Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate

Alisa Salmivalli; Otto Ettala; Pertti Nurminen; Pekka Kinnala; Peter J Boström; Ville Kytö

doi:10.1080/07853890.2023.2192046

Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate

Ann Med. 2023 Dec;55(1):1287-1294. doi: 10.1080/07853890.2023.2192046.

Authors

Alisa Salmivalli^{1

2}, Otto Ettala³, Pertti Nurminen³, Pekka Kinnala³, Peter J Boström³, Ville Kytö^{4

5

6}

Affiliations

¹ Department of Clinical Research, University of Turku, Turku, Finland.
² Department of Urology, Satasairaala Central Hospital, Wellbeing Services County of Satakunta, Pori, Finland.
³ Department of Urology, Turku University, Turku University Hospital, Turku, Finland.
⁴ Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
⁵ Turku Clinical Research Center, Turku University Hospital, Turku, Finland.
⁶ Research Services, Wellbeing Services County of Southwest Finland, Turku, Finland.

Abstract

Background: Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks.

Objective: To compare short- and long-term risks of PVP to those of TURP in the treatment of BPE.

Materials and methods: Consecutive patients who underwent elective PVP or TURP between 2006 and 2018 in 20 hospitals in Finland were retrospectively studied using a combination of national registries (n = 27,408; mean age 71 years). Short-term risks were postoperative mortality, major adverse cardiovascular events (MACE), and reoperations for bleeding. Long-term risks were reoperations for BPE or any urethral operations within 12 years. Differences between treatment groups were balanced by inverse probability of treatment weighting. Risks were analyzed using the Kaplan-Meier method and Cox regression.

Results: There were no differences in postoperative mortality or MACE between the study groups. Reoperations for bleeding were less frequent after PVP (0.9%, HR: 0.72, p = 0.042). Bleeding was more likely in patients with atrial fibrillation (number needed to treat [NNT] for PVP vs TURP: 61). Cumulative incidence for reoperation was higher after PVP (23.5%) than after TURP in long-term follow-up (17.8%; HR: 1.20, p < 0.0001, NNT: -31.7).

Conclusions: PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. Patients with high bleeding risk and a low likelihood of needing reoperation appear most suitable for laser vaporization.KEY MESSAGEPVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. PVP appears an attractive treatment option, especially for patients with high bleeding risk and a low likelihood of needing a reoperation.

Keywords: Long-term risks; Oral anticoagulation; PVP; Photoselective vaporization of the prostate; Reoperation; TURP; Transurethral resection of the prostate.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Laser Therapy* / adverse effects
Laser Therapy* / methods
Male
Prostate / surgery
Prostatic Hyperplasia* / complications
Prostatic Hyperplasia* / surgery
Retrospective Studies
Transurethral Resection of Prostate* / adverse effects
Transurethral Resection of Prostate* / methods
Treatment Outcome

Grants and funding

This work was supported by Paavo Nurmi foundation, State Research Funding, Finnish Foundation for Cardiovascular Research and Turku University Hospital foundation.