Skip to main content

Advertisement

Log in

Comparison of Patients Undergoing PVP Versus TURP for LUTS/BPH

  • Benign Prostatic Hyperplasia (K McVary, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) are currently the two most commonly performed procedures for the treatment of benign prostatic hyperplasia (BPH). While each procedure has been shown to be efficacious, TURP or PVP may be preferred in certain clinical scenarios. A number of factors may influence the choice of which patients undergo PVP or TURP. This decision may take into account patient characteristics, such as age, co-morbidities, predominance of irritative symptoms, and/or ongoing anticoagulation. Additionally, balancing desired outcomes with possible risks is critical. Considerations should include possible effects on sexual function, rates of reoperation, cost, and need for tissue specimen in those at risk for prostate cancer. The primary objective of this article is to summarize the comparative research of PVP and TURP and the implications on differences between patients who undergo either procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793–803.

    Article  PubMed  Google Scholar 

  2. Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002;59:877–83.

    Article  PubMed  Google Scholar 

  3. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: diagnosis and treatment recommendations. J Urol. 2003;170:530–47.

    Article  Google Scholar 

  4. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol. 2006;50:969–79. discussion 980.

    Article  PubMed  Google Scholar 

  5. Malek RS, Kuntzman RS, Barrett DM. High power potassium-titanyl-phosphate laser vaporization prostatectomy. J Urol. 2000;163:1730–3.

    Article  CAS  PubMed  Google Scholar 

  6. Hai MA, Malek RS. Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol. 2003;17:93–6.

    Article  PubMed  Google Scholar 

  7. Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012;79:1111–6.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Tang Y, Li J, Pu C, Bai Y, Yuan H, Wei Q, et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol. 2014;28:1107–14.

    Article  PubMed  Google Scholar 

  9. Cornu J-N, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A Systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2014. Large meta-analysis of both bipolar and monopolar TURP, HoLEP and PVP that compares outcomes such as safety and efficacy for each procedure.

  10. Bachmann A, Tubaro A, Barber N, d’ Ancona F, Muir G, Witzsch U, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial—the GOLIATH study. Eur Urol. 2014;65:931–42. This represents a large, well-designed multi-center randomized controlled trial of TURP vs. PVP demonstrating comparable outcomes at 6 months.

    Article  PubMed  Google Scholar 

  11. Bachmann A, Tubaro A, Barber N, d’ Ancona F, Muir G, Witzsch U, et al. A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study. J Urol. 2015;193:570–8.

    Article  PubMed  Google Scholar 

  12. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97.

    Article  PubMed  Google Scholar 

  13. Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F, et al. A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009;55:1345–57.

    Article  PubMed  Google Scholar 

  14. Thangasamy IA, Chalasani V, Bachmann A, Woo HH. Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012. Eur Urol. 2012;62:315–23. This paper provides a great review and analysis of combined data from all available randomized controlled trials between TURP and PVP in the first decade of existence of PVP.

    Article  PubMed  Google Scholar 

  15. May A, Broggi E, Lorphelin H, Tabchouri N, Giretti G, Pereira H, et al. Comparison of the risk of postoperative infection between transurethral vaporesection and transurethral resection of the prostate. Lasers Surg Med. 2014;46:405–11.

    Article  PubMed  Google Scholar 

  16. Guo S, Müller G, Lehmann K, Talimi S, Bonkat G, Püschel H, et al. The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study. Lasers Med Sci. 2015;30:1147–51. This is an important study with long term (5 year) postoperative follow-up that demonstrated significantly higher reoperation rates with PVP (80-W KTP) compared to TURP.

    Article  PubMed  Google Scholar 

  17. Franco G, De Nunzio C, Federico G, Laurenti C. Evaluation of sexual activity after prostatic surgery for benign prostatic hyperplasia assessed by pre-operative and post-operative questionnaire. Minerva Urol Nefrol. 2005;57:331–4.

    CAS  PubMed  Google Scholar 

  18. Muntener M, Aellig S, Kuettel R, Gehrlach C, Sulser T, Strebel RT. Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol. 2007;52:510–5.

    Article  PubMed  Google Scholar 

  19. Jaidane M, Arfa NB, Hmida W, Hidoussi A, Slama A, Sorba NB, et al. Effect of transurethral resection of the prostate on erectile function: a prospective comparative study. Int J Impot Res. 2010;22:146–51.

    Article  CAS  PubMed  Google Scholar 

  20. Becher EF, McVary KT. Surgical procedures for BPH/LUTS: impact on male sexual health: surgery for BPH/LUTS: impact on male sexual health. Sex Med Rev. 2014;2:47–55. This is an excellent review of the available literature comparing the impact of different surgical treatments for BPH, including PVP and TURP, on sexual function.

    Article  Google Scholar 

  21. Bruyère F, Puichaud A, Pereira H, Faivre d’Arcier B, Rouanet A, Floc’h AP, et al. Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol. 2010;58:207–11.

    Article  PubMed  Google Scholar 

  22. Horasanli K, Silay MS, Altay B, Tanriverdi O, Sarica K, Miroglu C. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology. 2008;71:247–51.

    Article  PubMed  Google Scholar 

  23. Pereira-Correia JA, de Moraes Sousa KD, Santos JBP, de Morais PD, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPSTM 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110:1184–9.

    Article  PubMed  Google Scholar 

  24. Mohanty NK, Vasudeva P, Kumar A, Prakash S, Jain M, Arora RP. Photoselective vaporization of prostate vs. transurethral resection of prostate: a prospective, randomized study with one year follow-up. Indian J Urol. 2012;28:307–12.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Lukacs B, Loeffler J, Bruyère F, Blanchet P, Gelet A, Coloby P, et al. 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. 2012;61:1165–73.

    Article  PubMed  Google Scholar 

  26. Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, et al. Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int. 2013;111:129–36.

    Article  PubMed  Google Scholar 

  27. Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, et al. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int. 2013;112:109–20.

    Article  PubMed  Google Scholar 

  28. Sandhu JS, Ng C, Vanderbrink BA, Egan C, Kaplan SA, Te AE. High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates. Urology. 2004;64:1155–9.

    Article  PubMed  Google Scholar 

  29. De Nunzio C, Miano R, Trucchi A, Miano L, Franco G, Squillacciotti S, et al. Photoselective prostatic vaporization for bladder outlet obstruction: 12-month evaluation of storage and voiding symptoms. J Urol. 2010;183:1098–103.

    Article  PubMed  Google Scholar 

  30. Schroeck FR, Hollingsworth JM, Kaufman SR, Hollenbeck BK, Wei JT. Population based trends in the surgical treatment of benign prostatic hyperplasia. J Urol. 2012;188:1837–41.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Strope SA, Yang L, Nepple KG, Andriole GL, Owens PL. Population based comparative effectiveness of transurethral resection of the prostate and laser therapy for benign prostatic hyperplasia. J Urol. 2012;187:1341–5.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Malik RD, Wang CE, Lapin B, Gerber GS, Helfand BT. Comparison of patients undergoing laser vaporization of the prostate versus TURP using the ACS-NSQIP database. Prostate Cancer Prostatic Dis. 2015;18:18–24. This is an important, recent study on types of patients treated with either PVP or TURP using large database sample, analysis over 2007-2012 allows observation of emerging trends as well.

    Article  CAS  PubMed  Google Scholar 

  33. Ruszat R, Wyler S, Forster T, Reich O, Stief CG, Gasser TC, et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol. 2007;51:1031–8. discussion 1038–41.

    Article  CAS  PubMed  Google Scholar 

  34. Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE. Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol. 2011;186:977–81.

    Article  PubMed  Google Scholar 

  35. Goh AC, Gonzalez RR. Photoselective laser vaporization prostatectomy versus transurethral prostate resection: a cost analysis. J Urol. 2010;183:1469–73.

    Article  PubMed  Google Scholar 

  36. Stovsky MD, Griffiths RI, Duff SB. A clinical outcomes and cost analysis comparing photoselective vaporization of the prostate to alternative minimally invasive therapies and transurethral prostate resection for the treatment of benign prostatic hyperplasia. J Urol. 2006;176:1500–6.

    Article  PubMed  Google Scholar 

  37. Whitty JA, Crosland P, Hewson K, Narula R, Nathan TR, Campbell PA, et al. A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia. BJU Int. 2014;113 Suppl 2:21–8.

    Article  PubMed  Google Scholar 

  38. Yin L, Teng J, Huang C-J, Zhang X, Xu D. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol. 2013;27:604–11.

    Article  PubMed  Google Scholar 

  39. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160–6.

    Article  PubMed  Google Scholar 

  40. Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T. Common trend: move to enucleation—is there a case for GreenLight enucleation? Development and description of the technique. World J Urol. 2015;33:539–47.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int. 2011;107:1030–43.

    Article  PubMed  Google Scholar 

  42. Gross AJ, Netsch C, Knipper S, Hölzel J, Bach T. Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution. Eur Urol. 2013;63:859–67.

    Article  PubMed  Google Scholar 

  43. Cho HJ, Shin SC, Cho JM, Kang JY, Yoo TK. The role of transurethral resection of the prostate for patients with an elevated prostate-specific antigen. Prostate Int. 2014;2:196–202. This recent paper provides a timeline for monitoring of PSA after TURP.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Henderson J, Ghani KR, Cook J, Fahey M, Schalken J, Thilagarajah R. The role of PCA3 testing in patients with a raised prostate-specific antigen level after Greenlight photoselective vaporization of the prostate. J Endourol Endourol Soc. 2010;24:1821–4.

    Article  Google Scholar 

  45. Helfand BT, Anderson CB, Fought A, Kim DY, Vyas A, McVary KT. Postoperative PSA and PSA velocity identify presence of prostate cancer after various surgical interventions for benign prostatic hyperplasia. Urology. 2009;74:177–83.

    Article  PubMed  Google Scholar 

  46. Klausner AP, Anderson BB, Espy PG, Despradel VM, Grob BM. Long term prostate-specific antigen trends following subcapsular prostatectomy. Can J Urol. 2010;17:5442–6.

  47. Meeks JJ, Maschino AC, McVary KT, Sandhu JS. Clinically significant prostate cancer is rarely missed by ablative procedures of the prostate in men with prostate specific antigen less than 4 ng/ml. J Urol. 2013;189:111–5.

  48. Grimm P, Sylvester J. Advances in brachytherapy. Rev Urol. 2004;6 Suppl 4:S37–48.

  49. Kollmeier MA, Stock RG, Cesaretti J, Stone NN. Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy. J Urol. 2005;173:808–12.

  50. Flam TA, Peyromaure M, Chauveinc L, Thiounn N, Firmin F, Cosset J-M, et al. Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer. J Urol. 2004;172:108–11.

  51. Abelson B, Reddy CA, Ciezki JP, Angermeier K, Ulchaker J, Klein EA, et al. Outcomes after photoselective vaporization of the prostate and transurethral resection of the prostate in patients who develop prostatic obstruction after radiation therapy. Urology. 2014;83:422–7.

  52. No D, Osterberg EC, Otto B, Naftali I, Choi B. Evaluation of continence following 532 nm laser prostatectomy for patients previously treated with radiation therapy or brachytherapy. Lasers Surg Med. 2013;45:358–61.

  53. Hirshberg ED, Klotz LH. Post transurethral resection of prostate incontinence in previously radiated prostate cancer patients. Can J Urol. 1998;5:560–3.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Blake B. Anderson, Joseph J. Pariser, and Brian T. Helfand each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Blake B. Anderson.

Additional information

This article is part of the Topical Collection on Benign Prostatic Hyperplasia

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anderson, B.B., Pariser, J.J. & Helfand, B.T. Comparison of Patients Undergoing PVP Versus TURP for LUTS/BPH. Curr Urol Rep 16, 55 (2015). https://doi.org/10.1007/s11934-015-0525-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-015-0525-7

Keywords

Navigation