Skip to main content

Advertisement

SpringerLink
Log in

A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml

  • Review Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

We conducted a meta-analysis to evaluate the efficacy and safety of photo selective vaporisation of the prostate (PVP) with the GreenLight Laser versus transurethral resection of the prostate (TURP) for the treatment of small-volume benign prostatic hyperplasia (BPH). As of July 2022, relevant literature in online databases such as Cochrane Library, PubMed, and Embase was searched, including studies published on or before that date, and there were 9 studies in total, including 5 RCTs and 4 non-RCTs. In total 1525 patients were included to compare the efficacy of PVP and TURP in treating BPH. The Cochrane Collaboration criteria were used to evaluate the risk of bias. The software was used for random effect meta-analysis with RevMan 5.3. Data extraction included: clinical baseline characteristics, perioperative parameters, complication rates, International Prostate Symptom Score (IPSS), prostate specific antigen (PSA), post-void residual urine (PVR), maximum flow rate (Qmax), and quality of life (QoL). The pooled analysis showed that PVP was associated with reduced blood loss, blood transfusion, clot retention, catheterization time, definitive catheter removal, and hospital stay, but was associated with longer operative time and more severe dysuria (all p < 0.05). The results of this meta-analysis show that PVP as a technique for the treatment of benign prostatic hyperplasia with a volume of less than 80 cc has similar efficacy to standard TURP in IPSS, PSA, PVR, Qmax and QoL, and is an effective alternative. It outperformed TURP in terms of blood transfusion, catheterization time and hospital stay, while TURP is superior to PVP in terms of operation time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

PVP:

Photoselective vaporisation of the prostate

TURP:

Transurethral resection of the prostate

BPH:

Benign prostatic hyperplasia

RCT:

Randomized controlled trials

IPSS:

International Prostate Symptom Score

PSA:

Prostate specific antigen

PVR:

Post-void residual urine

Qmax:

Maximum flow rate

QoL:

Quality of life

LUTSs:

Lower urinary tract symptoms

TURS:

Transurethral resection syndrome

Rezum:

Water vapour thermal therapy

PAE:

Prostate artery embolisation

UroLift:

Prostatic urethral lift

i-TIND:

Temporary implantable nitinol device

UTI:

Urinary tract infection

HoLEP:

Holmium laser enucleation of the prostate;

Tm:YAG:

Thulium: yttrium–aluminum-garnet

TFL:

Thulium fiber laser

HPS:

High Performance System

BMI:

Body Mass Index

References

  1. Hirayama A et al (2002) Comparison of parameters to determine the cause of urinary disturbance in men with prostate volume less than 20 milliliters. Int J Urol 9(10):554–9 (discussion 560)

    PubMed  Google Scholar 

  2. Irwin DE et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50(6):1306–14 (discussion 1314-5)

    PubMed  Google Scholar 

  3. Tao W et al (2017) The efficacy and safety of 2-μm continuous laser in the treatment of high-risk patients with benign prostatic hyperplasia. Lasers Med Sci 32(2):351–356

    PubMed  Google Scholar 

  4. Lerner LB et al (2021) Management of lower urinary tract symptoms attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management. J Urol 206(4):806–817

    PubMed  Google Scholar 

  5. Michel MC et al (1998) Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol 160(3 Pt 1):784–791

    CAS  PubMed  Google Scholar 

  6. Pirozzi L et al (2015) Current pharmacological treatment for male LUTS due to BPH: Dutasteride or finasteride? Curr Drug Targets 16(11):1165–1171

    CAS  PubMed  Google Scholar 

  7. Roehrborn CG (2008) BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int 101(Suppl 3):17–21

    PubMed  Google Scholar 

  8. Cantiello F et al (2021) Mechanical and ablative minimally invasive techniques for male LUTS due to Benign prostatic obstruction: A systematic review according to BPH-6 evaluation. Urol Int 105(9–10):858–868

    PubMed  Google Scholar 

  9. Thomas D et al (2017) Emerging drugs for the treatment of benign prostatic hyperplasia. Expert Opin Emerg Drugs 22(3):201–212

    CAS  PubMed  Google Scholar 

  10. Lokeshwar SD et al (2019) Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol 8(5):529–539

    PubMed  PubMed Central  Google Scholar 

  11. Hueber PA, Al-Asker A, Zorn KC (2011) Monopolar vs. bipolar TURP: assessing their clinical advantages. Can Urol Assoc J 5(6):390–1

    PubMed  PubMed Central  Google Scholar 

  12. Méndez-Probst CE et al (2011) A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate. Can Urol Assoc J 5(6):385–389

    PubMed  PubMed Central  Google Scholar 

  13. Reich O et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180(1):246–249

    PubMed  Google Scholar 

  14. Rassweiler J et al (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–79 (discussion 980)

    PubMed  Google Scholar 

  15. Madersbacher S, Roehrborn CG, Oelke M (2020) The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU Int 126(3):317–326

    PubMed  Google Scholar 

  16. Rieken M, Herrmann TRW, Füllhase C (2019) Surgical treatment of benign prostatic hyperplasia-resection, vaporization or enucleation? Urologe A 58(3):263–270

    CAS  PubMed  Google Scholar 

  17. Oelke M et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140

    PubMed  Google Scholar 

  18. Meng QQ et al (2019) Tranexamic acid is beneficial for reducing perioperative blood loss in transurethral resection of the prostate. Exp Ther Med 17(1):943–947

    CAS  PubMed  Google Scholar 

  19. Kuntzman RS et al (1996) Potassium-titanyl-phosphate laser vaporization of the prostate: a comparative functional and pathologic study in canines. Urology 48(4):575–583

    CAS  PubMed  Google Scholar 

  20. Kuntzman RS et al (1997) High-power (60-watt) potassium-titanyl-phosphate laser vaporization prostatectomy in living canines and in human and canine cadavers. Urology 49(5):703–708

    CAS  PubMed  Google Scholar 

  21. Lee R, Gonzalez RR, Te AE (2006) The evolution of photoselective vaporization prostatectomy (PVP): advancing the surgical treatment of benign prostatic hyperplasia. World J Urol 24(4):405–409

    PubMed  Google Scholar 

  22. Malek RS, Kuntzman RS, Barrett DM (2005) Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 174(4 Pt 1):1344–1348

    PubMed  Google Scholar 

  23. Ghobrial FK et al (2020) A randomized trial comparing bipolar transurethral vaporization of the prostate with GreenLight laser (xps-180watt) photoselective vaporization of the prostate for treatment of small to moderate benign prostatic obstruction: outcomes after 2 years. BJU Int 125(1):144–152

    PubMed  Google Scholar 

  24. Guo S et al (2015) The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study. Lasers Med Sci 30(3):1147–1151

    PubMed  Google Scholar 

  25. Kumar N et al (2016) Prospective randomized comparison of monopolar TURP, Bipolar TURP and Photoselective vaporization of the prostate in patients with benign prostatic obstruction: 36 months outcome. Low Urin Tract Symptoms 10(1):17–20

    PubMed  Google Scholar 

  26. Mattevi D et al (2020) Comparison of GreenLight 180-W XPS laser vaporization versus transurethral resection of the prostate: Outcomes of a single regional center. Arch Ital Urol Androl 92(3). https://doi.org/10.4081/aiua.2020.3.169

  27. Mordasini L et al (2018) 80-W greenlight laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic obstruction: 5-year outcomes of a single-center prospective randomized trial. Urology 116:144–149

    PubMed  Google Scholar 

  28. Pereira-Correia JA et al (2012) GreenLight HPS™ 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int 110(8):1184–1189

    PubMed  Google Scholar 

  29. Reimann M et al (2020) Outcome of photoselective vaporization of the prostate with the GreenLight-XPS 180 watt system compared to transurethral resection of the prostate. J Clin Med 8(7):1004.

  30. Telli O et al (2015) A prospective, randomized comparative study of monopolar transurethral resection of the prostate versus photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc. Ther Adv Urol 7(1):3–8

    PubMed  PubMed Central  Google Scholar 

  31. Thomas JA et al (2015) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of Benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol 69(1):94–102

    PubMed  Google Scholar 

  32. Tugcu V et al (2008) Comparison of photoselective vaporization of the prostate and transurethral resection of the prostate: a prospective nonrandomized bicenter trial with 2-year follow-up. J Endourol 22(7):1519–1525

    PubMed  Google Scholar 

  33. Ene C, Geavlete P, Geavlete B (2020) What’s New in Bipolar TURP for Surgical Management of BPH? Chirurgia (Bucur) 115(3):307–313

    PubMed  Google Scholar 

  34. Michalak J, Tzou D, Funk J (2015) HoLEP: the gold standard for the surgical management of BPH in the 21(st) century. Am J Clin Exp Urol 3(1):36–42

    PubMed  PubMed Central  Google Scholar 

  35. Fried NM, Murray KE (2005) High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 19(1):25–31

    PubMed  Google Scholar 

  36. Zhu Y et al (2015) Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol 33(4):509–515

    CAS  PubMed  Google Scholar 

  37. Bozzini G et al (2023) Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences? World J Urol 41(1):143–150

    CAS  PubMed  Google Scholar 

  38. Xue B et al (2013) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a prospective randomized trial. J Xray Sci Technol 21(1):125–132

    PubMed  Google Scholar 

  39. Bachmann A et al (2005) Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol 48(6):965–71 (discussion 972)

    PubMed  Google Scholar 

  40. Castellani D et al (2021) GreenLight Laser™ Photovaporization versus transurethral resection of the prostate: a systematic review and meta-analysis. Res Rep Urol 13:263–271

    PubMed  PubMed Central  Google Scholar 

  41. Tao W et al (2019) Application of 180W XPS GreenLight laser vaporization of the prostate for treatment of benign prostatic hyperplasia. J Xray Sci Technol 27(6):1121–1129

    CAS  PubMed  Google Scholar 

  42. Zhou Y et al (2016) Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials. Lasers Med Sci 31(3):485–495

    PubMed  Google Scholar 

  43. Yang TK et al (2015) Body mass index and age are predictors for symptom improvement after high-power laser vaporization for benign prostatic hyperplasia. J Formos Med Assoc 114(3):268–273

    PubMed  Google Scholar 

  44. Anderson BB, Pariser JJ, Helfand BT (2015) Comparison of patients undergoing PVP Versus TURP for LUTS/BPH. Curr Urol Rep 16(8):55

    PubMed  Google Scholar 

  45. Meeks JJ et al (2013) Clinically significant prostate cancer is rarely missed by ablative procedures of the prostate in men with prostate specific antigen less than 4 ng/ml. J Urol 189(1):111–115

    PubMed  Google Scholar 

  46. Tao W et al (2019) Comparison of vaporization using 120-W GreenLight laser versus 2-micrometer continuous laser for treating benign prostatic hyperplasia: A 24-month follow-up study of a single center. J Xray Sci Technol 27(4):755–764

    PubMed  Google Scholar 

  47. Te AE (2006) The next generation in laser treatments and the role of the greenlight high-performance system laser. Rev Urol 8 Suppl 3(Suppl 3):S24-30

    PubMed  Google Scholar 

  48. Rieken M, Kaplan SA (2018) Enucleation, vaporization, and resection: how to choose the best surgical treatment option for a patient with male lower urinary tract symptoms. Eur Urol Focus 4(1):8–10

    PubMed  Google Scholar 

  49. Wroclawski ML et al (2021) Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis. World J Urol 39(10):3711–3720

    PubMed  Google Scholar 

  50. Al-Ansari A et al (2010) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol 58(3):349–355

    PubMed  Google Scholar 

Download references

Funding

This work was supported by grants from the National Nature Science Foundation of China (No.81870525), Taishan Scholars Program of Shandong Province (No. tsqn201909199).

Author information

Authors and Affiliations

  1. Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China

    Shangjing Liu, Hongquan Liu, Huibao Yao, Fengze Sun & Jitao Wu

  2. Department of Urology, Beijing TianTan Hospital, Capital Medical University, No.119 South 4Th Ring West Road, Fengtai District, Beijing, 100070, China

    Zhongbao Zhou

Authors
  1. Shangjing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongquan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huibao Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fengze Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jitao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhongbao Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Zhongbao Zhou. Data curation: Shangjing Liu, Hongquan Liu. Formal analysis: Shangjing Liu, Huibao Yao, Fengze Sun. Funding acquisition: Jitao Wu. Investigation: Shangjing Liu, Huibao Yao, Fengze Sun. Methodology: Shangjing Liu, Hongquan Liu, Fengze Sun. Project administration: Zhongbao Zhou. Resources: Shangjing Liu, Hongquan Liu, Huibao Yao. Software: Shangjing Liu, Hongquan Liu. Supervision: Fengze Sun, Jitao Wu. Writing – original draft: Shangjing Liu, Hongquan Liu, Huibao Yao. Writing – review & editing: Zhongbao Zhou, Jitao Wu.

Corresponding authors

Correspondence to Jitao Wu or Zhongbao Zhou.

Ethics declarations

Ethics approval

No ethics to disclose.

Disclosures

All authors had no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Shangjing Liu, Hongquan Liu, Huibao Yao: co-first author.

Supplementary Information

Below is the link to the electronic supplementary material.

10103_2023_3794_MOESM1_ESM.pdf

Supplementary file1 (PDF 506 KB) Supplemental Figure 1. Forest plots show the improvement of PVP and TURP on various data at 12-month follow-up after treatment. (a) IPSS; (b) PSA; (c) PVR; (d) Qmax; (e) Qol. SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom

10103_2023_3794_MOESM2_ESM.pdf

Supplementary file2 (PDF 413 KB) Supplemental Figure 2. Forest plots show the improvement of PVP and TURP on various data at 24-month follow-up after treatment. (a) IPSS; (b) PVR; (c) Qmax; (d) Qol. SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom

10103_2023_3794_MOESM3_ESM.pdf

Supplementary file3 (PDF 287 KB) Supplemental Figure 3. Forest plots show the improvement of PVP and TURP on various data at 60-month follow-up after treatment. (a) IPSS; (b) PVR; (c) Qmax; (d) Qol. SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom

10103_2023_3794_MOESM4_ESM.pdf

Supplementary file4 (PDF 439 KB) Supplemental Figure 4. Forest plots showing various Postoperative Complications. (a) Bladder neck contracture; (b) Urethral stricture; (c) Urinary tract infection; (d) Urethral retention; (e) Reoperation rate. M-H, Mantel-Haenszel; CI, confidence interval; df, degrees of freedom

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, S., Liu, H., Yao, H. et al. A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml. Lasers Med Sci 38, 133 (2023). https://doi.org/10.1007/s10103-023-03794-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10103-023-03794-2

Keywords

Search

Navigation