Vaporization vs. enucleation techniques for BPO: do we have a standard?

Area of Science:

• Urology
• Minimally Invasive Surgery
• Laser Technology

Background:

• Benign prostatic obstruction (BPO) is a common condition requiring treatment.
• Transurethral surgical techniques are standard for BPO management.
• Holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP) are established procedures.

Purpose of the Study:

• To review recent publications on enucleation and vaporization procedures for BPO.
• To compare the evidence base for HoLEP, PVP, and alternative laser and bipolar techniques.
• To assess the current state of surgical options for transurethral treatment of BPO.

Main Methods:

• Literature review of recent publications on prostate enucleation and vaporization.
• Analysis of studies describing techniques using holmium, thulium, diode, GreenLight lasers, and bipolar energy.
• Assessment of the availability of prospective randomized trials (PRT) for various procedures.

Main Results:

• Enucleation procedures utilize various lasers (holmium, thulium, diode, GreenLight) and bipolar energy.
• Literature for most enucleation techniques beyond HoLEP is limited to initial descriptions or single-center series.
• Photoselective vaporization of the prostate (PVP) is described with different GreenLight laser wattages; limited data exists for thulium or bipolar vaporization.

Conclusions:

• Several alternative vaporization and enucleation procedures exist for transurethral BPO treatment.
• Limited PRT for these alternative procedures restrict their evidence base.
• HoLEP and PVP currently have the strongest evidence for treating benign prostatic obstruction.