What is the difference in prostate volume reduction between Transurethral Resection of the Prostate (TURP) and Green Light Laser?

Prostate Volume Reduction: TURP vs GreenLight Laser

TURP provides greater prostate volume reduction (44%) compared to GreenLight laser photoselective vaporization of the prostate (PVP) (31%) at 3 months post-procedure. 1

Comparative Efficacy in Volume Reduction

• TURP remains the gold standard surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) for prostates between 30-80 ml in size, with superior tissue removal capabilities 2, 3
• GreenLight laser PVP demonstrates comparable efficacy to TURP in terms of symptom improvement at 36 months follow-up, despite removing less prostate tissue 2
• In a direct comparison study, Aquablation resulted in less prostate volume reduction (31%) compared to TURP (44%) at 3 months (p=0.007), highlighting TURP's superior tissue removal capability 1

Clinical Outcomes Despite Volume Differences

• Both TURP and GreenLight PVP result in similar improvements in International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum flow rate (Qmax) despite the difference in volume reduction 4, 5
• A randomized clinical trial with 2-year follow-up showed equivalent IPSS reduction (-15.7 for PVP vs -14.9 for TURP) and Qmax improvement (+14.5 ml/s for PVP vs +13.1 ml/s for TURP) 4
• When comparing PVP with Holmium Laser Enucleation of the Prostate (HoLEP) in patients with prostate volume >60 ml, HoLEP provided significantly higher flow rates and lower post-void residual, suggesting superior tissue removal 2

Perioperative Advantages of GreenLight Laser

• Despite less tissue removal, GreenLight PVP offers shorter catheterization time (mean difference = -1.3 days) and hospital stay (mean difference = -2.1 days) compared to TURP 5
• GreenLight laser demonstrates superior hemostatic properties, resulting in lower transfusion rates (RR=0.26) and fewer clot retention episodes (RR=0.12) 5
• GreenLight laser can be safely performed in high-risk patients and those receiving anticoagulation therapy due to its excellent hemostatic properties 2, 6

Procedural Considerations

• GreenLight PVP has a longer operation time (approximately 10 minutes longer than TURP) but with shorter recovery periods 5, 7
• When using PVP for larger prostates (>60 ml), there is a 22% conversion rate to TURP, which should be considered when planning procedures for patients with larger prostates 2, 6
• The reoperation rate after 180-W XPS GreenLight laser was comparable with TURP, but significantly higher after 120-W HPS laser (11% vs 1.8%; p=0.04) 2

Clinical Implications

• For patients prioritizing faster recovery and reduced bleeding risk, GreenLight PVP may be preferable despite less volume reduction 6, 8
• For patients with larger prostates (>80 ml) requiring maximum tissue removal, TURP or enucleation procedures like HoLEP may be more appropriate 2
• Sexual dysfunction rates are lower with GreenLight PVP compared to TURP (RR=0.66), which may influence decision-making for sexually active patients 5

Pitfalls and Caveats

• The 22% conversion rate to TURP when using PVP for prostates >60ml should be considered when planning procedures 6
• Despite less tissue removal with GreenLight PVP, the long-term reoperation rates are similar to TURP when using the 180-W system 2
• The choice between procedures should consider prostate size, patient comorbidities (especially bleeding risk), and surgeon experience 2