Transurethral resection of the prostate, photoselective vaporization of the prostate functional outcomes found equivalent

Atlanta-Photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP) have no difference overall in intermediate-term functional outcomes for surgical treatment of lower urinary tract symptoms secondary to BPH, according to the results of a systematic review of studies with meta-analysis comparing the two procedures.

Of nine randomized, controlled trials in which PVP was the intervention and TURP was the control, six found no difference in functional outcomes, while two favored TURP and one favored PVP, said first author Isaac Thangasamy, MD, of Hornsby Ku-Ring-Gai Hospital, Sydney, Australia.

The safety and efficacy review encompassed biomedical databases from 2002 to 2012, combined with a search of the AUA and European Association of Urology conference proceedings from 2007 to 2011. The meta-analysis was performed with a random effects model; outcome variables were perioperative data, short- and long-term complications, and functional outcomes at 12 months.

Although the overall results suggest that the two procedures are equivalent in functional outcomes, differences were found in several perioperative variables, said Dr. Thangasamy of the study, which was presented at the AUA annual meeting in Atlanta and published in European Urology (2012; 62:315-23).

Differences seen in perioperative variables

PVP had a more favorable perioperative profile. The catheterization time and the length of the hospital stay were both significantly shorter in the PVP group by 1.91 days and 2.13 days, respectively (both, p<.0001). The likelihood of blood transfusion was also lower in the PVP patients (p=.03). However, the operative time was shorter in the TURP group by 19.64 minutes (p=.0003).

"We believe that PVP is a very acceptable alternative to TURP," Dr. Thangasamy said.

"PVP is associated with far less morbidity than TURP while still generating similar functional results of maximum urinary flow rates, symptom scores, and postvoid residual volumes. The benefit of a shorter length of hospital stay is further proof that PVP is a very suitable alternative," said Dr. Thangasamy, who worked on the study with Henry Woo, MD, and colleagues.

Dr. Thangasamy also told Urology Times that further randomized trials analyzing PVP and TURP in certain high-risk patients, such as those on anticoagulants and those with larger prostates, will shed further light on the improved safety profile of PVP.

"Many nonrandomized trials have already demonstrated this and, as such, obtaining ethical approval for randomized trials may prove to be difficult. We are also awaiting the results of a number of international multicenter randomized trials analyzing the latest 180-watt laser versus TURP."

Dr. Thangasamy also noted that one of the problems with most studies on PVP is that they have included procedures performed by surgeons in their learning curve.

"Now that PVP is a readily available technology, future randomized controlled trials should be multicenter and involve surgeons who are equally as experienced in performing PVP as surgeons are with performing TURP," he said.