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. 2023 Dec;55(1):1287-1294.
doi: 10.1080/07853890.2023.2192046.

Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate

Alisa Salmivalli  1   2 , Otto Ettala  3 , Pertti Nurminen  3 , Pekka Kinnala  3 , Peter J Boström  3 , Ville Kytö  4   5   6
Affiliations

Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate

Alisa Salmivalli et al. Ann Med. 2023 Dec.

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 (n = 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, p = 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, p < 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.

Keywords: Long-term risks; Oral anticoagulation; PVP; Photoselective vaporization of the prostate; Reoperation; TURP; Transurethral resection of the prostate.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Study flowchart.
Figure 2.
Figure 2.
(A) Cumulative incidence of prostatic urethra reoperation after photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP). (B) Cumulative incidence of distal urethra reoperation after photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP).
See this image and copyright information in PMC

Comment in

  • Benign Prostatic Hyperplasia.
    Kaplan SA. Kaplan SA. J Urol. 2023 Dec;210(6):908-910. doi: 10.1097/JU.0000000000003714. Epub 2023 Sep 25. J Urol. 2023. PMID: 37747152 No abstract available.

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