Prostatectomy using different lasers for the treatment of benign prostate hyperplasia in aging males

Figures & data

Table 1 Main characteristics of the different laser techniques

Laser technique	WL, nm	Chromophore(s)	Depth, mm	Application
PVP	532	Hemoglobin	0.80	Tissue vaporization
Tm laser prostatectomy	2,000	Water	0.25	Tissue vaporization, resection, enucleation
Diode laser prostatectomy	980	Water, hemoglobin	>0.50	Tissue vaporization

Abbreviations: PVP, photoselective vaporization of prostate; Tm, thulium; WL, wavelength.

Table 2 Baseline characteristics of patients in the three groups

Characteristics (mean ± standard deviation)	PVP (n=402)	Thulium (n=245)	Diode (n=70)	P
Age	71.3 ± 9.6	70.0 ± 8.1	72.7 ± 9.4	0.049
Diabetes mellitus	64 (15.9)	38 (15.5)	12 (17.1)	0.947
Hypertension	202 (50.2)	104 (42.4)	37 (52.9)	0.106
History of TURP	18 (4.5)	6 (2.4)	1 (1.4)	0.242
Aspirin	82 (20.4)	30 (12.2)	13 (18.6)	0.029
Warfarin	8 (2.0)	4 (1.6)	12 (17.1)	<0.001
Thrombocytopenia	37 (9.2)	13 (5.3)	6 (8.6)	0.195
ASA score =3 or 4	157 (39)	91 (37.1)	47 (67.1)	<0.001
IPSS	26.0 ± 3.8	25.5 ± 4.1	26.0 ± 3.6	0.197
PSA	6.1 ± 6.0	8.0 ± 6.1	8.5 ± 6.9	<0.001
Free PSA, %	25.3 ± 11.2	23.7 ± 8.3	25.2 ± 9.7	0.554
Volume of prostate	51.7 ± 20.9	68.4 ± 26.3	73.7 ± 37.8	<0.001
T-volume	25.7 ± 14.9	33.6 ± 18.3	37.6 ± 24.5	<0.001
Catheterization before op	125 (31.1)	93 (38.0)	34 (48.6)	0.010
Op with stone	21 (6.8)	29 (23.6)	1 (3.7)	0.010
Op time, minutes	106.9 ± 39.9	97.8 ± 39.0	98.6 ± 31.4	0.009

Note: Values in bold text, P<0.05 is significant difference.

Abbreviations: ASA, American Society of Anesthesiology; IPSS, International Prostatic Symptom Score; PSA, prostate-specific antigen; PVP, photoselective vaporization of prostate; Op, operation; TURP, transurethral resection of prostate; T-volume, transitional zone of prostate volume.

Table 3 Intraoperative, early, and late postoperative complications and outcomes in patients in the three groups

Mean ± SD (median) or n (%) variable	PVP (n=402)	Thulium (n=245)	Diode (n=70)	P
Follow-up (months)	38.7 (39)	25.2 (23)	24.4 (20)
Intraoperative complications
Blood transfusion	1 (0.2)	0 (0.0)	0 (0.0)	1.000
TURP syndrome	0 (0)	0 (0)	0 (0)	1.000
Early (<30 days) postoperative complications
Check bleeding	3 (0.7)	5 (2.0)	2 (2.9)	0.142
Re-catheterization	30 (7.5)	9 (3.7)	12 (17.1)	0.001
Urosepsis	8 (2.0)	4 (1.6)	1 (1.4)	1.000
Late (>30 days) postoperative complications
Reop: TURP or TUR-BN	20 (5.0)	6 (2.4)	4 (5.7)	0.237
Duration of hospitalization (days)	3.5 ± 1.4	3.5 ± 1.0	4.1 ± 1.2	<0.001

Abbreviations: Reop, reoperation; PVP, photoselective vaporization of prostate; SD, standard deviation; TUR-BN, transurethral resection of bladder neck; TURP, transurethral resection of prostate.

Figure 1 Logistic regression analysis for three types of laser prostatectomy: predicted (A) post-void residual urine volume, (B) peak-flow rate (PFR), and (C) prostate-specific antigen (PSA) level curves.

Note: A significant improvement was observed in terms of post-voiding residual urine volume, peak-flow rate, and PSA level, compared with preoperative levels (P<0.05).
Abbreviations: M, months; OP, operation; PVP, photoselective vaporization of prostate; RU, residual urine; SE, standard error.

Table 4 Logistic regression analysis to predict overall morbidities of laser prostatectomy

Op method Characteristic	PVP (n=402)		Thulium (n=245)		Diode (n=70)
	P	OR	P	OR	P	OR
Age	0.713	0.99	0.654	1.01	0.659	0.99
Diabetes mellitus	0.401	1.38	0.186	0.25	0.214	2.40
Hypertension	0.734	0.90	0.968	1.02	0.405	0.60
History of TURP	0.207	2.10	1.000	1.295a	1.000	4.00a
Thrombocytopenia	0.407	0.60	0.605	0.562a	0.402	2.17
IPSS	0.545	1.02	0.982	1.00	0.855	1.02
Prostate-specific antigen	0.740	0.99	0.083	1.06	0.297	1.05
Free prostate-specific antigen	0.940	1.00	0.511	1.03	0.554	1.04
Volume	0.131	1.01	0.003b	1.03b	0.089	1.02
T-volume	0.798	1.00	0.504	1.01	0.230	1.02
Catheterization before op	0.078	1.73	0.023b	2.92b	0.064c	3.33c
Surgical time	0.257	1.00	0.738	1.00	0.480	1.01

Note:

a Kruskal–Wallis test

b Analysis of variance test

c chi-square test.

Abbreviations: IPSS, International Prostatic symptom score; PVP, photoselective vaporization of prostate; op, operation; OR, odds ratio; TURP, transurethral resection of prostate; T-volume, transitional zone of prostate volume.