title: GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study.
abstract: OBJECTIVE
  After the advent of the GreenLight XPS™ (180 W) 532 nm laser, photoselective vapo-enucleation of the prostate could compete with holmium laser enucleation of the prostate as a size independent procedure. We assessed whether photoselective vapo-enucleation of the prostate-XPS is not less effective than holmium laser enucleation of prostate for improvement of lower urinary tract symptoms secondary to benign prostatic hyperplasia.
  
  
  METHODS
  A randomized controlled noninferiority trial comparing holmium laser enucleation of the prostate to photoselective vapo-enucleation of the prostate-XPS 180 W was conducted. I-PSS, flow rate, residual urine, prostate specific antigen and prostate volume changes as well as perioperative and late adverse events were compared. Noninferiority of I-PSS at 1 year was evaluated using a 1-sided test at 5% level of significance. The statistical significance of other comparators was assessed at the (2-sided) 5% level.
  
  
  RESULTS
  Overall 50 and 53 patients were included in the holmium laser enucleation and photoselective vapo-enucleation of the prostate groups, respectively. Operative time, hospital stay and time to catheter removal were comparable between the groups. There was significant, comparable improvement in I-PSS and post-void residual urine volume at 1, 4 and 12 months. After 4 months prostate size reduction was significantly higher in the holmium laser enucleation of prostate group (74.3% vs 43.1%, p=0.001). At 12 months maximum urine flow rate was significantly higher in the holmium laser enucleation of prostate group (26.4 ±11.5 vs 18.4 ±7.5 ml per second, p=0.03). Re-intervention was needed in 2 and 3 cases in the holmium laser enucleation and photoselective vapo-enucleation of the prostate groups, respectively (p=1.0). Mean estimated cost per holmium laser enucleation of prostate procedure was significantly lower than per photoselective vapo-enucleation of the prostate procedure.
  
  
  CONCLUSIONS
  Compared to holmium laser enucleation of prostate, GreenLight XPS laser photoselective vapo-enucleation of the prostate is safe, noninferior and effective in treatment of benign prostatic hyperplasia.
authors.affiliation: Urology Division, McGill University, Montreal, Canada; Mansoura Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: Urology Division, McGill University, Montreal, Canada; Department of Urology, Suez Canal University, Ismailia, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.affiliation: Mansoura Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: El-Nahas
authors.affiliation: Mansoura Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Shoma
authors.affiliation: Mansoura Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Adel
authors.initials: A
authors.lastname: Nabeeh
authors.affiliation: Urology Division, McGill University, Montreal, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Carrier
authors.affiliation: Urology Division, McGill University, Montreal, Canada. Electronic address: mostafa.elhilali@muhc.mcgill.ca.
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Elhilali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*
keywords: lasers; prostatic hyperplasia; solid state