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 May;65(5):931-42. doi: 10.1016/j.eururo.2013.10.040. Epub 2013 Nov 11.


Background: The comparative outcome with GreenLight (GL) photoselective vaporisation of the prostate and transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms due to benign prostatic obstruction (BPO) has been questioned.

Objective: The primary objective of the GOLIATH study was to evaluate the noninferiority of 180-W GL XPS (XPS) to TURP for International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) at 6 mo and the proportion of patients who were complication free.

Design, setting, and participants: Prospective randomised controlled trial at 29 centres in 9 European countries involving 281 patients with BPO.

Intervention: 180-W GL XPS system or TURP.

Outcome measurements and statistical analysis: Measurements used were IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and complications, perioperative parameters, and reintervention rates. Noninferiority was evaluated using one-sided tests at the 2.5% level of significance. The statistical significance of other comparisons was assessed at the (two-sided) 5% level.

Results and limitations: The study demonstrated the noninferiority of XPS to TURP for IPSS, Qmax, and complication-free proportion. PV and PVR were comparable between groups. Time until stable health status, length of catheterisation, and length of hospital stay were superior with XPS (p<0.001). Early reintervention rate within 30 d was three times higher after TURP (p=0.025); however, the overall postoperative reintervention rates were not significantly different between treatment arms. A limitation was the short follow-up.

Conclusions: XPS was shown to be noninferior (comparable) to TURP in terms of IPSS, Qmax, and proportion of patients free of complications. XPS results in a lower rate of early reinterventions but has a similar rate after 6 mo.

Trial registration: ClinicalTrials.gov, identifier NCT01218672.

Keywords: Adverse events; Benign prostatic obstruction (BPO); Clavien-Dindo classification; Efficacy; GreenLight XPS 180-W laser; Photoselective vaporisation of the prostate (PVP); Safety; TURP; Transurethral surgery.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Europe
  • Follow-Up Studies
  • Hemorrhage / etiology
  • Humans
  • Intention to Treat Analysis
  • Laser Therapy* / adverse effects
  • Length of Stay
  • Male
  • Middle Aged
  • Organ Size
  • Prospective Studies
  • Prostate / pathology*
  • Prostate-Specific Antigen / blood
  • Prostatectomy* / adverse effects
  • Prostatic Hyperplasia / blood
  • Prostatic Hyperplasia / complications*
  • Prostatic Hyperplasia / surgery*
  • Prostatism / etiology*
  • Prostatism / physiopathology
  • Severity of Illness Index
  • Time Factors
  • Urinary Catheterization
  • Urinary Incontinence / etiology
  • Urinary Retention / etiology
  • Urodynamics


  • Prostate-Specific Antigen

Associated data

  • ClinicalTrials.gov/NCT01218672