GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up.

BACKGROUND Photoselective vaporization (PVP) with the GreenLight HPS 120-W laser (GLL) was recently introduced for treatment of benign prostatic hyperplasia (BPH). OBJECTIVE To compare results of GLL PVP and transurethral resection of the prostate (TURP) for treatment of BPH. DESIGN, SETTING, AND PARTICIPANTS A total of 120 patients with BPH were randomly assigned to two equal groups: TURP or PVP. MEASUREMENTS Both groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Q(max)), and postvoid residual (PVR) urine were assessed at 1, 3, 6, 12, 24, and 36 mo. A total of 55 and 54 patients completed 36 mo of follow-up in the TURP and PVP groups, respectively. RESULTS AND LIMITATIONS Baseline characteristics were comparable. Mean operative time was significantly shorter for TURP. Compared to preoperative values, there was significant reduction in hemoglobin and serum sodium levels at the end of TURP only. A significant difference in favor of PVP was achieved regarding the duration of catheterization and hospital stay. In the PVP, no major intraoperative complications were recorded and none of the patients required blood transfusion. Among TURP patients, 12 (20%) required transfusion, 3 (5%) developed TUR syndrome, and capsule perforation was observed in 10 patients. There was dramatic improvement in Q(max), IPSS, and PVP compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up. Storage bladder symptoms were significantly higher in PVP. By the end of 36 mo, five patients in TURP and six in PVP were lost to follow-up. A redo procedure was required in one TURP patient and six PVP patients (p<0.05). Two TURP patients and four PVP patients developed bladder neck contracture (p>0.05) treated by bladder neck incision; none in either group experienced urethral stricture or urinary incontinence. CONCLUSIONS Compared with TURP, 120-W GLL PVP is safe and effective in treatment of BPH.