Introduction

Functional short-term outcome following 120W greenlight laser vaporization (LV) has been shown to be comparable to conventional transurethral resection of the prostate (TURP). However, mid-term results following 80W greenlight LV revealed that high retreatment rates are common after the procedure most likely due to insufficient tissue ablation. Short-term outcome of our 3D ultrasound volumetry study revealed a significantly lower volume reduction one year after 120W LV compared to TURP. Additional follow-up was now performed to investigate further changes in volume reduction and associated clinical outcome 3 years after LV and TURP.

Methods

A total of 174 patients (120W LV; n=98, 56% vs. TURP; n=76, 44%) were included in this prospective study and were followed for 3 years. Transrectal 3D ultrasound and planimetric volumetry of the prostate was performed preoperatively, after catheter removal, 6W, 6M, 12M and 3Y. Clinical outcome parameters (PSA, IPSS, Qmax, residual volume) were recorded preoperatively and at each follow-up visit.

Results

Median initial prostate volume was not significantly different between the groups (LV: 44.1ml, TURP: 44.8ml; p=0.47). After catheter removal, the relative prostate volume reduction (RVR) was significantly lower following LV (table). Six weeks and six months after LV RVR increased significantly (both p<0.001). However, RVR remained significantly lower after LV throughout the entire 3-year observation period (table). All clinical outcome parameters improved significantly and remained so for 3 years without relevant differences between the groups. No significant differences in overall re-treatment rates were observed (LV: 5 (5.1%), TURP: 5 (6.5%), p=0.75)

Conclusions

After 3 years, prostate volume reduction remained inferior after 120W greenlight LV compared to TURP. However, as yet the lower volume reduction did not translate into inferior functional outcome or higher retreatment rates. Further follow-up of our cohort will reveal if the extent of tissue ablation impacts the long-term outcome of the procedures.

Funding

none