by either Greenlight-PVP (photoselective vaporization of the prostate) or Hol-TUIP (Holmium laser transurethral incision of the prostate) were included.


From January 2002 through December 2010, 191 cases out of 1682 laser prostate surgeries were depicted. Greenlgiht - PVP was done in 144 (75.4%) cases and Hol-TUIP was done in 47 (24.6%) cases. Significantly shorter mean operating time, hospital stay and catheter duration were observed in Hol-TUIP group (30.3±16min, 0.8±0.8d and 1.3±1.9d) than in PVP group (45.8±22min, 0.3±0.4d and 0.4±0.6d) respectively (P<0.05) At one and five years post PVP there were reductions in mean IPSS, QOL and PVR with improvement of mean Qmax of (57.7%, 62.8%); (58.3%, 57.2%); (65.4, 73%) and (127.6%, 167.1%) respectively. At one and five years post Hol-TUIP there were reductions in mean IPSS, QOL and PVR with improvement of mean Qmax of (55.3%, 52.8%); (49.2%, 49%); (45%, 78.1%) and (67.4%, 35.4%) respectively. Subjective and objective urine flow parameters were comparable at different follow-up points. There was no significant difference between the two groups as regard early and late complications (P>0.05). Reoperation rate was 10.4% and 6.4% in PVP and Hol-TUIP groups respectively (P>0.05). The mean estimated cost per Hol-TUIP procedure was significantly lower than per PVP procedure (509.34CAD vs. 1765.92CAD) (P=0.002).


Hol-TUIP and Greenlight PVP seem to be equally effective, safe and durable surgical treatment options for small prostates even in high-risk patients.