Comparison Of Photoselective Vaporization Of The Prostate(PVP) And Transurethral Resection Of The Prostate(TURP): A Retrospective Nonrandomized Trial With 4-Year Follow-Up

Objective:To present our 4-year data comparing photoselective vaporization of the prostate(PVP) and transurethral resection of the prostate(TURP) for patients suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia(BPH).Methods:In this retrospective non-randomized study,82 patients with a prostatic volume 18-165 mL underwent PVP(47) or TURP(35).All PVP and TURP procedures were performed by experienced urologists. Functional follow-up included quantity of intraoperative and postoperative irrigation,preoperative and postoperative sodium and hemoglobin,measurement of maximum urinary flow rate(Qmax),post-void residual urine volume(PVR),International Prostate Symptom Score(IPSS), and qualityof-life score(QoL) within a 48-month period.These parametres were get through medical records and dialing.While anticoagulant therapy was discontinued before the operation in the TURP group,it was not discontinued in the PVP group.Results:1,There was no significant difference of baseline characteristics between the two groups(P＞0.05).2,No patients required blood transfusion and transurethral resection syndrome(TURS) was not observed in any patients in either group.3,Mean operative time was 85.9±9.5 minutes for PVP and 61.1±9.0 minutes for TURP(P＜0.001).The mean volume of saline irrigation used during and after the PVP procedures was significantly lower than that of mannitol irrigation during TURP and saline irrigation after TURP(P＜0.001).Levels of serum hemoglobin,serum sodium and serum potassium were significantly lower after TURP than those after PVP(P₀.001)(Table 2).4,Catheter indwelling time and hospitalization time of the PVP group were both shorter than those of the TURP group.5,IPSS,QOL and Qmax were improved significantly compared with that of preoperative(P＜0.001),but there was no significant difference between two groups(P＞0.05).6,In both groups,an immediate and highly significant improvement of Qmax,PVR,IPSS,and QoL was evident.All the cases were followed up for 1 to 48 months.There was significant difference between preoperation and postoperation in either group(p＜0.05),but not significantly different between the groups(p＞0.05).6,There were 1 case of urethral stricture,5 cases of incontinence of urine,1 case of urinary tract infection and 1 case of bladder neck contracture in the TURP group.While 2 case of urethral stricture,3 cases of incontinence of urine,1 case of urinary tract infection and 1 case of bladder neck contracture were found in the PVP group.No significant difference was found between the two groups(P＞0.05).Conclusions:1,PVP has lower complications intraoperation and higher safety and needs shorter postoperative recovery time than TURP.2,The rate of complications is equally low with both procedures.3,PVP has the advantage of shorter hospitalization and catherter indwelling time and no need for discontinuation of anticoagulant therapy compared to TURP.4,PVP has a similar outcome to TURP in a long run.5,Although the learning curve of PVP is short because of the specifics of KTP laser,surgeons should understand KTP laser tissue interaction and laser-delivery device characteristics prior to performing PVP.