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Ablative efficiency of 532-nm laser vaporization compared to transurethral resection of the prostate: results from a prospective three-dimensional ultrasound volumetry study

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Abstract

Purpose

To assess and compare postoperative prostate volume changes following 532-nm laser vaporization (LV) and transurethral resection of the prostate (TURP). To investigate whether differences in volume reduction are associated with differences in clinical outcome.

Methods

In this prospective, non-randomized study, 184 consecutive patients undergoing 120 W LV (n = 98) or TURP (n = 86) were included. Transrectal three-dimensional ultrasound and planimetric volumetry of the prostate were performed preoperatively, after catheter removal, 6 weeks, 6 and 12 months. Additionally, clinical outcome parameters were recorded. Mann–Whitney U test and analysis of covariance were utilized for statistical analysis.

Results

Postoperatively, a significant prostate volume reduction was detectable in both groups. However, the relative volume reduction was lower following LV (18.4 vs. 34.7 %, p < 0.001). After 6 weeks, prostate volumes continued to decrease in both groups, yet differences between the groups were less pronounced. Nonetheless, the relative volume reduction remained significantly lower following LV (12 months 43.3 vs. 50.3 %, p < 0.001). All clinical outcome parameters improved significantly in both groups. However, the maximum flow rate (Q max) and prostate-specific antigen (PSA) reduction were significantly lower following LV. Subgroup analyses revealed significant differences only if the initial prostate volume was >40 ml. Re-operations were necessary in three patients following LV.

Conclusions

The modest but significantly lower volume reduction following LV was associated with a lower PSA reduction, a lower Q max and more re-operations. Given the lack of long-term results after LV, our results are helpful for preoperative patient counseling. Patients with large prostates and no clear indication for the laser might not benefit from the procedure.

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References

  1. Descazeaud A, Robert G, Azzousi AR, Ballereau C, Lukacs B, Haillot O, Dumonceau O, Devonec M, Fourmarier M, Saussine C, de la Taille A (2009) Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review. BJU Int 103(9):1162–1165. doi:10.1111/j.1464-410X.2008.08284.x

    Article  PubMed  Google Scholar 

  2. Bouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Challacombe B, Costello AJ (2010) A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int 105(7):964–969. doi:10.1111/j.1464-410X.2009.08961.x

    Article  PubMed  Google Scholar 

  3. Teng J, Zhang D, Li Y, Yin L, Wang K, Cui X, Xu D (2013) Photoselective vaporization with the green light laser vs transurethral resection of the prostate for treating benign prostate hyperplasia: a systematic review and meta-analysis. BJU Int 111(2):312–323. doi:10.1111/j.1464-410X.2012.11395.x

    Article  PubMed  Google Scholar 

  4. Rieken M, Wyler S, Rentsch C, Bonkat G, Gasser TC, Bachmann A (2009) Long-term results of transurethral KTP-laser vaporisation of the prostate. J Urol Suppl 181(4):767

    Article  Google Scholar 

  5. Heinrich E, Wendt-Nordahl G, Honeck P, Alken P, Knoll T, Michel MS, Hacker A (2010) 120 W lithium triborate laser for photoselective vaporization of the prostate: comparison with 80 W potassium-titanyl-phosphate laser in an ex vivo model. J Endourol 24(1):75–79. doi:10.1089/end2009.0051

    Article  PubMed  Google Scholar 

  6. Te AE (2006) The next generation in laser treatments and the role of the GreenLight high performance system laser. Rev Urol 8(Suppl 3):24–30

    Google Scholar 

  7. Pereira-Correia JA, de Moraes Sousa KD, Santos JB, de Morais Perpétuo D, Lopes-da-Silva LF, Krambeck RL, Muller VJ, Vaz FP (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. doi:10.1111/j.1464-410X.2011.10878.x

    Article  PubMed  Google Scholar 

  8. Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J (2011) Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 107(7):1030–1043. doi:10.1111/j.1464-410X.2010.09954.x

    Article  PubMed  Google Scholar 

  9. Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, Shokeir AA (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):348–355. doi:10.1016/j.eururo.2010.05.026

    Article  Google Scholar 

  10. Hueber PA, Ben-Zvi T, Liberman D, Bhojani N, Gautam G, Deklaj T, Katz M, Zorn KC (2012) Mid term outcomes of initial 250 case experience with GreenLight 120 W-HPS photoselective vaporization prostatectomy for benign prostatic hyperplasia: comparison of prostate volumes <60 cc, 60 cc–100 cc and >100 cc. Can J Urol 19(5):6450–6458

    PubMed  Google Scholar 

  11. Aagaard J, Jonler M, Fuglsig S, Christensen LL, Jorgensen HS, Norgaard JP (1994) Total transurethral resection versus minimal transurethral resection of the prostate—a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume. Br J Urol 74(3):333–336

    Article  PubMed  CAS  Google Scholar 

  12. Madersbacher S, Marberger M (1999) Is transurethral resection of the prostate still justified? BJU Int 83(3):227–237

    Article  PubMed  CAS  Google Scholar 

  13. Tewari A, Indudhara R, Shinohara K, Schalow E, Woods M, Lee R, Anderson C, Narayan P (1996) Comparison of transrectal ultrasound prostatic volume estimation with magnetic resonance imaging volume estimation and surgical specimen weight in patients with benign prostatic hyperplasia. J Clin Ultrasound 24(4):169–174. doi:10.1002/(SICI)1097-0096(199605)24:4<169:AID-JCU2>3.0.CO;2-D

    Article  PubMed  CAS  Google Scholar 

  14. Hermanns T, Sulser T, Fatzer M, Baumgartner MK, Rey JM, Sigrist MW, Seifert H-H (2009) Laser fibre deterioration and loss of power output during photo-selective 80-W potassium-titanyl-phosphate laser vaporisation of the prostate. Eur Urol 55(3):679–685

    Article  PubMed  Google Scholar 

  15. Hartung R, May F (2002) Die transurethrale Elektroresektion der Prostata. Aktuel Urol 33(6):469–482

    Article  Google Scholar 

  16. de la Rosette J, Collins E, Bachmann A, Choi B, Muir G, Reich O, Gómez-Sancha F, Tabatabaei S, Woo H (2008) Historical aspects of laser therapy for benign prostatic hyperplasia. Eur Urol Suppl 7(4):363–369

    Article  Google Scholar 

  17. Kuntzman RS, Malek RS, Barrett DM, Bostwick DG (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

    Article  PubMed  CAS  Google Scholar 

  18. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397. doi:10.1016/j.eururo.2010.06.005

    Article  PubMed  Google Scholar 

  19. Agrawal MS, Aron M, Goel R (2005) Hemiresection of the prostate: short-term randomized comparison with standard transurethral resection. J Endourol 19(7):868–872. doi:10.1089/end.2005.19.868

    Article  PubMed  Google Scholar 

  20. Antunes AA, Srougi M, Coelho RF, Leite KR, Freire G de C (2009) Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected? Int Braz J Urol 35(6):683–689, discussion 689–691

    Google Scholar 

  21. Chen SS, Hong JG, Hsiao YJ, Chang LS (2000) The correlation between clinical outcome and residual prostatic weight ratio after transurethral resection of the prostate for benign prostatic hyperplasia. BJU Int 85(1):79–82

    Article  PubMed  CAS  Google Scholar 

  22. Hakenberg OW, Helke C, Manseck A, Wirth MP (2001) Is there a relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostatic hyperplasia. Eur Urol 39(4):412–417

    Article  PubMed  CAS  Google Scholar 

  23. Heinrich E, Schiefelbein F, Schoen G (2007) Technique and short-term outcome of green light laser (KTP, 80W) vaporisation of the prostate. Eur Urol 52(6):1632–1637

    Article  PubMed  Google Scholar 

  24. Hermanns T, Strebel DD, Hefermehl LJ, Gross O, Mortezavi A, Muller A, Eberli D, Müntener M, Michel MS, Meier AH, Sulser T, Seifert HH (2011) Lithium triborate laser vaporization of the prostate using the 120 w, high performance system laser: high performance all the way? J Urol 185(6):2241–2247. doi:10.1016/j.juro.2011.02.023

    Article  PubMed  Google Scholar 

  25. Tong S, Cardinal HN, McLoughlin RF, Downey DB, Fenster A (1998) Intra- and inter-observer variability and reliability of prostate volume measurement via two-dimensional and three-dimensional ultrasound imaging. Ultrasound Med Biol 24(5):673–681

    Article  PubMed  CAS  Google Scholar 

  26. Aarnink RG, Giesen RJ, de la Rosette JJ, Huynen AL, Debruyne FM, Wijkstra H (1995) Planimetric volumetry of the prostate: how accurate is it? Physiol Meas 16(3):141–150

    Article  PubMed  CAS  Google Scholar 

  27. Lukacs B, Loeffler J, Bruyere F, Blanchet P, Gelet A, Coloby P, De la Taille A, Lemaire P, Baron JC, Cornu JN, Aout M, Rousseau H, Vicaut E (2012) Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol 61(6):1165–1173. doi:10.1016/j.eururo.2012.01.052

    Article  PubMed  Google Scholar 

  28. Mamoulakis C, Schulze M, Skolarikos A, Alivizatos G, Scarpa RM, Rassweiler JJ, de la Rosette JJ, Scoffone CM (2013) Midterm results from an international multicentre randomised controlled trial comparing bipolar with monopolar transurethral resection of the prostate. Eur Urol 63(4):667–676. doi:10.1016/j.eururo.2012.10.003

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge Ms. Alexandra Veloudios for the excellent organization of the patient care during this study.

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Authors and Affiliations

  1. Department of Urology, University Hospital Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland

    Thomas Hermanns, Oliver Gross, Benedikt Kranzbühler, Lukas J. Hefermehl, Cédric Poyet, Alexander Müller, Maurice S. Michel, Daniel Eberli, Michael Müntener, Matthias Zimmermann, Tullio Sulser & Hans-Helge Seifert

  2. Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada

    Thomas Hermanns & Stanley A. Yap

  3. Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany

    Maurice S. Michel

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  1. Thomas Hermanns
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  2. Oliver Gross
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  3. Benedikt Kranzbühler
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Corresponding author

Correspondence to Thomas Hermanns.

Additional information

Thomas Hermanns and Oliver Gross have contributed equally to this work.

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Hermanns, T., Gross, O., Kranzbühler, B. et al. Ablative efficiency of 532-nm laser vaporization compared to transurethral resection of the prostate: results from a prospective three-dimensional ultrasound volumetry study. World J Urol 32, 1267–1274 (2014). https://doi.org/10.1007/s00345-013-1203-3

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  • DOI: https://doi.org/10.1007/s00345-013-1203-3

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