Login to Access Video or Poster Abstract: MP27-13
Sources of Funding: Boston Scientific, Richard Wolf

Introduction

Bipolar transurethral vaporization the prostate (B-TUVP) and Greenlight XPS Laser photovaporization (PVP) have emerged as standard therapies for BPH. While these two modalities have been evaluated extensively, data is lacking in direct comparison of PVP versus Bipolar Vaporization Electrode (BiVAP) or &[Prime]button TUVP&[Prime], whose unique geometric form enables high energy concentration for faster, more effective tissue vaporization than the conventional loop. We compared 12-month outcomes of Greenlight PVP and BiVAP for treatment of symptomatic BPH.

Methods

We conducted a single-site prospective, randomized study of Greenlight XPS PVP vs BiVAP in men age ≥ 18 years with symptomatic BPH defined by American Urological Association (AUA) symptom score ≥ 15, maximum urinary flow rate (QMax) < 15mL/sec, and prostate volume ≥ 30g. Exclusion criteria included prior surgical treatment for BPH, post-void residual (PVR) > 300mL, and prostate-specific antigen (PSA) ≥ 4 ng/mL. Eligible men were randomized in a 1:1 ratio. Men were followed at 1, 3, 6, and 12 months post-operatively for assessment of the primary outcomes, AUA symptom score and QMax. Chi-square and t-tests were utilized where applicable.

Results

Baseline characteristics for PVP vs BiVAP were similar with regard to age, race, Qmax, PVR, AUA Symptom score, and prostate volume (59.2 ± 28.8 vs 56.1 ± 22.8 g, p=0.62). There was no difference in peri-operative outcomes including mean length of procedure (48.4 ± 30.6 vs 49.8 ± 23.7 mins, p=0.83), length of stay (100% vs 100% discharged within 24 hrs, p=1.00), and length of catheterization (76.7% vs 71.4% catheter removal within 24 hrs, p=0.78). At 12 months, mean improvement in AUA symptom score was slightly greater for PVP vs BiVAP, approaching but not reaching statistical significance (-14.7 ± 9.0 vs -10.5 ± 8.6, p=0.10). At 12 months, there were no differences in mean Qmax, PVR, or prostate volume between the groups (all p > 0.05).

Conclusions

Both Greenlight PVP and BiVAP TURP are safe and effective treatments for men with symptomatic BPH desiring surgery. Selection of operative approach should be driven by unique patient characteristics and surgeon experience.

Funding

Boston Scientific, Richard Wolf