Photoselective vaporization of the prostate – towards a new standard

Many technologies have been mooted as equal to transurethral resection of the prostate (TURP) without gaining widespread acceptance owing to lack of randomized trials. The GreenLight laser system (American Medical Systems, Minnetonka, MN) gives an 80-W laser ablation system for photovaporization of the prostate (PVP) and here is compared to TURP in such a trial. One hundred and twenty patients are randomized to undergo TURP or PVP after evaluation, which is repeated at 1, 3, 6 and 12 months. Irrigation use, length of catherization time (LOC), length of hospital stay (LOS), blood loss, cost and operative time are also assessed. To date 87 patients are evaluable. In summary, both groups showed a significant increase in maximal flow rate (Qmax) from baseline (P<0.05). In the TURP group it increased from 8.7 to 17.9 ml/s (149%), and in the PVP group from 8.5 to 20.6 ml/s (167%). international prostrate symptom scores (IPS-scores) decreased from 25.4 to 11.1 in the TURP group (56.5%), and from 27.2 to 12.2 in the PVP group (54.08%). Similar trends were seen in relation to bother and quality of life scores. There was no difference in sexual function as measured by baseline sexual function questionnaires. LOC was significantly less in the PVP group (P<0.001), the mean for PVP being 13 h (range 0–24) vs 44.7 h for TURP (range 6–192). A similar situation was seen in relation to LOS (P<0.000000001), with the mean of the PVP group being 1.09 days (range 1–2) and the mean for the TURP group being 3.6 days (range 3–9). Adverse events were less frequent in the PVP group. Costs are also 22% less in the PVP group. This trial demonstrates that PVP is an effective technique when compared to TURP, producing equivalent improvements in flow rates and IPSS scores with markedly reduced LOS, LOC and adverse events. Long-term follow-up is being undertaken to ensure durability of these results.