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]

Source

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

Abstract

OBJECTIVES:

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.

METHODOLOGY:

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.

RESULTS:

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).

CONCLUSION:

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