Prostatic enucleation vs. photoselective vaporization of prostate vs. simple prostatectomy: Performance, functional...

The aim of our study was to evaluate if laser techniques, successively adopted in our center (photoselective vaporization of prostate (PVP) 120W then 180W then greenLEP/HoLEP), improved the efficacy of BPH surgery, the prostate volume (PV) treated and the patient satisfaction.

A monocentric retrospective study including patients treated with simple prostatectomy (SP), GreenLEP/HoLEP (laser enucleation [LE]), and PVP between 2009 and 2022. The primary endpoint was treatment speed (grams per hour of surgery). Secondary endpoints included overall satisfaction, blood transfusion rate, rehospitalization rate within 90 days, and postoperative incontinence.

A total of 1049 patients were included, including 174 (16.6%) SP, 163 (15.5%) LE, and 712 (67.9%) PVP with a median preoperative PV of 120mL [100-159], 90mL [71-120], and 60mL[44-90](P<0.001). Median follow-up duration was 14months[4.2-48.65]. The treatment speed for SP, LE, and PVP was: 60mL/h [48-120], 30mL/h [18-36], and 24mL/h [12-36] (P<0.001). The length of hospital stay was: 9days [9-10], 4days [3-5], and 4days [3-5] (P<0.001). Overall patient satisfaction (at 3months) for SP, LE, and PVP was 84.5%, 90.8% and 78.6%, (P<0.001). The blood transfusion rate was 10.9%, 3.7%, and 1.3% (P<0.001). The rehospitalization rate (<90days) was 8.1%, 11% and 7.3.0% (P=0.286). And the postoperative incontinence rate was 2.9%, 7.4%, and 3.7%(P=0.057) at 1 year.

All three techniques were associated with a high satisfaction rate. SP was the fastest technique but was linked to the longest hospital stay and the highest transfusion rates. It was only performed for PV>100mL. For PV<100mL, LE was faster than PVP and had a higher subjective satisfaction rate.