Greenlight Laser Photoselective Vaporization Vs Open Simple Prostatectomy: Long-term Functional Outcomes After Treatment of Large Volume Prostates (> 80 cc)

Purpose: To compare long-term outcomes between photoselective vaporization (PVP) and Open simple prostatectomy (OSP) for prostates > 80 cc.

Methods: Men operated either by PVP or OSP for BPH > 80 cc were included in two expert centres. Functional and uroflowmetric outcomes were assessed pre- and postoperatively. Data were collected prospectively in the PVP group and retrospectively in the OSP group and compared at long-term follow-up. Complications and re-intervention rates were used as main outcomes.

Results: 332 men underwent surgery: 132 PVP were performed in a fist expert-centre and 200 OSP were performed in a second one with a median follow-up of 54 and 48 months, respectively. Mean Prostate volume was similar between OSP and PVP group (119 vs 116 cc). Major complications were more common in the OSP group (12.5 vs 1.5%, p < 0.001). At long-term follow-up, Qmax was higher and PVR was lower (p < 0.05) in the OSP group. IPSS score was similar between groups (p = 0.45) but the Qol was better in the OSP group (0.9 vs. 1.6; p < 0.05). There were more re-interventions in the PVP group compared to OSP (15.2 vs. 0%, p < 0.005).

Conclusion: PVP is a good alternative for prostates > 80 cc particularly for fragile patients as it is associated with a lower complication rate. At long-term follow-up, IPSS was similar between groups, but Qol was better in the OSP group. Patients treated by PVP should be informed that they could require reoperation in 15% of the cases.