Laser vs. bipolar prostate vaporization in bleeding-prone patients: a randomized trial and cutting-edge analysis

To compare effectiveness and safety of transurethral diode laser vaporization of prostate (diode LVP) versus bipolar transurethral vaporization of prostate (B-TUVP) in symptomatic benign prostatic hyperplasia (BPH) patients receiving oral anticoagulants/anti-platelet drugs.

All symptomatic prostate patients receiving oral anticoagulants/anti-platelet drugs are prospectively enrolled in the study between January 2023 to May 2024 in our institution. Of total 98 patients were randomized to B-TUVP (48 patients) or diode LVP (50 patients). The primary outcome is to compare B-TUVP with diode LVP regarding operative bleeding and postoperative hemoglobin drop. Secondary outcomes assess time of urinary irrigation, time of urethral catheter removal, length of hospital stays, and 6-month postoperative functional outcomes; IPSS, postoperative flow rate, and postvoid residual urine.

Baseline characteristics were similar in both groups. Diode LVP group had a significantly higher postoperative hemoglobin with a lower drop compared to B-TUVP group (p = 0.032, p = 0.007; respectively). The diode LVP group had a significantly reduced urinary irrigation duration compared to the B-TUVP group (p = 0.031). Also, diode LVP patients had early catheter removal compared to those in the B-TUVP group (p = 0.014). Additionally, the diode group had a notably reduced hospital stay duration compared to the B-TUVP group (p = 0.024). There were no significant differences between both groups regarding 6-month postoperative IPSS, Q max and PVRU.

Diode LVP of the prostate is a safer alternative for treating BPH with fewer risks compared to B-TUVP especially in patients receiving anticoagulants. Nonetheless, both treatments yield similar 6-months functional outcomes.