Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser.

purposesGreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients.

methodsData were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients' perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used.

resultsWe evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50-90) and 2.8 ng/ml (IQR 1.7-4.3), respectively. The median operative time and applied energy were 60 min (IQR 45-75) and 250 kJ (IQR 160-364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median Q

conclusionThe availability of three different GreenLight laser techniques allows surgeons with different skills to safety use this technology that remains effective with high patient satisfaction. Anatomical vaporization seems to guarantee the best balance between functional outcomes, surgical procedures and complications.