Photoselective enucleation of prostate versus tranuretheral resection of the prostate for large-size benign prostatic hyperplasia: a randomized prospective controlled study

Abstract

Objective To compare the efficacy and safety of photoselective sharp-enucleation of prostate with end-firing fibre (PSEP) and tranuretheral resection of the prostate (TURP) in the treatment of large-size benign prostatic hyperplasia (BPH). Methods According to the inclusion and exclusion criteria of the study, totally 94 BPH patients with prostate volume (PV) >80 mL admitted in our hospital from July 2018 to December 2019 were prospectively enrolled, and then randomized into TURP and PSEP group, with 47 cases in each group. Preoperative and perioperative data were collected, and maximum flow rate (Qmax), international prostate symptom score (IPSS), post-void residual urine (PVR), quality of life score (Qols), score of international consultation on incontinence questionnaire-urinary incontinence-short form (ICI-Q-SF), prostate-specific antigen (PSA) level, PV and related complications in 1 and 6 months after surgery were recorded and compared between the 2 groups. Results There were 43 and 44 patients completing the followed-up in PSEP and TURP groups respectively in 6 month postoperatively. No significant differences were found in baseline data between the 2 groups, and Qmax, PVR, PSA level, and scores of IPSS, Qols and ICI-Q-SF were significantly improved at 1 and 6 months after surgery in both groups. The operation time (71.6±21.2 vs 87.6±18.9 min, P < 0.01), bladder irrigation time (7.1±5.7 vs 19.8 ±8.6 h, P < 0.01), catheterization period (3.4±1.7 vs 4.4±1.6 d, P < 0.01), and length of hospital stay (4.3±1.0 vs 5.2±1.3 d, P < 0.01) were significantly shorter in the PSEP group than those in the TURP group. The former group also had remarkably milder haemoglobin dropping (5.5±3.2 vs 12.2±6.6 g/L, P < 0.01), and more obviously smaller PV (21.3±4.0 vs 25.2±6.1 mL, P < 0.01) in 6 months when compared with the latter group. What's more, there was no statistical difference in the incidence of postoperative complications between them. Conclusion Both PSEP and TURP show good efficacy and safety in the treatment of large-size BPH. Compared with TURP, PSEP has the advantages of high surgical efficiency, less bleeding, more thorough tissue removal, and faster postoperative recovery. It is an optional choice for the patients with large-size BPH.

Keywords

• benign prostatic hyperplasia
• laser
• transurethral electrovaporization of the prostate
• large prostate