120w Greenlight PVP And Plasma Turis For The Treatment Of Elderly High Risk Benign Prostatic Hyperplasia

Background:In the past decades,several technologies have been developed to treatbenign prostatic hyperplasia with minimal risks and acceptable efficacy. As analternative to transurethral resection of the prostate(TURP),greenlightphotoselective vaporization of the prostate(PVP) provides abloodless,safe,effective relief of lower urinary tract symptoms for men withbenign prostatic hyperplasia.As the use of bipolar electrosurgicaltechnology,transurethral resection of prostate in saline(TURis),has shown lesscomplications and comparable results to the standard TURP in early andshort-term follow-ups.Objectives:This prospective randomized controlled trial（RCT）aims to compare theclinical effectiveness，safety，cost-effectiveness of PVP and TURis compared toconventional TURP for the treatment of benign prostatic hyperplasia in elderlyhigh risk patients，thus to provide high level evidence for clinical practice. Methods:From July2011to December2013，208patients met the inclusion criteria，and were randomly assigned to PVP（n=60） group or TURis group（n=89） orTURP group（n=59）。We prospectively collected patients’ demographic data，perioperative outcomes，complications.Consenting subjects were assessed atbaseline，1and3months following surgery.We compared the data among thethree surgical groups with SPSS software.Results:The operations were successful in three groups.No patient lost to follow-upat1and3months post-operation.The mean age of PVP group，TURis group andTURP group was75.7±5.5year，75.4±4.4year and74.8±4.6year，there were nostatistically significant difference among groups（P＞0.05）.There were also nostatistically significant difference in prostate volume，preoperative hemoglobin，preoperative serum sodium，international prostate symptom score（IPSS）andquality of life（P＞0.05）. There was statistically significant difference inprostate-specific antigen(PSA) between PVP group and TURis group（P=0.003）.There were no statistically significant difference in PSA between PVP groupand TURP group（P=0.056）,either between TURis group and TURP group（P=0.378）.PVP group，TURis group and TURP group mean operative time was112.3±39.1minutes,84.6±38.7minutes and100.1±56.3minutes，TURis groupoperative time was significantly shorter than the other groups（P＜0.05），PVPand TURP group operative time was no statistical difference（P=0.135）.PVPgroup patients with preoperative hemoglobin，serum sodium and postoperativecompared statistically significan（tP＜0.05）.PVP group catheterization time was significantly shorter than TURis and TURP group， the difference wasstatistically significant（P＜0.05）.TURP group patients had a significantlylonger of hospitalization days than TURis and PVP group，the difference wasstatistically significan（tP＜0.05）.Among the three groups of patients in hospitalwere statistically significant difference with the total cos（tP＜0.05），PVP groupwas the most，TURis group was the least.Three groups of patients withpostoperative follow-up1month，3months IPSS and QoL scores comparedwith preoperative were statistically significant（P＜0.05），there was nostatistical difference between every two groups（P＞0.05）.Conclusion:Both PVP and TURis are as effective as TURP in symptom reduction andimprovement of QoL at short term，the two operations relative to TURP with theadvantages of easy procedure，safety，less complications.The new GreenlightHPS120W laser PVP has the advantages of less blood loss，faster recovery，shorter hospitalization days，is an even better minimally invasive option forelderly high-risk benign prostatic hyperplasia patients.