Greenlight Top-firing Sharp Enucleation Of The Prostate Versus Photoselective Vaporisation Of Prostate For The Treatment Of Benign Prostatic Hyperplasia

Objective:To compare the efficacy and safety of Green Light top-firing sharp enucleation of the prostate(GTSEP)and photoselective vaporisation of the prostate(PVP)for the treatment of benign prostatic hyperplasia(BPH).The research results were helpful for the clinical application of our novel procedure GTSEP.Methods:154 patients diagnosed as BPH in the urology department of the first affiliated hospital of the army medical university from June 2018 to April 2019 were selected and randomly divided into GTSEP group(n=77)and PVP group(n=77),which were administrated with GTSEP and PVP treatment,respectively.The detailed information about history of disease,the urodynamic examination,transrectal ultrasound of the prostate,residual urine of bladder and related questionnaires should be accomplished before operation.Age,International prostatic Symptom Score(IPSS),quality of life Score(QoLs),post-void residual urine(PVR),maximum urine flow rate(Qmax),Prostate volume(PV),prostate-specific antigen(PSA)and so on were collected.All operations were performed by two experienced urologists,During the perioperative period,the operation time,energy applied of fiber,bladder injury,capsular perforation,length of hospital stay and length of catheterisation were collected.After the operation,the duration of continuous bladder irrigation was usually 2-12 hours,depending on the color of the urine,and stoped when the rinse was clear.All patients were followed at 1,6 month postoperatively.Qmax,PVR,PSA,transrectal ultrasound of the prostate(only six months),routine urinalysis and so on were completed.IPSS,QoLs,urinary tract infection,bleeding,urethral stricture,bladder neck contracture,stress urinary incontinence and other complications during this period were also recorded and compared between the two groups.Results74 patients in each group completed follow-up.There was no significant difference in baseline characteristics between the two groups.There was no bladder injury in the two groups during the operation,and there was no significant difference in the rate of capsular perforation,length of hospital stay and length of catheterisation between the two groups.The operation time was significantly shorter for the GTSEP group compared to the PVP group(41±16.4minVS 50.1±18.1min,P= 0.001).The energy applied of fiber was lower than that of PVP group(133.6±54.6KJ VS 267.2±77.7KJ,P<0.001).One month after the operation,the lower urinary tract symptoms of the two groups were significantly improved compared with the preoperative symptoms,there were significant differences in IPSS,Qols,PVR,Qmax and PSA of the two groups(P<0.001)compared with baseline.However,there was no significant difference in IPSS,Qols,PVR,Qmax and PSA between the two groups one month after the operation(P>0.05).At 6 months after the operation,IPSS,Qols and Qmax of the two groups continued to improve compared with 1 month after the operation(P<0.05),there was no significant difference in PVR and PSA(P>0.05).There was no significant difference in IPSS,Qols,PVR,Qmax and PSA between the two groups at 6 months(P>0.05),the PV of GTSEP group was smaller than that of PVP group(22.4±2.4ml VS 23.3±1.9ml,P=0.011).There was no significant difference in the rate of complications between the two groups at 1 month and 6 months after surgery(P>0.05).Conclusion:Both GTSEP and PVP can achieve good efficacy and safety in BPH treatment.GTSEP can remove more tissue than PVP,and was superior to PVP in operation time.