Photoselective vaporization of the prostate using 80-W or 120-W laser has equivalent functional outcomes but less bleeding, shorter catheterization times and shorter hospital stay than traditional TURP
Photoselective vaporization of the prostate (PVP) is an alternate method that is challenging traditional transurethral resection of the prostate (TURP) because of its lesser morbidity. PVP is when a laser vaporizes the prostate tissue and coagulates it at he same time. This is possible because of the wavelength of the laser at 532-nm which travels through the fluid medium and is absorbed by hemoglobin in cells. The prostate tissue turns into gas by way of the laser energy and is vaporized. This study is a systematic review of 9 randomised trials which have compared head-to-head these 2 techniques – PVP v TURP between 2002 – 2012. The results are promising in favor of PVP, either using the 80-W or 120-W systems:
- shorter catheter time by 2 days
- shorter hospital stay by 2.13 days
- less clot retention post operatively
- substantially less blood transfusion rates
- no TUR syndrome since saline rather than glycine is used
- no differences in functional outcomes at the average follow up periods of the 9 trials of 12-36 months – that is similar symptom score and flow rate improvements
- PVP has longer operation time by about 20 minutes.
This is a very important topic because BPH affects 60% of men at 70-80 years old. Also TURP has been associated with morbidity such as bleeding and TUR syndrome, and has a retreatment rate of 5-15% at 5 years.