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

Figures & data

Figure 1. Study flowchart.

Table 1. Baseline features of benign prostate hyperplasia patients treated with laser or TURP. Features of all patients and inverse probability weight-balanced cohort. SMD = standardized mean difference.

Variable	Original study population				Weighted study population
	PVP	TURP			PVP	TURP
	n = 5331	n = 16,538	P-value	|SMD|	n = 5,342	n = 16,587	P-value	|SMD|
Age, years (SD)	70.3 (8.6)	70.6 (8.5)	0.008	0.042	70.5 (8.5)	70.5 (8.7)	0.790	0.004
AIDS/HIV	0.1%	0.1%	0.106	0.023	0.1%	0.1%	0.973	0.001
Alcohol abuse	2.0%	2.6%	0.020	0.038	2.5%	2.5%	0.906	0.002
Anemia	1.3%	1.5%	0.356	0.015	1.4%	1.4%	0.856	0.003
Atrial fibrillation	17.7%	12.1%	<0.0001	0.159	13.5%	13.5%	0.995	0.0001
Cerebrovascular disease	11.7%	9.6%	<0.0001	0.070	10.0%	10.1%	0.770	0.005
Chronic pulmonary disease	8.4%	8.8%	0.354	0.015	8.4%	8.7%	0.557	0.009
Coagulopathy	0.6%	0.4%	0.085	0.026	0.4%	0.4%	0.919	0.002
Dementia	3.1%	3.0%	0.817	0.004	3.1%	3.0%	0.810	0.004
Diabetes	12.2%	11.6%	0.213	0.020	11.6%	11.7%	0.802	0.004
Heart failure	8.1%	6.4%	< 0.0001	0.064	6.8%	6.8%	0.837	0.003
Heart valve disease	5.8%	4.1%	< 0.0001	0.078	4.6%	4.6%	0.972	0.001
Hypertension	27.9%	25.6%	0.001	0.052	25.8%	26.1%	0.670	0.007
Liver disease	1.0%	0.9%	0.607	0.008	0.9%	0.9%	0.984	0.0003
Neurological disease*	4.6%	4.8%	0.170	0.022	4.7%	4.6%	0.779	0.004
Cancer**	8.3%	8.2%	0.840	0.003	8.1%	8.2%	0.684	0.006
Metastatic	0.2%	0.3%	0.906	0.002	0.2%	0.3%	0.934	0.001
Paralysis	0.3%	0.6%	0.021	0.039	0.5%	0.5%	0.555	0.009
Peripheral vascular disease	5.5%	4.7%	0.011	0.039	4.8%	4.9%	0.745	0.005
Prior myocardial infarction	7.0%	5.9%	0.004	0.044	6.3%	6.2%	0.719	0.005
Psychotic disorder	0.8%	1.3%	0.001	0.054	1.2%	1.2%	0.990	0.0002
Rheumatic disease	2.5%	2.9%	0.146	0.023	2.8%	2.8%	0.925	0.001
Renal failure	2.7%	3.0%	0.276	0.017	2.9%	2.9%	0.940	0.001
University hospital***	51.3%	43.5%	< 0.0001	0.157	44.5%	44.5%	0.293	0.017
Year of operation			< 0.0001	0.246			0.954	0.009

* Other than cerebrovascular disease

** Patients with urogenital cancer were excluded

*** As the surgical center.

Table 2. Short-term postoperative mortality, MACE, and major bleeding rates for benign prostate hyperplasia patients treated with PVP or TURP (reference group).

Short-term risks	Adjusted %		Adjusted HR
	PVP	TURP	HR (95%CI)	P-value	NNT
Postoperative mortality
All patients	0.4%	0.6%	0.72 (0.46–1.12)	0.144	583.0
<70 years	0.1%	0.2%	0.48 (0.14–1.61)	0.235	782.2
≥70 years	0.7%	0.9%	0.75 (0.46–1.24)	0.263	434.9
Atrial fibrillation	0.2%	0.1%	1.15 (0.61–2.18)	0.660	−497.7
No atrial fibrillation	0.3%	0.5%	0.54 (0.28–1.01)	0.051	431.1
MACE
All patients	1.8%	2.0%	0.87 (0.69–1.10)	0.253	386.1
<70 years	0.9%	1.1%	0.86 (0.54–1.35)	0.503	664.5
≥70 years	2.5%	2.8%	0.88 (0.67–1.15)	0.337	301.4
Atrial fibrillation	3.5%	4.3%	0.83 (0.55–1.23)	0.351	140.6
No atrial fibrillation	1.5%	1.7%	0.90 (0.69–1.18)	0.440	599.8
Reoperation due to bleeding
All patients	0.9%	1.3%	0.72 (0.53–0.99)	0.042	284.8
<70 years	1.1%	1.3%	0.83 (0.55–1.26)	0.379	441.4
≥70 years	0.7%	1.2%	0.58 (0.36–0.94)	0.028	199.1
Atrial fibrillation	1.3%	2.9%	0.44 (0.24–0.81)	0.009	61.1
No atrial fibrillation	0.9%	1.0%	0.86 (0.60–1.23)	0.411	721.0

HR: Hazard ratio; NNT: number needed to treat.

Figure 2. (A) Cumulative incidence of prostatic urethra reoperation after photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP). (B) Cumulative incidence of distal urethra reoperation after photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP).

Table 3. Long-term (12-year) reoperations for benign prostate hyperplasia patients treated with PVP or TURP (reference group).

Long-term risks	Adjusted %		Adjusted HR
	PVP	TURP	HR (95% CI)	P-value	NNT
Reoperation, overall
All patients	23.5%	17.8%	1.20 (1.09–1.31)	<0.0001	−−31.7
<70 years	25.3%	17.3%	1.29 (1.14–1.47)	<0.0001	−22.5
≥70 years	19.4%	17.8%	1.31 (1.00–1.39)	0.058	−20.6
Atrial fibrillation	31.0%	16.3%	1.69 (1.34–2.14)	<0.0001	−10.3
No atrial fibrillation	22.8%	17.9%	1.15 (1.04–1.27)	0.006	−41.8
Reoperation of prostatic urethra
All patients	21.3%	13.2%	1.66 (1.41–1.72)	<0.0001	−12.9
<70 years	23.2%	13.4%	1.67 (1.45–1.92)	<0.0001	−12.6
≥70 years	17.2%	12.6%	1.48 (1.28–1.71)	<0.0001	−18.3
Atrial fibrillation	28.5%	11.2%	2.24 (1.72–2.93)	<0.0001	−8.2
No atrial fibrillation	20.7%	13.4%	1.49 (1.34–1.66)	<0.0001	−17.0
Reoperation of distal urethra
All patients	4.4%	6.0%	0.64 (0.53–0.77)	<0.0001	47.4
<70 years	4.5%	5.2%	0.66 (0.51–0.86)	0.002	57.6
≥70 years	4.2%	6.9%	0.63 (0.49–0.81)	0.0003	40.0
Atrial fibrillation	6.3%	6.9%	1.07 (0.70–1.63)	0.760	−216.4
No atrial fibrillation	4.2%	6.0%	0.60 (0.49–0.73)	<0.0001	42.6

HR: Hazard ratio; NNT: number needed to treat.

Data availability statement

The data that support the findings of this study were obtained from the National Institute for Health and Welfare of Finland (permission no: THL/2245/5.05.00/2019). Mortality data were obtained from Statistics Finland (TK-53-484-20). Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of National Institute for Health and Welfare and Statistics Finland.