Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies

Abstract

Objective: To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Design: Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

Data sources: PubMed, EMBASE, the Cochrane Library until October 2018.

Eligibility criteria: Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.

Data extraction and synthesis: Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).

Results: 22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=-0.08; 95% CI -0.13 to -0.02; p=0.007), and IPSS (MD = -0.10; 95% CI -0.15 to -0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant.

Conclusion: PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.

Keywords: benign prostatic hyperplasia (BPH); lower urinary tract symptoms (LUTS); meta-analysis; photoselective vaporisation of the prostate (PVP); transurethral resection of the prostate (TURP).

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Figure 2

Forest plot of IPSS at 3 months (a1), 6 months (a2), 12 months (a3) and 24 months (a4); forest plot of Qmax at 3 months (b1), 6 months (b2), 12 months (b3) and 24 months (b4); forest plot of Pvr at 3 months (c1), 6 months (c2), 12 months (c3) and 24 months (c4); forest plot of QoL at 3 months (d1), 6 months (d2), 12 months (d3) and 24 months (d4); forest plot of IIEF at 3 months (e1), 6 months (e2), 12 months (e3) and 24 months (e4). IIEF, International Index of Erectile Function; IPSS, International Prostate Symptom Score; PVR, postvoid residual volume; Qmax, maximum flow rate; QoL, quality of life

Figure 3

Sensitivity analysis of the Qmax at 24-month follow-up (A); PVR at 3-month follow-up (B); operation times (C); and period of hospitalisation (D). PVR, postvoid residual volume; Qmax, maximum flow rate.