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A randomized trial of photoselective vaporization of the prostate using the 80‐W potassium‐titanyl‐phosphate laser vs transurethral prostatectomy, with a 1‐year follow‐up
Author(s) -
BouchierHayes David M.,
Van Appledorn Scott,
Bugeja Pat,
Crowe Helen,
Challacombe Ben,
Costello Anthony J.
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08961.x
Subject(s) - medicine , urology , prostate , randomized controlled trial , international prostate symptom score , transurethral resection of the prostate , prostatectomy , sexual function , lower urinary tract symptoms , surgery , cancer
Study Type – Therapy (RCT)
Level of Evidence 2b OBJECTIVE To compare the potassium‐titanyl‐phosphate Greenlight TM 80‐W laser ablation system for photovaporization of the prostate (PVP; Laserscope, San Jose, CA, USA) with transurethral resection of the prostate (TURP), as many technologies have been proposed as equivalent or superior to TURP without gaining widespread acceptance, due to lack of data from randomized trials. PATIENTS AND METHODS In all, 120 patients were randomized to undergo either TURP or PVP after a full urological evaluation, which was repeated at 1, 3, 6 and 12 months after surgery. Irrigation use, duration of catheterization (DOC), length of hospital stay (LOS), blood loss, cost and operative time were also assessed. RESULTS Both groups showed a significant increase in mean ( sd ) maximum urinary flow rate from baseline ( P < 0.05); in the TURP group from 8.9 (3.0) to 19.4 (8.7) mL/s (154%), and in the PVP group from 8.8 (2.5) to 18.6 (8.2) mL/s (136%). The International Prostate Symptom Score (IPSS) decreased from 25.4 (5.7) to 10.9 (9.4) in the TURP group (53%), and from 25.3 (5.9) to 8.9 (7.6) in the PVP group (61%). The trends were similar for the bother and Quality of Life scores. There was no difference in sexual function as measured by Baseline Sexual Function Questionnaires. The DOC was significantly less in the PVP than the TURP group ( P < 0.001), with a mean (range) of 13 (0–24) h vs 44.7 (6–192) h. The situation was similar for LOS ( P < 0.001), with a mean (range) of 1.09 (1–2) and 3.6 (3–9) days in the PVP and TURP groups, respectively. Adverse events and complications were less frequent in the PVP group. Costs were also 22% less in the PVP group. CONCLUSIONS This trial shows that PVP is an effective technique when compared to TURP, producing equivalent improvements in flow rates and IPSS with the advantages of markedly reduced LOS, DOC and adverse events. A long‐term follow‐up is being undertaken to ensure durability of these results.