Short- and Long-term Risks of Photoselective Laser Vaporization of the Prostate: a Population-based Comparison with Transurethral Resection of the Prostate

Overview

Journal Ann Med

Publisher Informa Healthcare

Specialty General Medicine

Date 2023 Mar 28

PMID 36974584

Authors

Alisa Salmivalli

Otto Ettala

Pertti Nurminen

Pekka Kinnala

Peter J Bostrom

Ville Kyto

Affiliations

Soon will be listed here.

Abstract

Background: Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks.

Objective: To compare short- and long-term risks of PVP to those of TURP in the treatment of BPE.

Materials And Methods: Consecutive patients who underwent elective PVP or TURP between 2006 and 2018 in 20 hospitals in Finland were retrospectively studied using a combination of national registries ( = 27,408; mean age 71 years). Short-term risks were postoperative mortality, major adverse cardiovascular events (MACE), and reoperations for bleeding. Long-term risks were reoperations for BPE or any urethral operations within 12 years. Differences between treatment groups were balanced by inverse probability of treatment weighting. Risks were analyzed using the Kaplan-Meier method and Cox regression.

Results: There were no differences in postoperative mortality or MACE between the study groups. Reoperations for bleeding were less frequent after PVP (0.9%, HR: 0.72, = 0.042). Bleeding was more likely in patients with atrial fibrillation (number needed to treat [NNT] for PVP vs TURP: 61). Cumulative incidence for reoperation was higher after PVP (23.5%) than after TURP in long-term follow-up (17.8%; HR: 1.20, < 0.0001, NNT: -31.7).

Conclusions: PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. Patients with high bleeding risk and a low likelihood of needing reoperation appear most suitable for laser vaporization.KEY MESSAGEPVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. PVP appears an attractive treatment option, especially for patients with high bleeding risk and a low likelihood of needing a reoperation.

Citing Articles

Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review.

Kronenberg P, Cerrato C, Juliebo-Jones P, Herrmann T, Tokas T, Somani B World J Urol. 2023; 41(12):3817-3827.

PMID: 37906263 DOI: 10.1007/s00345-023-04669-5.

Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques.

Hughes T, Harper P, Somani B Life (Basel). 2023; 13(10).

PMID: 37895457 PMC: 10608556. DOI: 10.3390/life13102077.

References

Sandhu J, Ng C, Gonzalez R, Kaplan S, Te A . Photoselective laser vaporization prostatectomy in men receiving anticoagulants. J Endourol. 2005; 19(10):1196-8. DOI: 10.1089/end.2005.19.1196. View

Ortner G, Nagele U, Herrmann T, Tokas T . Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review. World J Urol. 2021; 40(3):697-708. DOI: 10.1007/s00345-021-03769-4. View

Gratzke C, Bachmann A, Descazeaud A, Drake M, Madersbacher S, Mamoulakis C . EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015; 67(6):1099-1109. DOI: 10.1016/j.eururo.2014.12.038. View

Ruszat R, Seitz M, Wyler S, Abe C, Rieken M, Reich O . GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures. Eur Urol. 2008; 54(4):893-901. DOI: 10.1016/j.eururo.2008.04.053. View

Deb S, Austin P, Tu J, Ko D, Mazer C, Kiss A . A Review of Propensity-Score Methods and Their Use in Cardiovascular Research. Can J Cardiol. 2015; 32(2):259-65. DOI: 10.1016/j.cjca.2015.05.015. View

Bachmann A, Schurch L, Ruszat R, Wyler S, Seifert H, Muller A . Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol. 2005; 48(6):965-71. DOI: 10.1016/j.eururo.2005.07.001. View

Rassweiler J, Teber D, Kuntz R, Hofmann R . Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006; 50(5):969-79. DOI: 10.1016/j.eururo.2005.12.042. View

Cornu J, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C . A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2014; 67(6):1066-1096. DOI: 10.1016/j.eururo.2014.06.017. View

Sund R . Quality of the Finnish Hospital Discharge Register: a systematic review. Scand J Public Health. 2012; 40(6):505-15. DOI: 10.1177/1403494812456637. View

10.

Shaw J, Kaplovitch E, Douketis J . Periprocedural Management of Oral Anticoagulation. Med Clin North Am. 2020; 104(4):709-726. DOI: 10.1016/j.mcna.2020.02.005. View

11.

Ahyai S, Gilling P, Kaplan S, Kuntz R, Madersbacher S, Montorsi F . Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010; 58(3):384-97. DOI: 10.1016/j.eururo.2010.06.005. View

12.

Altman D, Andersen P . Calculating the number needed to treat for trials where the outcome is time to an event. BMJ. 1999; 319(7223):1492-5. PMC: 1117211. DOI: 10.1136/bmj.319.7223.1492. View

13.

Bachmann A, Tubaro A, Barber N, dAncona F, Muir G, Witzsch U . 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study. Eur Urol. 2013; 65(5):931-42. DOI: 10.1016/j.eururo.2013.10.040. View

14.

Hermanns T, Gross O, Kranzbuhler B, Hefermehl L, Poyet C, Muller A . Ablative efficiency of 532-nm laser vaporization compared to transurethral resection of the prostate: results from a prospective three-dimensional ultrasound volumetry study. World J Urol. 2013; 32(5):1267-74. DOI: 10.1007/s00345-013-1203-3. View

15.

Elshal A, Soltan M, El-Tabey N, Laymon M, Nabeeh A . Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo-enucleation of the prostate for treatment of large benign prostate obstruction: 3-years outcomes. BJU Int. 2020; 126(6):731-738. DOI: 10.1111/bju.15161. View

16.

Austin P, Schuster T . The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: A simulation study. Stat Methods Med Res. 2014; 25(5):2214-2237. PMC: 5051602. DOI: 10.1177/0962280213519716. View

17.

Ruszat R, Wyler S, Forster T, Reich O, Stief C, Gasser T . Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol. 2006; 51(4):1031-8. DOI: 10.1016/j.eururo.2006.08.006. View

18.

Bhojani N, Gandaglia G, Sood A, Rai A, Pucheril D, Chang S . Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program. J Endourol. 2014; 28(7):831-40. DOI: 10.1089/end.2013.0805. View

19.

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

20.

Liang X, Wu W, Huang Y, Zhang S, Huang J, Zeng T . Safety of Surgery in benign Prostatic Hyperplasia Patients on Antiplatelet or Anticoagulant Therapy: A Systematic Review and Meta-Analysis. Urol J. 2020; 18(2):151-159. DOI: 10.22037/uj.v16i7.5974. View